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Nervous and Mental Disease Monograph Series No. 17

Freud's Theories of the
Neuroses

By

DR. EDUARDJHJTSCHMANN

of Vienna

New York
1913

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Nervous and Mental Disease Monograph
Series, No. 17

FREUD'S theories OF THE
NEUROSES

BY

DR. EDUARD HITSCHMANN

of Vienna

Authorized Translation by

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With an Introduction by Ernest Jones, M.D., M.R.C.P.,

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1^(3

INTRODUCTION

BY

Ernest Jones, M.D. (London), M.R.C.P. (London),

Associate Professor of Psychiatry, University of Toronto; Secretary
OF THE American Psycho-Analytic Association

Dr. Hitschmann has in this volume undertaken an important
task, namely, a synthetic presentation of the Freudian theory. It
will on all sides be acknowledged that the need for this has long
been felt, the reason being that it is exceedingly difficult properly
to grasp the significance of the theory from the reading only of
disconnected fragments, which taken in themselves often present
an appearance that is far from convincing.

The especial difficulty inherent in any attempt to render a
connected description as is here given lies in the fact that the
Freudian theory represents not a fixed philosophic doctrine but
a growing body of science. Strangely enough this has sometimes
been made a source of reproach to Professor Freud, as indicating
a fluctuating change and lack of stability in his conclusions. It
is certainly true that during the gradual evolution of his methods
and conclusions, an evolution which is still in progress, he has
been led to introduce various modifications into his earlier views.
These have always been, however, of the nature of amplifications
rather than of retractions, increasing experience having shown
him that some of his earlier views were, though correct so far as
they went, yet incomplete and at times imperfectly oriented.

This very evolution is surely evidence in itself that the conclu-
sions reached are based on definite data of experience, and repre-
sent no subjective opinions of the author; a theory of such novel
and intricate matters as unconscious mental processes should, on
the contrary, arouse a justifiable suspicion were it promulgated
as being complete and perfect from its inception. The further
consideration has to be weighed that the field of Professor Freud's
investigations has undergone a remarkable widening in the course
of years. Confined at first to the study of the neuroses, it became

iii

IV INTRODUCTION

extended first to the subject of normal dream life, of the processes
underlying the production of wit, and the development and varia-
tion of the instinct of sex. In the past eight years it has been
further extended so as to comprise on the one hand various devi-
ations from the normal, such as criminality, certain psychoses,
failures in mental functioning with healthy people, the nature and
origin of sexual perversions, and on the other hand an increasing
number of more normal manifestations, such as the source of
literary and artistic inspiration, the evolution of language, the
structure and meaning of religious, mythological and superstitious
beliefs, and the sources of many other human interests and activi-
ties, encroaching thus in ever widening circles on the domain of
normal psychology. These last named extensions, Dr. Hitsch-
mann has here for the first time given a connected account of,
one which no doubt would have been less brief had not the main
purpose of the book been a medical one ; those who are interested
in these important aspects of psycho-analysis may be referred to
a special journal, Imago, which is devoted to the non-medical
applications of the subject. When one works systematically over
the apparently disconnected fields here mentioned, one realizes
more and more both the breadth and the unity of the fundamental
conceptions that follow from psycho-analytic investigations. They
constitute an organic whole, and it would seem that the time is
now ripe for a presentation of them as such.

In carrying out this task, Dr. Hitschmann has been singularly
successful. Being in near personal touch with Professor Freud
himself and also having at his disf>osal an extensive psycho-
analytic experience, he is in a position to render an especially
faithful presentation of both the theory and the practice of the
subject. He has subordinated his personal views and striven to
reproduce Professor Freud's own as exactly as possible, making
indeed lengthy quotations from the latter's writings so as to fur-
nish an additional safeguard against any deflections. The book
should therefore be invaluable to those who contemplate making
a serious study of this important subject, and should serve as a
useful introduction to more detailed and special publications.

When Dr. Hitschmann asked me to suggest the name of a
translator for his book, I must confess that I felt at a considerable
loss, for it was clear to me that the task would be no easy one.

INTRODUCTION V

German is a harder language to translate from than French, and
as most of the sentences have to be entirely reconstructed, the
translator must have a thorough knowledge both of German and
of the subject-matter, especially so in such a book as the present
one where so much material is tightly packed into a relatively
small space. Further, not only had English equivalents to be
found for the new terms that inevitably accompany new ideas,
but so much of the thought was novel and strange that in order
to make the translation intelligible especial care had to be taken
in couching the language in an unambiguous, lucid and accurately
grammatical form, a responsibility not always realized by trans-
lators of scientific works. I had the good fortune, however, of
being able to enlist the energies of Dr. Payne, who has, as I know
from a personal acquaintance with his work, a thorough knowl-
edge and understanding of psycho-analysis and whose care in
rendering the precise meaning of the original combined with a
rare happiness of expression will commend itself to all his readers.
Dr. Payne has further enriched the book with a number of foot-
notes that elucidate particularly difficult passages in the text, and
has added bibliographical references to some of the rapidly accu-
mulating literature in English. May his translation win the
success it is justly entitled to.

Ernest Jones.

PREFACE

The motives that led me to believe there is a need for a sum-
mary of the Freudian investigations have only been strengthened
during its preparation.

The book is intended to serve as an introduction as well as an
incentive to the study of Freud's works and the application of the
psycho-analytic methods ; it aims at separating from the ranks of
the indifferent and antagonistic those whose position is due to
insufficient or erroneous information; finally it is desired that
this book by pointing out the unsolved problems of the theory may
further their solution.

Later editions will have to take into consideration the progress
or modifications as well as the new views arising from them. I
am greatly indebted to Professor Freud for his revision and many
suggestions and to Dr. O. Rank for his collaboration in prepar-
ing the book.

Dr. Eduard Hitschmann.

Vienna,

Autumn, 1910.

vu

TABLE OF CONTENTS

Introduction to the English Edition by Dr. Ernest Jones iii

Introduction i

Aim and Scope of the Book. Adherents and Opponents, db-

jections. Objections to the Theory. Attempt at Refutation and

Explanation of Them.

CHAPTER I

General Theory of the Neuroses 7

Freud's Field of Work. General Pathology. Classification
of the Neuroses. Course of Development of Freud's Theory of
the Neuroses. General Etiology. Role of Sexuality and Heredity.
The Psycho-Sexual Constitution. Cultural Sexual Morality.
Reference to the Therapy.

CHAPTER II
The True Neuroses 15

A. Neurasthenia. Clinical Picture. Etiology. Prophylaxis
and Therapy. B. Anxiety-Neurosis. Symptomatology. Etiology.
■ Theory. C. Refutation of the Objections to the Sexual Etiology
of the True Neuroses.

CHAPTER III
The Sexual Instinct 31

Existence and Significance of Sexuality in Children. Opposi-
tion to the Acceptance of this Discovery. The Sexual Theory:
A. Infantile Sexuality: i. Sexuality of the Suckling. 2. Sexuality
in Children. 3. Changes at Puberty. B. Deviations of the Sexual
Instinct: Inversion, Perversion, Fetichism, Sadism, Masochism,
Exhibitionism, etc. C. Sexuality of Neurotics. Confirmation of the
Theory by Analysis of Neuroses of Children. Infantile Sexual
Theories. Nuclear Complex of the Neuroses.

CHAPTER IV
The Unconscious 50

Consciousness and the Unconscious. Common Meaning of
Unconscious. Hypnosis and Double Consciousness. The Uncon-
scious in Hysteria. Resistance and Repression. Genesis and Con-
tent of the Real Unconscious. The Complex. The Free Asso-
ciation. The Association Experiment. Determinism of All
Mental Processes. The Phenomena of the Unconscious in the
Psychopathology of Everyday Life. The Unconscious in Wit and
Dream Formation.

IX

X CONTENTS

CHAPTER V

The Dream 60

Chief Characteristics of the Dream: Wish-fulfillment, Sexual
Erotic Content. The Dream Sources. The Dream Distortion
(manifest and latent content). The Dream-Making. Interpreta-
tion Technique: (a) by Symbolism, (&) by Associations. Tech-
nical Rules. Typical Dreams.

CHAPTER VI

Hysteria 75

Freud's Position in the Theory of Hysteria. Repression and
Conversion. Sexuality and Infantilism. The Hysterical Mind.
The Hysterical Symptom: Its Somatic and Psychic Foundations.
The Hysterical Phantasies. The Hysterical Attack. Nervous Dis-
turbances. Neurotic Anxiety (Anxiety-Dream, Anxiety-Hysteria,
Phobia). Concerning the Psychoses,

CHAPTER VII

The Obsessional Neurosis 100

Relation to Hysteria. Substitution Instead of Conversion.
Characteristic Obsession. Nature and Mechanism of the Obses-
sional Neurosis (1896). Remarks on a Case of Obsessional
Neurosis (1909). Significance of the Instinct in Life (Sadism).
Love and Hate; Obsession and Doubt. Mechanism of Distor-
tion. Some Mental Peculiarities of the Obsessed.

CHAPTER VIII

Psycho-analytic Method of Investigation and Treatment 114

Its Peculiarity (Specific Therapy). History of the Develop-
ment of This Method. General Technique. Art of Interpreta-
tion. Indications and Contra-indications. The Transference.
Refutation of the Objections to the Method.

CHAPTER IX

General Prophylaxis of the Neuroses 135

Cultural Sexual Morality. Sexual Education. Sexual En-
lightenment

CHAPTER X

Application of Psycho-analysis 142

Significance of Psycho-analysis for Medicine. Significance
for the Psychology of Normal Individuals and for Normal Psy-
chology (Unconscious, Dream, Wit). Psychopathology of Every-
day Life. Elucidation of the Psychology of Psychopaths, Crimi-
nals, Artists, Poets, Geniuses (Characterology). Significance for
the History of Culture and Folk Psychology.

Chronological Review of the Freudian Writings 150

References to the Publications in English 153

FREUD'S THEORY OF THE NEUROSES

INTRODUCTION

Aim and Scope of the Book. Adherents and Opponents. Objections
and Opposition to the Theory. Attempt at Refutation or Explanation
of Them.

The following condensed presentation of the present status of
Freud's theory of the neuroses is justified in the first place by
the difficulty of the subject, the constantly increasing extent of
the publications dealing with it and the fact that the lack of a
systematic arrangement of Freud's writings has made the first
perusal and study of them a hard task. Freud has never pre-
tended to offer a completely elaborated theory of the neuroses;
indeed he could not have done so, since he proceeded from prac-
tical experience which of necessity could only develop and deepen
by degrees. A theory, complete and well rounded at the begin-
ning, could only be the product of speculation, which might indeed
be suitable for a philosophical system but not for a medical study.
Nevertheless, the foundation and framework of the theory are
already erected so that it is time to attempt a provisional review
of the whole. It is obvious that this synthetic presentation avoids
either filling in or concealing the necessary gaps ; on the contrary,
it will call attention to them and thus point out the problems still
to be solved. The book is meant to be purely a review ; it there-
fore uses many of Freud's own words and has especially endeav-
ored to place the empirical foundations of his investigations in the
foreground. It has in view the arousing of interest in the study
and examination of this important method among distant circles
of medical men both in the clinic and in private practice, and
hopes in this way to be able to show the general validity of it.
Where, but a short time ago only a small band of zealous col-
leagues were gathered around Freud, now in recent years the
Freudian doctrine has found, especially in foreign countries, an

2 freud's theory of the neuroses

echo of agreement and a group of influential adherents.^ Still,
wide circles of the medical profession either remain indifferent
or are led astray and alarmed by the extreme attacks of certain
fanatical opponents. It is imperative, therefore, to begin by
exposing the motives which lie at the bottom of so much of the
opposition to an unprejudiced examination of these new and
original conceptions, at the same time refuting some objections
which often enough arise from only an incomplete understanding
of the theories which they oppose.

Naturally, one can only do justice to the Freudian doctrines,
which have in no way been evolved from theories but slowly de-
veloped from painfully acquired experience, when he has tried out
in practice the method of mental investigation (psycho-analysis)
derived from them. The difficulty which is experienced in
attempting this has many causes. In the first place, it may be
explained by the fact that for the present generation of physicians
educated in the chemico-anatomico-pathological school it is almost
impossible to allow a proper place to psychic causes of disease.
It is customary to be satisfied with the hereditary and constitu-
tional theories of the neuroses. By far the greatest and most
universal opposition raised against the Freudian doctrines has
been because of the disclosure of an unfailing sexual agency in
the causation of neurotic manifestations. Here the resistance, a
normal one, lies in the nature of the thing itself, since healthy and
slightly neurotic individuals are inclined for intelligible reasons
to deny the paramount importance of sexuality: the healthy,
because it constitutes no problem for them; the others because of
their unconsious need to spread a veil over their own weaknesses.

Unfortunately, physicians in their personal relation to the ques-
tion of sexual life have not been given any preference over the
rest of the children of men and many of them stand under the ban
of that combination of prudery and lust which governs the atti-
tude of most cultivated people in sexual matters. Even those
whose medical experience will not allow them to escape from the

^ This applies especially to the Swiss school with Bleuler and Jung
at its head. Compare the important works of this school in the bibli-
ography of the Jahrhuch fur psychoanalytische und psychopathologische
Forschungen, published under the supervision of Bleuler and Freud and
edited by Jung, Vol. II, 1910.

INTRODUCTION 3

observation that sexuality plays an important role in the neuroses
deny the universal application of this experience and dispute the
conclusion that in every case the exciting or decisive causes must
be of a sexual nature. Against this attitude is Freud's assertion
that his experience of many years has as yet shown no exception
to this rule. It will thus be necessary to wait and see if in the
use of the method of investigation developed by Freud any excep-
tions may be proven.^

In strange contrast to this reproach of unjustified generaliza-
tions is brought forward from another side the assertion that
Freud's teaching brings forth absolutely nothing new, but merely
reiterates the old naive folk-opinion which brought the affections
into close connection with nervous and mental diseases. While
Freud has acknowledged with satisfaction these supporters who
are in no way to be despised, still it must be kept clearly in mind
what a distance separates his exact scientific methods and demon-
strations from these primitive and naive folk-beliefs. This applies
especially to the question of whether or not dreams can be inter-
preted; that dreams are susceptible of a genuine scientific inves-
tigation the scholastics deny ; against this learned opinion, Freud's
splendid work has produced the proof that dreams have a real
meaning in the sense of the primitive folk-belief. Whoever con-
descends to interpret his own or another's dreams according to
the Freudian principles will soon bow respectfully before this,
perhaps the most important of Freud's contributions, and arrive
at identical results.^ On the other hand, the common sentiment
of all people in favor of free-will in mental processes is in direct
opposition to the recognition by the Freudian theory of a strict de-
terminism of every psychic process ; likewise, the ignorance of sym-
bolism which is indispensable for dream and symptom interpreta-
tion creates a doubt of its reality and justification.* Finally, much
opposition has been manifested against the numerous observations
which Freud has reported concerning the early sexual expressions

'One may compare with this the course of development of the etio-
logical views regarding tabes dorsalis where now syphilis is considered
an invariable antecedent.

'Compare for example Eberhard Buchner. "Traum und Traumde-
tung," in Frankfurter Zeitung of Jan. 30, 1910.

*Both of these objections which arise from the nature of things will
be made intelligible and refuted in the course of the presentation.

4 freud's theory of the neuroses

of children which until now were quoted by others merely as odd
or as frightful examples of precocious depravity. Here again
anyone who has made similar observations can be convinced of
the universality of these occurrences ; indeed one should not spare
himself the trouble of directing his attention to such unpleas-
ant signs.

A part of the antagonism is explained by the fact that Freud
is compelled by his investigations to use the word sexuality in a
broader sense than usual, giving it about the same meaning as the
word " love " in the German language, thus asserting the under-
lying unity of all love from the grossly sensual sexual intercourse
to the most unassuming exhibition of affection. The use of the
term sexuality in the Freudian sense is justified psychologically
and brings forward a most fruitful point of view. It is also
obvious that not only the actual activities of the sexual life but
also its phantasies are to be considered. Freud refuses to counte-
nance the narrow and degraded use of the word sexuality on
which a part of the antagonism rests.

A condition which has hitherto really hindered to a certain
degree the diffusion and confirmation of Freud's views regarding
the neuroses is the fact that so far there is no systematic and
complete exposition of the method of the analysis; in medicine,
one is usually accustomed to acquire the method and thus be in a
position to test it at first hand. Further, a practical demonstra-
tion of the method, a public psycho-analysis as it were, is impos-
sible. Of course, it is always possible for those really interested
to acquire the technique by personal contact with Freud and by
their own subsequent exertions which as a matter of fact many
have succeeded in doing. On the other hand, the technical diffi-
culties in the way of reproducing the analyses render learning
from examples a hard task. Freud's relatively few published
analyses" are only put forth in fragmentary form because their
complete reproduction would take an enormous space and bring
the physician into conflict with his duty of discretion. On the
other hand, individual details torn from their context lose the

"Freud, "Bruchstiick einer Hysterieanalyse " (Literature index No.
2i), "Analyse der Phobie eines fiinfjahrigen Knaben" (Jahrb. I), " Be-
merkungen uber einen Fall von Zwangsneurose " (ebenda). Further,
compare L. Binswanger, " Versuch einer Hysterieanalyse" (ebenda) as
well as other articles in the Jahrbuch with brief analyses.

INTRODUCTION 5

greatest part of their power to convince. For these reasons, the
present exposition cannot cite case records. For the rest, one
could not by innumerable examples or brochures convince those
who will not allow themselves to be convinced, while those who
have already gained a conviction of the objective reality of the
unconscious pathogenic material already possess in their own
experience the means of confirming the progress in the realm of
the Freudian theory of the neuroses. They will also be in the best
position to oppose those all too numerous individuals who will
always repeat the assertion that much of the pathogenic sexual
material which the analysis uncovers in the patients examined has
been suggested to them. He who has listened to such a patient
calmly and without prejudice for hours at a time will be easily
convinced that every neurotic is full of the subject and is only
waiting to confide to an appreciative listener the secrets carefully
guarded from others, even from those nearest him. Only by the
way of psycho-analysis can the therapeutic results be attained
which are in no way connected with the personality and authority
of an individual as many sceptically assert, but lie in the correct
conception and utilization of the method and its technique.

. In the attempt to justify by plausible objections the untenable
antipathy against this new-fashioned and in no way easily acquired
system, the reproach has been raised against Freud's conclusions
that they are not trustworthy because in the course of years they
have undergone more than one modification. It is really scarcely
necessary to defend against this reproach an investigator who has
carried through so revolutionary a life work, many years without
aid or encouragement from his colleagues. Freud himself has
dismissed it with these words : " Whoever believes in the develop-
ment of human intelligence will hear without surprise that I have
learned to discard a part of the opinions once put forth, to modify
another part. Still, I have been able to hold the greatest part
unchanged and need retract absolutely nothing as entirely wrong
and quite worthless." For the intelligent, the gradual evolution
of the Freudian doctrines is rather the proof of a remarkable con-
ception in the beginning, which remains essentially unchanged and
only undergoes a more detailed elaboration in certain parts. This
progressive development gives the best assurance for the belief
that this theory is nothing else than the accumulation of continued

6 FREUD S THEORY OF THE NEUROSES

and deepening experience. It should in no way be denied that there
are still to-day many points in the Freudian field of work in part
unexplained, in part not sufficiently verified and that it will require
not less than a generation of strenuous labor to carry the system
to its full completion. It may be foreseen that the contents of
the Freudian philosophy will then be an indispensable part of
medical education and that the science of psycho-analysis in the
hands of the next generation of physicians will succeed to an
indispensable practical importance.

CHAPTER I

GENERAL THEORY OF THE NEUROSES

Freud's Field of Work. General Pathology. Classification of the
Neuroses. Course of Development of Freud's Theory of the Neuroses.
General Etiology. Role of Sexuality and of Heredity. The Psycho-
sexual Constitution. The Cultural Sexual Morality. Reference to the
Therapy.

The field of Freud's work comprises the neuroses in the nar-
rower sense as well as certain closely related psychoses, such as
paranoia, acute hallucinatory confusion, etc. Formerly, numerous
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, while 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
obsessional neurosis (Zwangsneurose). According to Freud's
opinion, the neuroses deserve the name sexual-neuroses, since for
these clinical pictures 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 importance and practical significance. In a classical
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 two clinical
pictures true neuroses because their cause lies in the present
abnormal condition of the sexual function of the individual and
in opposition 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 childhood.

'"t)ber die Berechtigung, von der Neurasthenie einen bestimmten
Symptomenkomplex als * Angstneurose ' abzutrennen," Lit. No. 4.

^ In the following presentation, neurasthenia and hysteria will be used
as the best known examples of their kind.

7

8 freud's theory of the neuroses

Further, these infantile experiences and impressions which only
later become actively pathogenic turn out to belong without excep-
tion to the erotic life which is generally though erroneously
believed to be completely negligible in the child. Thus in every
case of neurosis, a sexual 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 expres-
sion in physical or mental manifestations 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 neurasthenia, can be produced by
certain injurious influences of the sexual life without any neces-
sary 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 psychoneuroses 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 recog-
nized that the symptoms of the disorders (hysteria, obsessional
neurosis, etc.) are psychogenic, depending on the activity of uncon-
scious (repressed) idea-complexes. This same method has also
recognized these complexes and shown them to be universally of
a sexual erotic content ; they arise from the sexual needs of indi-
viduals ungratified in the broadest sense of the word and afford
them a kind of substitute gratification.

^JDie yalue_of the theoretical^ distinctk>n between the toxic
(true) neuroses and the psychogenic neuroses h 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 neuras-
thenia, anxiety-neurosis with hysteria (compare later "anxiety-
hysteria"). In all these cases, a mixed and combined 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 empha-
sized that for about fifteen years Freud has not had opportunity

GENERAL THEORY OF THE NEUROSES 9

to continue his investigation of the true neuroses, hence this part
of the theory has not experienced a further expansion. The im-
portant progress which the comprehension of the nature of the
psychoneurotic troubles has made in the meantime will place their
relation to the true neuroses in a somewhat different light and it
will probably necessitate a revision in this field in the near future.
The more limited field of Freud's work is constituted by the
psychoneurotic forms, especially hysteria and the obsessional
neurosis, and it is exceedingly instructive to follow the steps in the
development of the nucleus of the Freudian doctrine if one wishes
to appreciate the full extent and value of his theory of the etiolog-
ical significance of the psychosexual agencies for the neuroses.

As a pupil of Charcot in Paris in 1885-1886, Freud received
important incentives to investigation.^ Prominent among these
was the step by which Charcot surpassed the level of his original
conception of hysteria and assured himself the fame of being the
first to explain this enigmatical malady, a fact of great significance
for the further investigations in this field. While Charcot was
engaged in the study of the hysterical paralyses which follow
dreams the idea came to him to reproduce these paralyses artifi-
cially 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 gained the mastery of the patient's brain in moments of
special disposition. Thus was the mechanism of an hysterical
symptom elucidated for the first time and this incomparably beauti-
ful 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 noteworthy case of hys-

' Compare Freud's obituary notice on Charcot, Lit. No. 23. While
lecturer in Vienna University, Freud translated into German the most
important works of his French master, J. M. Charcot, " Poliklinische
Vortrage," School-year 1887-88. " Neue Vorlesungen iiber die Krank-
heiten des Nervensystems, indesondere iiber Hysterie." H. Bernheim,
" Die Suggestion und ihre Heilwirkung." " Neue Studien uber Hypno-
tismus, Suggestion, und Psychotherapie." Collected by the press of F.
Deuticke, Vienna and Leipzic.

lO FREUD S THEORY OF THE NEUROSES

teria which, in so-called hypnoidal states, revealed to the attending
physician 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 affect and having the patient
describe the event in all possible detail and give the affect expres-
sion in words. Following this classical observation of Breuer's,
as you might say the first psycho-analysis, Freud applied the
cathartic method to a series of cases with success. Breuer and
Freud arrived at conclusions which permitted of bridging the gap
between the traumatic hysteria of Charcot and the general non-
traumatic variety. Their conception was that the hysterical
symptoms are the continued activities of mental traumas, the
accompanying affects of which have been separated by special
conditions from the conscious mental processes and are accord-
ingly in a position to attain an abnormal path to bodily innervation
(conversion). The terms "pent-up affect," "conversion," "to
abreact " sum up the characteristics of this view. It showed these
painful ex|>eriences " repressed into the unconscious," the affects
of the original idea not abreacted as " pent-up " ; only by the com-
plete expression of this idea in words could the pathogenic 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 affect may remain separated from all associations in con-
sciousness; the emotion thus set free may become attached to
other not unbearable ideas and these from this false association
become obsessions in the broader sense of the term (substitution).
Hysteria and obsessional neurosis are thus both to be considered
as cases of unsuccessful defence.

In the further investigation of the psychoneuroses to which
Freud now devoted himself exclusively, he found upon a more
detailed study of the causative psychic traumas from which the
hysterical symptoms were supposed to be derived that these orig-
inal 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 " trau-
matic experience" thus lost its supreme importance and Freud

GENERAL THEORY OF THE NEUROSES II

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 further
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. Here-
with was revealed for the first time an etiological condition of an
hysterical 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 these sexual erotic events of
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
infantile 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 content can produce
a psychic effect only by the aid of the memory, here is revealed
the insight that hysterical symptoms never arise without the
cooperation 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
belong 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 experi-
ences were often consciously remembered by individuals who re-
mained 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 noteworthy and very instructive error was

12 freud's theory of the neuroses

exposed and by a deepened insight into the constitutional factors,
overcome. Freud had previously revealed in the " Drei Abhand-
lungen zur Sexualtheorie "® the whole polymorphous fulness 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
sexual 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 oT
a neurosis came to the foreground. When Freud had finally suc-
"ceeded 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 individuals, belong in exquisite fashion, besides quantitative
transgressions, a hereditary predisposition which Freud has de-
scribed in a narrower sense as the psychosexual constitution. In
this decisive importance of the instinctive life and its psycho-
sexually conditioned disharmonies there has been attained a pro-
visional 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 apply himself at first to the exciting agencies; in this
connection, he has not overlooked but repeatedly called attention
to the fact that besides the agencies in the psychosexual field,
the etiology of the neuroses may be conditioned both by inherit-
ance and by a special constitution and that the neuroses, like all
other diseases, have complex causes. Though more recently the
theory of an hereditary predisposition has undergone a certain
abridgment, still there is no doubt that there are neuropathic

•Translation by Brill in Monograph Series of Journal of Nervous
and Mental Disease.

GENERAL THEORY OF THE NEUROSES 1 3

families in which an hereditary taint can be clearly traced.^"
Freud thus assumes that the heredity finds expression in a pecu-
liar psychosexual constitution of the individual which asserts
itself in an abnormally strong and many-sided instinctive 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 repre-
sensation of this instinct lays claim to. This early and excessive
development of the sexual instinct brought about by constitutional
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 mysterious-
ness of hysteria by the perception of two opposing forces, a too
severe sexual abstinence 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 matur-
ing process or of external 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 symptoms. The mani-
fold varieties and the different possibilities of development of
such an abnormal psychosexual constitution Freud has explained
in detail in his " Drei Abhandlungen zur Sexualtheorie." Added
to the hereditary and constitutional prerequisite conditions of the
neurosis, there are many premature sexual experiences and activi-
ties which act as agencies favoring its outbreak; the importance
of these could have been so long overlooked only because so much
more attention 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 childhood.
Freud has done a great service in calling attention to the early
seduction of children by other children or adults and the abnormal

" Freud has emphatically pointed out more than once that in more
than half of his cases of severe hysteria, obsessional neurosis 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.

14 FREUD S THEORY OF THE NEUROSES

reaction to these experiences as a result of an especial suscepti-
bility 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 constitution."^^ Besides the admitted
share of true heredity, Freud has revealed a pseudo-heredity in
the influence of an environment of nervous people, namely the
nervous parents, and has shown that there is a nearer way than
heredity for nervous 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 out-
break at the earliest possible moment."" Thus upon more care-
ful analysis, what appears to be hereditary transmission resolves
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 injuries and
restrictions on a natural life, is an important factor in the causa-
tion of nervous diseases, especially the true neuroses. Cultural,
indeed still more frequently, material agencies often place insur-
mountable 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 gratification. Much more difficult is the treatment of the
psychoneuroses ; for the healing of these a very complicated psy-
chological technique has been perfected, which will be explained
later ; in certain particulars this is still undergoing deepening and
refinement.

"The admission that there may be such a combination of diflferent
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.

"Lit No. 20.

CHAPTER II

THE TRUE NEUROSES

A. Neurasthenia: Clinical Picture; Etiology; Prophylaxis and
Therapy. B. Anxiety-Neurosis: Symptomatology; Etiology; Theory. C.
Refutation of the Objections to the Sexual Etiology of the True Neuroses.

A. True Neurasthenia

As already related, while Freud was following the causative
sexual injuries in detail, he succeeded in showing that neuras-
thenia as it had been described by the earlier authors resolved
itself into two typical clinical pictures : into so-called " true
neurasthenia" and into anxiety-neurosis, which forms not only
have a specific etiology but can also be sharply differentiated clin-
ically. Under neurasthenia, Freud understands those frequent
symptom-complexes of pressure in the head, spinal irritation,
dyspepsia with flatulency and constipation, paresthesias, dimin-
ished potency, as well as a prevailing emotional depression.
According to Freud's views, this clinical picture corresponds to
the specific cause of excessive masturbation or frequent pollutions
or better expressed: neurasthenia may in every case be traced
back to a condition of the nervous system which has been acquired
through excessive masturbation or arisen spontaneously from
frequent pollutions.^^ This picture of neurasthenia is a fairly
uniform one, hence the various pseudo-neurasthenias (as the
nervous disturbances of cachexia and arterio-sclerosis, the early
conditions of progressive paralysis and of many of the psychoses,
etc.) may be more sharply differentiated from true neurasthenia
than formerly. Further, according to Moebius's proposal many
a status nervosi of hereditary degenerates can be placed at one
side and one will also find reasons for classifying many neuroses
which are to-day called neurasthenia, especially those of inter-
mittent or periodical nature, more properly as melancholia (cyclo-
thymia). The neurasthenia of the authors really includes much
more, but also much that is ill-defined. The place of hypochondria

"Lit No. 23.

15

1 6 freud's theory of the neuroses

remains for the present unexplained, though certain forms seem
to correspond to a third form of true neurosis.

To make easier the comprehension of true neurasthenia, the
course of development of a typical case may be briefly sketched.
A boy who practices onanism excessively" at puberty usually re-
mains without control until, warned by companions or one of those
dangerous popular scientific books, he is changed into an hypo-
chondriac who interprets the symptoms of his neurasthenia as the
premonitory signs of a softening of the brain and spinal tubercu-
losis resulting from his self -pollution. Falling into anxiety and
depression, he suddenly gives up his masturbation and often
begins to suffer from frequent pollutions. The outlet provided
for the discharge of the sexual product by the act of masturbation
does not correspond to the complicated spinal reflex act with its
psychic preliminaries as provided by normal coitus. From this
abuse arises also the widespread symptom of ejaculatio prsecox,
which betrays years afterward the youth who had been greatly
given to onanism with phantasies.^" Such men are usually not in
condition to give the woman the normal outlet for her excitement
and gratification of coitus, a condition which, as will later be
explained in detail, leads to anxiety-neurosis in the woman. It
is obvious that it is the duty of the physician to forbid the excess-
ive onanist his manner of sexual gratification. But it is recom-
mended that this be done without dire predictions of the terrible
results of continuing this vice, in contrast to the pseudo-scientific
articles ; rather it should be done by advising a gradual giving up
of the practice and seeking to strengthen the patient by dietetic
and hydrotherapeutic measures. If frequent pollutions still con-
tinue then a strict avoidance of all incentives to sexual excitement
seems indicated as well as a regulation of the digestion. If the
patient is not helped by these measures then it becomes necessary
to recommend a normal method of gratifying the sexual appetite.
For the sexual need once aroused and long gratified no longer
permits itself to be silenced, but only transferred to another object.

"Light forms of neurasthenia because of corresponding conditions
may be found in childhood.

"The so-called "mental onanism" (phantasies leading to ejaculation),
further the protracted masturbation which puts off the ejaculation, finally
the "masturbatio interrupta" which prevents the ejaculation seem to be
especially injurious (Stekel).

THE TRUE NEUROSES 1 7

A therapeutic interference of that kind is also best suited to con-
vince the practical physician of the correctness of the specific
etiology of neurasthenia here described; for a cure follows the
removal of the sexual injury. That the former therapeutic meas-
ures, such as sanitarium treatment, travel and water cures, etc.,
now and then show results is explainable by the fact that unin-
tentionally they also change the patient's sexual relations, which,
according to recent investigations, are regularly the cause of such
apparent results. These improvements are therefore often only
transitory and especially unreliable.

The chief service which the wise physician can render to the
neurasthenic lies in the prophylaxis. If excessive masturbation
in youth is the cause of neurasthenia, then the prevention of the
same in both sexes deserves more attention than it has yet received.
Until now, the weighty question of masturbation could, however,
receive no decisive answer because, on the one hand, the existence
of masturbation in the suckling and child has not been sufficiently
recognized and, on the other hand, no agreement has been reached
between the disparate medical views regarding the onanism of
puberty and later life. The purely autoerotic masturbation in
the littlest children may seldom and only in excessive cases demand
the interference of the tutor, not to mention the physician.
Childish onanism around the third to fourth or fifth years must
within certain limits be considered a normal phenomenon.^'
Further, this is normally soon replaced by the so-called latent
period. If this does not occur or if the practice becomes excess-
ive, then it must be checked. Nevertheless, terrifying and
gruff prohibition is to be avoided ; much more can be accomplished
by gentler methods. Often in the neurosis which breaks out later
there appears the anxious hallucination of parental prohibitions;
through the quite customary threat of cutting off the penis, a
further psychic trauma may be inflicted which is frequently fol-
lowed by lasting and pernicious results.

Far more important is the problem of the onanism of puberty
and later life, over which the most opposite experiences are

*• Among the patients suflfering from impotence, are a relatively large
number who have never practiced onanism at all, and there seems to exist
a connection between the neglect of the act of masturbation which pre-
supposes a certain activity and the sexual weakness.

1 8 freud's theory of the neuroses

reported and the most contradictory views held. It must be
emphasized at the beginning that this onanism can not be entirely
avoided, because in our civilized social organization too great an
interval has been interposed between the awakening of the sexual
instinct and the possibility of its regular gratification. There is
thus the necessity of allowing this mode of gratification up to a
certain degree, that is within moderate limits and with quieting
explanations; it can then be observed that this happens without
real injury. The injuriousness of a precocious or later excessive
onanism is only in small part conditioned by the very nature of
masturbation. There is, however, a special sexual constitution
which causes certain people to become ill as a result of masturba-
tion while others bear their onanism of puberty, which is nothing
more than the revival of the masturbation of earliest childhood,
without noticeable injury. In general, the injuriousness especially
of excessive masturbation is not to be doubted in the least, even
if a part of the medical profession is not inclined to share the
hypochondriacal exaggerations of many nervous patients who
would trace back all evil to their self -gratification. The injurious-
ness begins in the somatic field in that onanism gives occasion to
excessive sexual activity, does not take into consideration all the
psychological sources of excitement, affords inadequate relief and
diminishes potency.^^ More important are the injuries in the
mental field. These come to light both in the demands of the
sexual life and also in those of the social life. For the former,
a serious result is a lasting inability to endure abstinence or coitus
interruptus. Further, there comes about a sort of turning away
from reality, from the female sexual object, which is later dis-
closed in an intolerance of the necessary imperfections in the
same. As one of the chief mental injuries of onanism, must
finally be asserted the fact that it favors in every relation the
fixation of an infantile condition which furnishes the proper
foundation for the psychoneurotic illness. The injuries which
the onanist experiences for his social life are numerous. The easy
attainability of the goal of gratification in masturbation weakens
the individual — according to the Freudian principle of psycho-
sexual parallelism, that is the typicalness of the sexual life for his

" The stomachache of onanists should also be mentioned. (Compare
Lit. No. 34.)

THE TRUE NEUROSES I9

behavior in other relations of hfe — for the strife of Hfe which
can no longer be undertaken with the necessary display of energy.
Through his turning away from society, the masturbator becomes
antisocial and betrays the result of his vain strife against passion
in a number of other characteristics, as weak will power, doubt
of the possibility of accomplishment and similar self-reproaches.
Thus, there seems to be a kind of mental type for him who has
misused onanism. From these considerations, the theory of
neurasthenia should undergo a revision.

B. The Anxiety-Neurosis^*

Especially valuable for medicine has been Freud's sharp differ-
entiation of the symptom-complex of the anxiety-neurosis^^ from
the previously described clinical picture of true neurasthenia.
The name anxiety-neurosis arises from the fact that the various
components of this symptom-complex are grouped around the
cardinal symptom of anxiety to which each individual symptom
shows a definite relationship.

I. Clinical Symptomatology of Anxiety-Neurosis. — The clin-
ical picture of the anxiety-neurosis comprises the following
symptoms :

1. General irritability and irritation. A special point of value
is the expression of this heightened irritability through an hyperes-
thesia for visual impressions but especially through an hyperes-
thesia for sounds, hypersensitiveness to noises. This is also fre-
quently the cause of sleeplessness, of which more than one form
belongs to the anxiety-neurosis.

2. Anxious expectation, a condition which can be best illus-
trated by example. A lady, for example, who is suffering from
anxious expectation, thinks of pneumonia every time her hus-
band, who has catarrh, has an attack of coughing and sees in her
mind his funeral passing by. If, on her way home, she sees two
persons standing together in front of the door, she cannot help

"Abbreviated repetition of Freud's work. Lit. No. 4. Attention
should here be called to the fact that the English has no exact equivalent
for the German word " Angst " which connotes apprehension, dread, fear,
etc., in addition to anxiety, which is the nearest English word and the one
which will be used throughout this translation. Trans.

"As a forerunner of the Freudian view may be mentioned the work
of E. Hecker, "t)ber larvierte und abortive Angstzustande bei Neuras-
thenie" (Zentralblatt fur Nervenheilkunde, Dez., 1893).

20 freud's theory of the neuroses

thinking that one of her children may have fallen out of the
window; when she hears the bell ring, someone is bringing bad
news, etc., while in all these cases, there is no especial occasion
to strengthen such a mere possibility. For one form of anxious
expectation, that in respect to the person's own health, one can-
not avoid the old name, hypochondria.

A further expression of anxious expectation is the frequent
tendency to anxiety for certainty found in persons of great moral
scrupulousness, which likewise varies from the normal up to
skepticism.

The anxious expectation is the nuclear symptom of the neu-
rosis ; in it may plainly be seen a part of the theory of the same.
It can be said that there is here a quantity of free-floating fear
(Angst) at hand which in the expectation rules the choice of ideas
and is always ready to attach itself to any passing idea.

3. The anxiousness which is constantly present can, however,
also break through into consciousness suddenly, without being
awakened by the course of ideas, thus causing an attack of anxiety.
Such an anxiety attack may consist of either an anxious feeling
without any associated idea or of the idea of impending death, of
a stroke, of threatening insanity, or some paresthesia may be
mixed with the anxious feeling (like the hysterical aura), or
finally, with the feeling of anxiety may come a disturbance of one
or more of the bodily functions, the respiration, circulation, vaso-
motor innervation, glandular functions, etc. Out of this combina-
tion, the patient emphasizes now one, now another factor, he com-
plains of heart cramp, dyspnea, sweating, ravenous appetite, etc.,
and in his representation the anxious feeling frequently becomes
obscured or becomes really unrecognizable and described as a
" bad feeling " of indefinite discomfort.

4. There are therefore rudimentary attacks of anxiety and
equivalents of the anxiety attack of which Freud has prepared
the following list :

(a) Disturbances of the heart's action, palpitation with brief
arrh)rthmia, with longer attacks of tachycardia up to severe condi-
tions of cardiac weakness, the differentiation of which from
organic affections of the heart is not always easy; pseudo-angina
pectoris,^" a delicate diagnostic field.

** Compare M. Herz, "Die sexuelle psychogene Herzneurose (Phreno-
kardie)," Braumuller, Vienna and Leipzic, 1909.

THE TRUE NEUROSES 21

(b) Disturbances of respiration, many forms of nervous
dyspnea,^^ asthmatic attacks, etc. These attacks, however, are
not always accompanied by recognizable anxiety.

(c) Attacks of sweating, often nocturnal.

(d) Attacks of shaking and trembling, which may only too
easily be taken for hysterical.

(e) Attacks of ravenous appetite often accompanied by
vertigo.

(/) Diarrhea in form of attacks.

(g) Attacks of locomotor vertigo.^^

(h) Attacks of so-called congestions, about everything which
has been called vasomotor neurasthenia. Here may be mentioned
the vasomotor edemas, the sudden dying of a finger, an arm or
foot (angina pectoris vasomotoria).^'

(i) Attacks of paresthesias (these, however, seldom without
anxiety or a similar feeling of discomfort).

5. Nothing but a variety of anxiety attack are the frequent
night terrors (pavor nocturnus of adults), commonly accom-
panied by anxiety, dyspnea, sweating,^* etc. This disturbance
occasions a second form of sleeplessness in the framework of the
anxiety-neurosis. In addition, the pavor nocturnus of children
shows a form which undoubtedly belongs to anxiety-neurosis.
It frequently has an hysterical touch which makes it appear as
something special and brings it into closer connection with the
anxiety-hysteria which will be discussed later.

6. A prominent place in the symptomatology of the anxiety-
neurosis is occupied by vertigo which, in its lightest forms, is
better designated as giddiness, in its severer types as "attack of
vertigo" with or without anxiety, which belongs to the severest

^Compare M. Herz, "tJber eine Form der falschen Dyspnoe (* Seuf-
zerkrampf ')," Wiener Klin. Wochenschrift, 1909, No. 39. Both articles
of Herz give superfluous new names to partial phenomena of the anxiety-
neurosis.

*■ The vertigo can become a foundation for a locomotor phobia such
as agoraphobia.

* Compare Curschmann (Mainz), "t)ber Angina pectoris vasa-
motoria," III. Jahresversammlung d. Gesellsch. Deutscher Nervenarzte,
Vienna, 1909.

"Concerning the characteristic dreams, compare the latter part of
chapter on hysteria.

22 FREUD S THEORY OF THE NEUROSES

symptoms of the neurosis. This vertigo never leads to complete
loss of equilibrium. On the other hand, it seems possible for
such an attack of vertigo to be replaced by an attack of profound
weakness.^' Other fatigue conditions of the anxiety-neurosis
appear to depend on a heart collapse. Dizziness at heights, on
mountains and precipices likewise frequently accompanies anxiety-
neurosis.

7. On a basis of a chronic anxiousness (anxious expectation)
on the one hand, and a tendency to attacks of vertigo on the other,
two groups of typical phobias develop, the first in regard to gen-
eral physiological menaces, the other in regard to locomotion. To
the first group belong the anxiety over snakes, thunder, darkness,
vermin and the like as well as the typical moral overscrupulous-
ness.^" Forms of skepticism; here the unattached anxiety is
plainly applied to the strengthening of doubts which are instinc-
tively implanted in every person.

The other group embraces agoraphobia with all its varieties
collectively characterized by its relation to locomotion.^^ A pre-
ceding attack of anxiety is here frequently the foundation of
the phobia.

8. The digestion in anxiety-neurosis undergoes only a few but
characteristic disturbances. Sensations like a tendency to nausea
and vomiting are not rare and the symptom of ravenous appetite
either alone or with other congestions can give something of a
rudimentary attack of anxiety ; as a chronic change, analogous to
the anxious expectation, is found a tendency to diarrhea which
has given occasion for the strangest diagnostic errors. The
diarrhea is the analogue of the frequent micturition of the anxiety-
neurosis.

9. The paresthesias which may accompany the vertigo or
attack of anxiety are of interest because of the fact that they are
associated in a regular sequence like the sensations of the hys-
terical aura. Nevertheless, these associated feelings, in contrast

"Occasionally a sudden unexpected feeling of fatigue precedes it.
Stekel, " Nervose Angstzustande und ihre Behandlung." Urban und
Schwarzenberg, Vienna and Berlin, 1908.

**An intensive sexual feeling of guilt, which can already be cultivated
by children, always depends on the suppression of excessive libido.

* For this, the complete psychoneurotic mechanism is necessary (com-
pare later).

THE TRUE NEUROSES 23

to the hysterical, are atypical and changeable. A large number
of so-called rheumatic patients really suffer from anxiety-
neurosis.^* In addition, many cases of anxiety-neurosis show a
tendency to hallucinations ; these cannot be considered hysterical.

ID. Many of the so-called symptoms which accompany or re-
place the anxiety-neurosis appear in chronic form. This applies
especially to the diarrhea, vertigo and the paresthesias.

II. Occurrence and Etiology of the Anxiety-Neurosis. — ^As
already explained, the morphology of this malady is the corollary
of a typical etiology which makes it preferable to consider men
and women separately. Anxiety-neurosis occurs in females classi-
fied according to their age and positions in life in the following
cases :

(a) As anxiety of virgins or adolescents. A number of indis-
putable observations have shown that a first experience with the
sexual problem, a rather sudden revelation of what up to that time
had been veiled, for example by the sight of the sexual act or of
the male genitals, by a lecture, printed or pictorial representation,
can cause an anxiety-neurosis in a maturing girl which is com-
bined with hysteria in an almost typical manner f^

■ (b) As anxiety of the newly married. Young women who
have remained anesthetic during the first co-habitations often
develop an anxiety neurosis which disappears again after the
anesthesia has given way to a normal feeling. Total anesthesia
is not meant here, but that of those women who are excitable up
to a certain degree but are incompletely gratified ;

(c) As anxiety of women whose husbands exhibit ejaculatio
praecox or a very diminished potency.

(d) Anxiety of women whose husbands practice coitus inter-
ruptus or reservatus. These last two cases belong together, for
it is easily proven from the analysis of a great number of cases
that the occurrence depends on whether or not the woman is
gratified during coitus. In the latter case, the ground is prepared
for the outbreak of an anxiety-neurosis. On the other hand, if
the husband can gratify the woman either through a better per-

** Compare F. Pineles, " Zur Klinik und Pathogenese der sogenannten
' Harnsaureschmerzen,' " Wiener Klin. Wochenschr., 1909, No. 21.

"According to the present status of the theory, this is more properly
classed as anxiety-hysteria (Angsthystefie).

24 FREUD S THEORY OF THE NEUROSES

formance of the act or by preventing ejaculation at the beginning
of the act, she remains free from anxiety-neurosis. The con-
gressus reservatus by means of a condom exposes the woman to
no injury if she is very easily excited or the man very potent; in
other cases, this kind of conception-preventing intercourse is not
less injurious than the other forms ;

(e) As anxiety of widows and intentional abstainers, often in
t)rpical combination with obsessions ;

(/) As anxiety in the climacteric, during the last great climax
of the sexual appetite.

Classes c, d, e embrace the conditions under which the anxiety-
neurosis begins most frequently in the female sex and earliest,
independent of hereditary disposition.

For the conditions of the anxiety-neurosis in men, Freud has
formulated the following groups analogous to those found in
women :

(a) Anxiety of intentional abstainers, frequently combined
with symptoms of defence (obsessions, hysteria).

{b) Anxiety of men as a result of unsatisfied excitement (dur-
ing the engagement period), further of persons who through fear
of the results of sexual intercourse content themselves with fond-
ling and looking at the woman. This group of conditions (which
is also transferable unchanged to the other sex), engagement,
relations with sexual forebearance, afford the purest cases of the
neurosis.

(c) Anxiety of men who practice coitus interruptus, therewith
delaying the ejaculation until the woman is gratified. This form
of anxiety-neurosis in men is usually mixed with neurasthenia.

{d) Anxiety of men in the senium. There are men who
show*" a climacteric like that of women and at the time of their
diminishing potency and increasing libido, develop anxiety-
neurosis.

For both sexes, the two following classes apply:

{e) Neurasthenics as a result of masturbation fall into
anxiety-neurosis as soon as they forego their method of sexual
gratification. These persons have rendered themselves especially
unable to stand abstinence.

It is here important for the understanding of the anxiety-

" Compare F, Pineles, /. c.

THE TRUE NEUROSES 2$

neurosis to notice that a very serious case of this condition occurs
only in men who remain potent and in women not entirely
anesthetic.

(/) Anxiety-neurosis arises in both sexes occasionally from
overwork, exhausting exertion, for example, night watching,
nursing the sick and after severe illness.^^

In addition to the results of his observations, Freud has sought
to give a theoretical interpretation of the pathogenesis of anxiety-
neurosis in which he takes into account the observation that many
cases of anxiety-neurosis accompany an appreciable lessening of
the libido or psychic pleasure.

In the points adduced thus far concerning the anxiety-neurosis
there are sufficient stopping points from which to gain a view of
the mechanism of this neurosis. One gains the impression that it
has to do with an accumulation of excitement; that the anxiety
which corresponds to this accumulated excitement as psychic
anxiety which finds no outlet is of somatic origin ; and further that
the accumulated excitement is of a sexual nature. These hints
favor the expectation that the mechanism of the anxiety-neurosis
is to be sought in the diversion of the somatic sexual excitement
from the psychic and in the abnormal application of this diverted
excitement caused thereby. This idea of the mechanism of the
anxiety-neurosis can be made clearer by a consideration of the
normal sexual process, at first only as it occurs in men. The
normal sexual act may be sketched as follows: First there is an
accumulation of somatic excitation ; this increases to a point where
it occasions a psychic irritation, creating the libido ; finally this is
discharged by a complicated spinal reflex act which must also
carry off the psychic excitement simultaneously. Such a psychic
discharge is only possible by the way which Freud has called ade-
quate or specific action. The etiology of true neurasthenia and
anxiety-neurosis finds its place in the outline of this representation
of the sexual process, which in essentials is also applicable to the
woman. Neurasthenia ensues every time the adequate discharge
is replaced by an inadequate one, as when normal coitus under
favorable conditions is replaced by masturbation or spontaneous

*^ Compare in this connection the remarks on the sexual mechanism in
distinction from sexual etiology (later in this chapter).

26 freud's theory of the neuroses

pollution ; all agencies, however, which hinder the psychic utiliza-
tion of the somatic excitement conduce to anxiety-neurosis.

The previously described etiological conditions of anxiety-
neurosis disclose the common characteristic of accumulation of
excitement. Intentional abstinence constitutes the first etiological
factor for the man in that it prevents the specific action which
should follow the libido. The somatic excitement is thus accumu-
lated and is discharged in other ways. In this way, abstinence
leads to anxiety-neurosis. Abstinence is also the real factor in
the second etiological group, that of frustrated excitement. The
third class, that of coitus with precautions (reservatus), acts
injuriously by disturbing the psychic preparation for the sexual
discharge since it interposes another diverting psychic task before
allowing the completion of the sexual act. Anxiety in the senium
(climacteric of men) demands another explanation. There is
here, as in the climacteric of women, such an increase in the
production of somatic excitement that the mind proves relatively
inefficient to care for the same.

The etiological conditions in the woman may without difficulty
be viewed from the same standpoints. In addition, the disa-
greement between the somatic and the psychic in the course of the
sexual excitement can occur earlier in the woman and is more
difficult to remove than in the man.

Thus, the Freudian view considers the symptoms of the
anxiety-neurosis as substitutes in a way for the omitted specific
action which should follow the sexual excitement. As a further
corroboration of this view, it should be remembered that also in
normal coitus the excitement is accompanied by acceleration of
the respiration, palpitation, sweating, congestion, etc. In the cor-
responding attack of anxiety of our neurosis, there is the dyspnea,
palpitation, etc., of coitus isolated and exaggerated.

In those exceptional cases which do not arise from specific
causes but from other banal injuries, such as nursing the sick,
overwork, etc., the sexual etiology is indeed absent but the illness
is established on the foundation of a sexual mechanism, since
general exhaustion renders the mind unable to care for the somatic
excitement which continually makes demands on it.

This reference to the exceptional causes of the anxiety-neurosis
is always overlooked by the critics who, in opposition to Freud,

THE TRUE NEUROSES 2/

think they have found anxiety-neuroses without sexual injury.
This explanation of a sexual mechanism replacing a sexual etiol-
ogy is, however, a very important one, and it is easy to make the
same one for those very similar cases of neurasthenia not of
sexual etiology, for example, those occurring with arterio-scle-
rosis. In these conditions, the disease may also arise from indi-
rect disturbances of the elaboration of sexual products like the
primary disturbances of other organic processes. By the substi-
tution of a sexual mechanism for the sexual accidents, there may
result a progress in the comprehension of the true neuroses similar
to that which the theory of the psychoneu roses experienced when
the importance of the sexual traumas was replaced by infantilism
of sexuality.

C. Refutation of the Objections brought against the
Sexual Etiology of the True Neuroses

As already mentioned, the formerly much greater field of the
neuroses has been lessened by the diseases of the blood-forming
glands. Neurasthenia and anxiety-neurosis constitute the transi-
tion from the sexual neuroses to such exquisite toxic diseases of
the nervous system. They are caused by disturbances of sexual
processes in the organism which we must call chemical. Further,
they actually show a great similarity to the phenomena of intoxi-
cation and abstinence ; the similarity to Basedow's and Addison's
diseases is obvious.

Freud, in his assertions regarding the etiology of the true
neuroses, knew that in bringing forward the sexual etiology he
adduced nothing completely new, for the undercurrents in medical
literature which took this fact into account have never disappeared.
Indeed, in many of these undercurrents, the cure of " sexual diffi-
culties " and " nervous weakness " has been united in a common
promise. Further, the official medicine of the schools has really
noticed these relations, although it has acted as if it knew nothing
of them. It may easily be perceived that a dim perception of the
predominating importance of sexual agencies in the production of
nervousness such as Freud has recently sought to establish scien-
tifically has never been absent from the consciousness of the laity,
as many of the naive but fundamentally correct expressions of
patients concerning the cause of their troubles indicate.

28 freud's theory of the neuroses

The chief objection to Freud's assertion of a sexual etiology
of the anxiety-neurosis concerns the fact that abnormal relations
of the sexual life are so exceedingly frequent that they must
always be at hand whenever sought. Thus, the existence of these
in cases of anxiety-neurosis cited does not prove that the etiology
of the neurosis lies therein. Further, the number who practice
coitus interruptus and the like must be incomparably greater than
the number afflicted with anxiety-neurosis. In reply to this, it
may be asserted that in the recognized tremendous frequency of
the neuroses and of anxiety-neurosis in particular, one ought not
to expect to find a rare etiological agent ; further, that a postulate
of pathology is actually fulfilled in this case, namely, that in the
investigation of etiology, the etiological agent must be proved
more frequent than its result, since for the latter other conditions
(as disposition, total of specific etiologies, other banal injuries)
may be required ; finally, that the detailed analysis of suitable cases
of anxiety-neurosis proves the significance of the sexual agency
beyond dispute.

Perhaps many a one who is entirely ready to take into account
the sexual etiology of the nervous malady will still repudiate it as
one-sided because he is not requested to direct his attention also
to the other agencies commonly mentioned by the authors. It is
far from Freud's intention to substitute the sexual etiology of the
neuroses for every other, hence he would explain that the efficiency
of these remains. Freud means rather that in addition to all the
known and probably rightly recognized etiological agencies of the
authorities are added the sexual, which have not been sufficiently
appreciated. It should not be forgotten that the etiological prob-
lem of the neuroses is at least as complicated as that of other
diseases. A single pathogenic influence is almost never sufficient ;
for most, a combination of etiological agencies is necessary, which
aid one another and which cannot be brought into opposition to
one another. The sexual agencies in the etiology of tiie neuroses
deserve, however, according to Freud's estimate, to be assigned a
prominent place in the etiological series. For only these will be
found missing in no case, these alone are able to produce the
neurosis without other assistance, so that the other agencies seem
reduced to the role of predisposing or supplementary causes ; these
alone enable the physician to recognize certain relations between

THE TRUE NEUROSES 29

the variety and multitude of clinical pictures. Heredity, which is
so strongly emphasized by most authors, is undoubtedly an im-
portant factor where it is found ; it permits a severe case of illness
to result where otherwise only a very mild one would have ensued.
Heredity alone is inaccessible to the physician's efforts, while the
sexual causes are just those which offer him a good opportunity
for his therapeutic activity. The agency of overwork, which
physicians so gladly tell their patients is the cause of their neurosis,
is subjected to excessive abuse. The physicians will have to
accustom themselves to explaining to the official who has " over-
taxed" himself in his office or the housewife whose household
duties have been " too hard " that they are not sick because they
have sought to perform duties really easy for a civilized brain but
because they have in the meantime grossly neglected and stifled
their sexual life. Whoever approaches the cases from this side
will find the proof of how valuable for the anamnesis are these
points of view. Naturally, he who would convince himself from
his patients whether or not their neuroses are really connected
with their sexual life, cannot avoid making express inquiries
regarding their sexual life and giving a truthful explanation of
the same without being diverted from this medical duty by ethic-
ally colored arguments. It would facilitate his task if the patients
might know with what certainty the trained physician can now
detect the meaning of their neurotic difficulties and the inference
from these to the real sexual etiology. The semblance of negative
cases without sexual etiology, which might be given by a negative
result of the examination, is explained by the fact that behind such
cases is an hysteria (anxiety-hysteria) or obsessional neurosis
which the actual neurosis merely imitates. Such hysterias in the
form of neurasthenia are not at all rare; a more penetrating in-
vestigation by means of psycho-analysis invariably unmasks them.
For the very frequent mixed forms of true and psycho-neuroses,
it is recommended in many cases to overlook at first the psycho-
neurotic component in the clinical picture and to combat thera-
peutically the true neurosis ; in this way one can sometimes succeed
in becoming master also of the separated psychoneurosis.

The anxiety-neurosis is such a widespread malady that it is
daily encountered in practice. Its prevention would be a weighty
social task; still, the elimination of certain injuries is dependent

30 freud's theory of the neuroses

on so many material and social factors that an ideal accomplish-
ment of the task under present civilized conditions is not to be
thought of. This much can be said, that only an individual who
has no great sexual appetite can endure abstinence and that the
entire abstinence before marriage is not to be generally recom-
mended, let alone demanded, since it can lead in many cases to
deficient capacity for work and indeed directly to a neurosis. Still,
complete abstinence is repeatedly harmless just as frustrated
excitement or methods of imperfect gratification are. Finally, if
it is necessary for a married couple to go without children, harm-
less measures for the prevention of conception must be employed
which are suited to the tolerance of the individuals participating.
That from this standpoint a liberal legislation in relation to the
introduction of artificial abortion may be favored is conceivable.®^
Thus, here again, just as in the prophylaxis of neurasthenia, it is
shown that these neuroses are rooted in a true sense in our whole
present-day sexual morality and that only a thorough change of
our entire social and economic organization can bring humanity
the solution of the old inherited evil of nervousness.

"Compare Wittels, "Die sexuelle Not." C. W. Stern, Vienna and
Leipzic, 1909. V

CHAPTER III

THE SEXUAL INSTINCT

Existence and Significance of Sexuality in Children ; Opposition to the
Acceptance of This Discovery. The Sexual Theory: A. Infantile Sexu-
ality: I. Sexuality of the Suckling. 2. Sexuality in Children. 3. Changes
at Puberty. B. The Deviations of the Sexual Instinct: Inversion, Per-
version, Fetichism, Sadism, Masochism, Exhibitionism, etc. C. Sexuality
of Neurotics. Confirmation of the Theory by Analysis of Neuroses of
Children. Infantile " Sexual Theories." Nuclear-Complex of the Neuroses.

Freud has discovered by way of psycho-analysis the existence
of a sexual life in children and has described the phenomena in
detail in his classic, " Drei Abhandlungen zur Sexualtheorie." The
entirely new conception that the pure, innocent child could have
a sexual life met much opposition. Besides this sentimental oppo-
sition, there is the infantile amnesia which veils^^ the first years of
childhood for most people up to the sixth or eighth year and
hinders their acknowledging the fact of infantile sexuality. And
still we know that our memory can be fully reviewed and repro-
duced at no time of life ; on the other hand, psycho-analysis has
shown that the very impressions which we have forgotten leave
behind the deepest traces in our mental life and have become
determining for our whole later development. Thus, there can
be no real forgetting of childhood impressions, but only an amnesia
like that which we observe in neurotics for their later experiences,
the essential feature of which is a mere detention of consciousness
(repression). This is the first amnesia which appears in the life
of an individual and it seems probable that no hysterical amnesia
would be possible without this infantile amnesia.

It is the same with the observations of sexual expressions in

"This amnesia for the first years of childhood is not a complete one
but is broken through by entirely isolated childhood memories of indif-
ferent and secondary content behind which, however, is hidden a weighty
and important content which may be shown by psycho-analysis. Freud
has called these " cover-memories " because they serve as substitutes for
the really important impressions, the direct reproduction of which meets a
resistance. (Compare Lit. No. 13.)

31

32 FREUD S THEORY OF THE NEUROSES

childhood as with many other observations, they only really im-
press one when they are examined and described collectively. The
physicians who have once directed their attention to this side of
the child's mental life will find'* in every case traces of a sexual
instinct early expressing itself; hence Freud can assert without
injustice that the time will soon come when one will publish as
rare exceptions cases which in no way betray expressions of sex-
uality in the first years of life.

A. The Infantile Sexuality

I. Sexuality in the Suckling. — Freud has emphasized the fact
that the child brings with it into the world the germ of sexuality
and enjoys in the taking of nourishment sexual pleasure which it
ever after seeks to procure by sucking, independent of the taking
of food. The Hungarian pediatrist. Dr. Lindner, has devoted a
penetrating study to the sucking or pleasure-sucking of children.'^
The sucking which appears in the suckling and if it becomes fixed
as a childish fault can be continued even up to the years of
maturity, consists in a rhythmically repeated sucking movement
with the mouth (lips) in which the object of taking nourishment
is excluded. One part of the lips or any other skin surface which'
can be reached, perhaps the big toe, is taken as the object on which
the sucking is carried out. Therewith appears a complete absorp-
tion of the attention and the "pleasure-sucking" ends in falling
asleep or even in a kind of orgasm.*" Often, there is combined
with the pleasure-sucking a rubbing of certain sensitive parts of
the body, the breast, the external genitals, etc. In this way, many
children proceed from sucking to masturbation. There is no
doubt that we are here dealing with a sexual condition which pre-
sents, however, many difficulties to its comprehension, since the
instinct is not directed toward other persons but is gratified on
the child's own body in a manner called by H. Ellis, " autoerotic."
In this connection, the mouth and lips are revealed as erogenous

•* Compare for example Bleuler's work on " Sexuelle Abnormitaten
der Kinder" (Jahrbuch d. schweiz. Ges f. Schulgesundheitspflege, IX,
1908).

'* Jahrbuch fur Kinderheilkunde, N. R, XIV, 1879.

"Here is already shown something which is applicable to the whole
of life, namely, that sexual gratification is the best hypnotic. Most cases
of nervous insomnia go back to lack of sexual gratification.

THE SEXUAL INSTINCT 33

zones, a significance which they retain in later normal life in the
kiss. For many, it may occasion surprise to learn that sucking
is exhibited independently of its relation to the hunger instinct.
It is, however, plain that the mouth zone is at first concerned
only with the gratifying of the hunger instinct; later, the desire
for a repetition of pleasurable experiences gained in this way is
separated from the need of taking nourishment, thereby trans-
forming this mucous surface into an erogenous zone. It is to be
assumed that even those children who later remain normal had the
childish fault of sucking in whom the erogenous importance of the
lip zone was constitutionally strengthened. If this accentuation
persists, these children as adults become passionately fond of kiss-
ing, tend to perverse kissing or if men show a strong tendency to
smoking and drinking. If the repression intervenes, however,
then there is produced an aversion for eating and hysterical vomit-
ing. Because of these different functions of the lip-zone, the
repression is carried over to the hunger instinct. All later hyster-
icals with disturbances of eating, globus, snoring in the throat and
vomiting have during childhood been energetic suckers.

Both the essential characteristics of infantile sexual expres-
sion which the sucking displays, namely, autoeroticism and the
domination of the erogenous zones, exhibit also the other activities
of the infantile sexual instinct. Thus, in particular, the mastur-
bation of the suckling which scarcely an individual escapes and
which is plainly appointed to fix the future primacy of the genital
zone for the later sexual functions. The action which allays the
irritation and furnishes the gratification consists of a rubbing fric-
tion with the hand or a pressure of the tightly approximated thighs.

To one who is little acquainted with neurotics and who has not
encountered these phenomena in adult patients in their full im-
portance, Freud's disclosure that the anal zone of the child may
afford pleasurable sensations seems at first hardly conceivable.'^
Nevertheless, one can occasionally observe in little children that
they refuse to empty the bowels when they are placed on the closet
because they obtain pleasure from defecation when the retained
stool by its accumulation excites strong muscular contractions and
in the passage through the anus produces a strong irritation of the
mucosa. Therewith, the pleasurable sensation must be realized

"Remains of continued " analeroticism " are often found in adults.

34 FREUD S THEORY OF THE NEUROSES

besides the painful one. The frequent intestinal catarrhs of child-
hood afford occasion for intense excitement of these erogenous
zones. Intestinal catarrh in the youngest years makes the patients
" nervous " as it is called. In later neurotic maladies, these exert
a determining influence on the symptomatology of the neurosis,
placing at its disposal the whole range of intestinal disturbances.
Thus, the original masturbationary irritation of the anal zone
which is often practiced by older children and adult neurotics with
the aid of the fingers is one of the roots of the constipation so
frequently found in neuropaths. The great importance of the anal
zone is reflected in the fact that one finds only few neurotics who
have not their special skatalogical customs, ceremonials, etc. It
is just these coprophiliacs, that is, those who associated pleasur-
able emotions with the excements in childhood, who are most
profoundly perplexed by the repression; Freud has shown the
important part which these instinctive impulses destined to be sup-
pressed play in the later character formation. Psycho-analysis of
neurotics revealed the fact, purely empiric, that individuals who
have successfully repressed an anal eroticism, which was originally
intense, regularly show certain traits of character in unmistakable
form: orderliness, frugality, and stubbornness.'^

Also entirely new is the Freudian discovery that the neck of
the bladder can serve as an erogenous zone. Pollution in the child
lacking a sexual secretion seems to take the form of an excretion
of urine and may lie at the bottom of many cases of eneuresis.
Further, in later life, especially in neurotics there occurs simul-
taneously with the sexual excitement a desire to micturate and
urination very frequently appears in dreams as the symbol of the
sexual act.'® The bed-wetting which plays a great role in the
previous histories of neurotics is repeatedly closely connected with
masturbation.

The sources of all these sexual excitements lie in part in in-
ternal processes, in part are brought about through peripheral
irritation of these zones (anal, genital) by the cleansing as well
as by caressing of parents and nurses.

* For the attempt at a psychological explanation of the connection,
compare Freud, " Charakter und Analerotik," Lit. No. 29.

** The biological problems connected with the theory of the erogenous
zones are treated in a valuable " Studie fiber Minderwertigkeit von
Organen," by Dr. Alf. Adler (Urban & Schwarzenberg, Vienna and Ber-
lin, 1907).

THE SEXUAL INSTINCT 35

These germs of sexual excitement in the new born develop for
a time, then undergo a progressive suppression in a " latent period "
which is normally interrupted about the third or fourth year,
During this period of complete or merely partial latency, as a
result of organic processes (organic repression)*" and the indis-
pensable help of the education, the mental forces are formed which
appear later as inhibitions to the sexual instinct and narrow its
course like dams: the disgust, the feeling of shame, the esthetic
and moral standards of ideas. During the latent period, another
part of these sexual energies is separated from the sexual aim and
applied to cultural and social ends, a process which Freud has
designated by the name sublimation as important for culture, his-
tory and the individual. The possibility of certain components
of the sexual instinct being diverted from the original goal to a
higher and no longer sexual aim furnishes in later life additional
energies to our mental powers; to these, we probably owe our
highest cultural attainments.

From this point of view, the often expressed skepticism regard-
ing the specific virulence of the sexual etiology loses its justifica-
tion. No instinct so important and necessary for the furtherance
of culture is limited and suppressed like the sexual instinct, from
childhood on, chiefly in its perverse manifestations. The afflic-
tions known as neuroses are to be traced back to the manifold
forms of misfortune which may befall this transformation process
of the components of the sexual instinct.

2. Sexuality in Children. — The sexuality of the suckling re-
turns in the years of childhood, although a fixed time for this can-
not be named. This reappearance of sexual activity is determined
by internal causes and external conditions. At the head, stands
the influence of seduction, which treats the child prematurely as
sexual object. Recent investigations have shown that the child
now and then very prematurely, at the age of three to five years,
is capable of a choice of an object accompanied by affects and not
merely of a series of autoerotic gratifications. This premature
sexual appetite is directed at first toward the parents and nurses,
a choice of object which springs from the dependency of the child.

** The nature of this process which corresponds in a way to an organic
developmental tendency is still unexplained; its importance for the origin
of the psychoneuroses is pointed out in the chapter on hysteria.

36 freud's theory of the neuroses

One can also observe without trouble that the apparently most
harmless love affairs of little children are not without an erotic
tinge.*^

It is obvious that seduction is not necessary to awaken the
sexual life of the child in this second period and that such awak-
ening can also occur spontaneously from internal causes. It is
now instructive to observe that the child under the influence of
occasional seduction can become polymorphous-perverse, that is
to say, can be seduced to all possible transgressions; this shows
that it brings along within its own person the possibility for this
condition. It brings with it the tendency to all perversions and as
a result of its bisexual nature also the tendency toward inversion
(homosexuality) ; its development either into a neurosis or nor-
mality is conditioned on the special emphasis of certain instincts
and zones as well as on the experiences of childhood. All the
peculiarities of this second infantile sexual activity lie behind the
deepest impressions in the (unconscious) memory of the indi-
viduals and condition the development of their characters if they
remain healthy, of the symptomatology of their neuroses if they
become afflicted with one after puberty. In the latter case, one
finds this sexual period forgotten and the conscious memories
formed of it displaced. Freud, however, also brings the normal
infantile amnesia into connection with this infantile sexual activ-
ity. Through psycho-analytic investigation, it has been possible
to render this forgotten material conscious and thereby overcome
an obsession which came from the unconscious psychic material.

The perversions contained in the polymorphous-perverse tend-
encies may be traced back to a series of partial or component
instincts which in themselves, however, are not primary. Besides
an instinct not itself sexual arising from motor impulse sources,
one distinguishes in these a contribution from an irritation of the
receptive organ (skin, mucosa, sense organ) of the erogenous zones,
the excitation of which lends to the instinct the sexual character;
as such partial or component instincts, Freud has revealed exhibi-
tionism, the peeping tendency, active and passive algolagnia
(sadism and masochism) and others. The undisguised pleasure
of the little child in the undressing of its body and in particular

** Compare the interesting work of Sanford Bell, " A preliminary study
of the emotion of love between the sexes" (Atner. Jour. Psych., 1902).

THE SEXUAL INSTINCT 37

of its genital parts shows the exhibitionistic tendency. The coun-
terpart of this in later life as a perverse tendency is the curiosity
to see the genitals of other persons (Schaulust, peeping tendency)
which under suitable influence can attain a great importance for
the sexual life of the child. Looking at and handling the genitals
of playmates is not rare and such children become voyeurs (peep-
ers), ardent observers of the micturition and defecation of others.
The roots of sadism are easily detected in normal individuals in
the aggression which the sexuality of most male individuals
exhibits, the biological importance of which may lie in the neces-
sity of overcoming the resistance of the sexual object otherwise
than by the act of courtship. Thus, sadism corresponds to an
aggressive component of the sexual instinct which has become
independent and exaggerated through having been moved by dis-
placement to a preponderating influence. Nevertheless, the com-
plete psychological analysis of the sadistic instinct has not yet
succeeded. Also for masochism, a normal root cannot be denied
in the sexual overvaluation (compare later). As a further root
of masochism, the painful irritation of the skin of the buttocks in
spanking is to be emphasized.

The study of the component instincts revealed the important
discovery that the sexual instinct itself is not a unit but a com-
posite structure of many components which are again set free in
the perversions.

For the origin of sexual excitation in this second period of
sexuality in childhood, we go back to the following : (a) To an
imitation of a gratification experienced in connection with other
organic processes (for example, sucking) ; (b) to suitable periph-
eral irritation of erogenous zones; (c) to the expression of some
instinct, the origin of which is not entirely plain to us as yet, as
the peeping tendency (Schautrieb) and the tendency to cruelty.

Rhythmical mechanical movements of the body likewise cause
pleasurable sensations; hence, swinging, being tossed, rocking, as
well as railroad and carriage journeys are so much liked by
children.*^ That the muscular activity set up by scuffling and

** Freud thinks that we may assume that these influences which in mild
intensity are sources of sexual excitement may have, when connected by
fright with violent mechanical shaking, an etiological significance for
hysteriform traumatic neurosis. He has, however, not yet taken trau-
matic hysteria into the scope of his investigation.

38 freud's theory of the neuroses

wrestling with playmates can serve as a sexual excitation is also
recognized. Fear and anxiety can likewise call forth sexual excita-
tion, in connection with which the feelings of irritation caused
by anxiety in school children which can then lead to onanism and
pollution may be particularly mentioned. Finally, it is undeniable
that the concentration of the attention on an intellectual task in
young or mature persons may result in a coincident sexual excita-
tion ; this is probably the only just ground for attributing nervous
disturbances to intellectual overwork, a cause formerly assigned
but always doubtful.

3. The Changes at Puberty. — The latent period lasts, apart
from the interruptions mentioned, up to the changes at puberty
in which the heretofore autoerotic character of the sexual activity
is lost and the instinct finds its object. Until now, this was com-
posed of separate instincts and derived from erogenous zones
which sought independently of one another a certain pleasure as
the only sexual goal. The new sexual aim which is created by the
changes of puberty and is characterized by an amalgamation of
all instinctive tendencies which proceed from the erogenous zones
consists in the man in the discharge of the sexual product ; for the
accomplishment of this, there must be a subordination of all the
erogenous zones to the primacy of the genital zone, which is facili-
tated by the development of the genital organs and the elaboration
of the seminal secretion. To the conditions which first appear at
puberty, there is also added that "pleasure of gratification"
(Befriedigungslust) of sexuality which ends the normal sexual
act: the end-pleasure (Endlust). The pleasure derived previously
from the excitation of the erogenous zones needs a name for itself
and is called in contrast by Freud, the fore-pleasure (Vorlust).*'
The finding of an object is influenced by the infantile inclination
of the child towards its parents and nurses which is revived at
puberty and similarly directed by the incest barriers against these
persons which have been erected in the meantime.

Both these essential changes at puberty, the primacy of the
genital zone and the finding of an object, are indispensable for the
establishment of a normal sexual life. If, on account of patho-

*" Later material on the mechanism of the fore-pleasure as well as on
the nature of pleasure in general is found in Freud's work " Der Witz
und seine Beziehung zum Unbewussten " (Lit. No. 19).

THE SEXUAL INSTINCT 39

logical heredity and accidental experiences, this amalgamation of
the excitations springing from various sources and its application
to the sexual object does not occur, then there results the patho-
logical deviations of the sexual instinct, determined in part by
earlier processes, such as a preservation of a definite part of the
original polymorphous-perverse tendency. The perversions are
thus developed from seeds which are present in the undifferen-
tiated tendencies of the child and constitute in adults a condition
of arrested development.

Puberty is also the period in which the development of the
two sexes widely diverges in respect to the new sexual aim. That
of the male is of the more far reaching influence, while in the
female, a kind of retrograde process sets in. The autoerotic
activity of both sexes has been the same, and in respect to the
manifestation of masturbation in the genital zone one could make
the statement that the sexuality of the little girl has throughout a
masculine character. The chief erogenous zone in the female
child is situated in the clitoris, the homologue of the glans of
the male penis. This excitability of the clitoris, however, at
puberty, which brings a great influx of libido to the boy, under-
goes a new repression. Thus, it is a characteristic of male sexual
life which the repression thereby destroys. The transference of
the excitability of the clitoris to the vaginal entrance often takes
a certain time for its accomplishment during which the young
woman is often anesthetic for coitus. If the clitoris zone attempts
to retain the great activity which it had in childhood and refuses
to give up its excitability, then the anesthesia becomes permanent.
In this vicissitude of the chief erogenous zone as well as in the
new increase of repression at puberty lie the chief conditions for
the predisposition of the woman for a neurosis, especially hysteria.
If one would give a definite meaning to the terms masculine and
feminine, he could make the assertion that libido is regularly and
lawfully a masculine attribute whether it occurs in man or woman
and not taking its object into account which may be either man
or woman.

B. Deviations of the Sexual Instinct

By the aid of the analytic investigation of the sexual instinct
in the neurotic, Freud has been able to interpret exhaustively the

40 FREUD S THEORY OF THE NEUROSES

*l

pathological deviations of the instinct of sex and to indicate its
relation to the normal. These deviations are not to be considered
a priori pathological, but only in their exclusiveness and fixation
lies the justification for considering the so-called perversions
symptoms of disease. Freud has greatly illuminated this extended
field of phenomena, in doing which he divides the perversions into
two groups, according as the deviation concerns the sexual object
or the sexual aim.

I. Deviations in Respect to the Sexual Object. — Among these,
inversion, as Freud calls homosexuality, shows the greatest diver-
sity and therefore the most difficult problems. The persons hav-
ing this perversion are either (a) absolutely inverted, that is,
their sexual object can belong only to the same sex; {b) amphi-
genously inverted (psycho-sexual hermaphrodites), that is, their
sexual object can belong to the same sex or to the opposite sex;
(c) occasionally inverted. A satisfactory explanation of inversion
is afforded only by the perception that there is in everyone an
original bisexual tendency which is also established anatomically.
Normal development leads from bisexuality to the primacy of the
heterosexual instinct ; thus, inversion corresponds to a disturbance
of development. In this perception, the inadequate question of
whether it is inborn or acquired disappears. It arises undoubtedly
in earliest childhood and has as a foundation, disturbances which
the sexual instinct encounters in its development. In every case,
it is absolutely inadmissible to differentiate a special homosexual
instinct; it is not a peculiarity of the instinctive life but of the
choice of an object which constitutes the homosexual. The prob-
lem of homosexuality is a very involved one and embraces quite
different types of sexual activity and development. One should
expressly distinguish whether the inversion has inverted the sexual
character of the object or that of the subject. The sexual object
of the male invert is frequently not of the same sex in his essential
characteristic but a union of the characteristics of both sexes
with the fixed condition of masculinity of body (genitals). The
analysis of the phobia of a five year old boy brought Freud the
explanation of this condition. One finds among homosexuals in
later life, who according to Freud's and Sadger's** observations

** J. Sadger : " Fragment der Psychoanalyse eines Homosexuellen "
(Jahrb. f. sex. Zwischenstufen, 1908). Same, "Zur Atiologie der kon-

THE SEXUAL INSTINCT 4I

pass through in childhood an amphigenous stage, the same infantile
overvaluation of the genitals, especially of the penis as distin-
guished this little patient. This premature preponderance of the
masculine organ determines the fate of the homosexual. They
choose the woman as the sexual object in their childhood so long
as they presuppose in woman the existence of that part of the
body which is apparently indispensable to them ; with the convic-
tion that the woman has deceived them in this point, the woman
ceases to be acceptable as sexual object. They cannot do without
the penis on the person who should stimulate them to sexual inter-
course and in favorable cases fix their libido upon the " woman
with the penis," the youth of effeminate appearance. The homo-
sexuals have thus remained fixed during the course of develop-
ment from autoeroticism to love of an object in a position nearer
autoeroticism. The presupposition of a penis on the woman is
one of those frequent infantile sexual theories developed by the
still unenlightened child whose sexual curiosity is already
awakened.

Although psycho-analysis has as yet furnished no complete
explanation of the origin of inversion, still it can disclose the
psychic mechanism in certain cases and enrich the discussion con-
cerning this. In the cases thus far investigated, it can be asserted
that those who later become inverted pass through during the first
years of childhood a phase of very intense but short-lived fixation
on the woman (usually the mother), after the conclusion of which
they identify themselves with the woman and take themselves for
the sexual object, that is, proceeding from narcism, they seek
young men like their own person whom they wish to love as the
mother loved them. In this connection, it has been discovered that
the supposed inverted were in no way insusceptible to the stimulus
of the woman but the excitement called forth by the woman is
continually transposed to a male object. Thus they repeat during
their whole life the mechanism by which their inversion was occa-
sioned. Their obsessional striving after the man shows itself as
conditioned by their restless flight from the woman. Meanwhile,
it is to be noticed that thus far psycho-analysis has undertaken
to analyze only a few types of inversion : persons with generally

traren Sexualempfindung " {Mediz. Klinik, 1909). Same, "1st die kon-
trare Sexualempfindung heilbar?" {Zeitschr. f. Sexualwissenschaft, 1908).

42 FREUDS THEORY OF THE NEUROSES

restricted sexual activity whose sexuality is exhibited as inversion.
The development of homosexuality seems further to be favored
for both sexes by purely feminine surroundings during the period
of growth.

Exceptionally, sexually immature persons and animals may
also be taken as sexual objects, thus throwing a light on the nature
of the sexual instinct which in contrast to hunger permits of so
many kinds of variations and such a degradation of its object.

2. The deviations in respect to the sexual aim which are de-
scribed as perversions Freud divides into (a) anatomic trans-
gressions of the portions of the body appointed for the sexual
union; (b) lingering over the intermediary relations to the sexual
object which should normally be passed through quickly on the
way to the final sexual goal. In the most normal sexual process,
those steps are already discernible, the development of which leads
to the deviations which are called perversions.

(a) The psychic valuation which the sexual object shares as
the wish-goal of the sexual instinct is limited in the rarest cases
to the genitals but usually encroaches on the whole body and
radiates to the psychic field. It is this psychic " sexual overvalua-
tion " which endures so badly the limitation of the sexual aim and
helps to bring other parts of the body to serve as sexual goals.
In the elaboration of these most varied anatomical transgressions,
a need for variation is unmistakable. The importance of the
agency of sexual overvaluation may be best studied in the man
whose sexual life is open to investigation while that of the woman
in part because of cultural limitation, in part through conventional
concealment and insincerity is hidden in darkness.

The application of the lip and mouth mucosa to the normal
kiss is generally practiced among most peoples. On the contrary,
against the union of the lip-mouth-zone with the sexual organ of
the other sex there are various strong feelings of disgust. In
this disgust, Freud sees one of the forces which have brought
about the limitation of th^ sexual aim. As a rule, these stop short
of the genitals. However, if the genitals become the object of the
disgust (sexual refusal) this is to be considered a characteristic
sign of hysteria (especially among females). In connection with
this, it may be noted that with hystericals, certain other portions
of the body, as mouth and anal mucosa, may assume as it were the
significance and role of genitals.

THE SEXUAL INSTINCT 43

Freud brings into connection with the sexual overvaluation
the common abnormality of fetichism. The fetichistic substitute
for the sexual object is in general a part of the body only slightly
adapted to the sexual purpose (foot, hair) or an inanimate object
which stands in near relation to the sexual person (pieces of
clothing, linen, shoes, etc.). A certain degree of fetichism is
always peculiar to normal love. This first becomes pathological
when the striving after the fetich becomes fixed and takes the
place 'of the normal goal. Further, when the fetich becomes sepa-
rated from the definite person and becomes the sole sexual object.
A certain diminution in the desire for the normal sexual goal
seems to be a presupposition for all cases (executive weakness of
the sexual apparatus). In the choice of the fetich, there is shown,
as Binet first asserted and as was later affirmed by numerous
proofs, the persisting influence of a sexual impression usually
received in early childhood. In other cases, it is a symbolic asso-
ciation of thoughts usually not conscious to the individual which
has influenced the substitution of the object by the fetich. Psycho-
analysis could recently fill out the previous gaps in the understand-
ing of fetichism by pointing out the significance of a pleasure
derived from smell (Riechlust) for the choice of the fetich which
has been lost through repression. Feet and hair are peculiarly
odoriferous objects which after the renunciation of the pleasure
derived from the smell and corresponding idealization are raised
to fetiches.*' In the perversion corresponding to the foot-
fetichism, the bad-smelling foot is accordingly the original sexual
object. Another contribution to the explanation of fetichistic
preference for the foot is revealed in the infantile sexual theories
to be discussed later ; the foot represents the greatly missed i>enis
of the woman.**

(b) Fixations of temporary sexual goals. All external and
internal conditions which render difficult the attainment of the
normal sexual aim or long defer it (impotence, costliness of the
sexual object, dangers of the sexual act) strengthen the tendency

* This conception is confirmed by an investigation by Abraham on a
case of shoe and corset fetichism (Jahrbuch, 1910). For pleasure in
smelling, compare Jahrbuch, I, 2, page 420.

** The foot is an ancient symbol of the penis long used in myths and
corresponding to the shoe or slipper symbol of the female genitals. Com-
pare Aigremont, " Schuh- and Fuss-Fetichismus und Erotik," Leipzic, 1909.

44 FREUD S THEORY OF THE NEUROSES

to prolong the preparatory acts and form new sexual goals from
these which may replace the normal. Closer investigation always
shows that the apparently most strange of these new purposes are
already hinted at in the normal sexual process and provided by
the intimacies which serve for the excitement of themselves and
the opposite party. In this respect, the fondling of the sexual
object plays the greatest role. A certain amount of fondling and
a prolongation of the intermediary sexual goal of sexually toned
looking at is present in a certain degree in most normal men. The
pleasure of looking (Schaulust) becomes a perversion (a) when
it is limited exclusively to the genitals, (b) when it is joined with
the overcoming of the disgust (voyeurs, peepers), onlookers at the
excretory functions, (c) when it represses the normal sexual goal
instead of preparing for it. The latter is shown most clearly in
the case of the exhibitionists who display their genitals. In this
perversion there stands forth most distinctly a curious trait which
is also sometimes present in other perversions. The sexual goal
is really present here in double form, in active and passive form.
Thus, these instincts appear in contrasting pairs. The same is the
case in one of the most frequent and important of the perver-
sions, in the instinct to inflict pain on the sexual object (sadism)
and its opposite (masochism) also called active and passive
algolagnia.

C. The Sexual Instinct of Neurotics

The results which have come to Freud from the conditions
described are intimately connected with the starting point of his
theory, since they have afforded an important point of view for
understanding the sexual instinct of neurotics. Neurotics are
really persons with strongly formed impulses which have in the
course of development been repressed and unconsciously become
perverse. Their sexual instinct displays, therefore, all the devia-
tions which we have studied as variations of the normal and as
expressions of the pathological sexual life and their unconscious
phantasies show during the process of rendering these conscious
by analysis the same content as the fixed acts of the perverts.

(a) In the unconscious mental life of all neurotics without
exception, are found impulses to inversion,*' fixation of the libido

" Compare Alf. Adler, " Der psychische Hermaphroditismus im Leben
und in der Neurose," Fortschritte d. Medizin, 1910.

THE SEXUAL INSTINCT 45

on persons of the same sex, a discovery which is of especial im-
portance for the elucidation of hysteria in males.

(b) Among the psychoneurotics may be detected all the tend-
encies to the anatomic transgressions existing in the unconscious
as symptom-creators; among such occurring with especial fre-
quency and intensity are those which convert the oral and anal
mucosa to the role of genitals.

(c) A most important role among the symptom-creators of
the psychoneuroses is played by the component instincts which
were discussed as creators of the new sexual goal; these appear
mostly in contrasting pairs, the peeping tendency and the exhibi-
tionistic tendency, the active and passive tendency to cruelty. The
contribution of the latter is indispensable to the comprehension of
the painful nature of the symptoms and almost invariably controls
a part of the social relations of the patients. Where such an in-
stinct which is capable of being paired with an opposite is found
in the unconscious, the second part may regularly be detected as
acting. Every active perversion is thus accompanied by its pass-
ive counterpart. For example, whoever has difficulty in following
the repression of sadistic impulses, finds another entrance to the
symptoms by way of the masochistic tendency. The complete agree-
ment with the conduct of the corresponding positive perversions
is certainly very noteworthy. In the clinical picture, however, one
or the other of the contrasting tendencies plays the paramount role.

In a clear case of psychoneurosis, there is seldom only one of
these perverse tendencies present, usually a large number of them
and as a rule traces of all.

The sexuality of neurotics discloses one kind of repression of
the instinctive life which exceeds the normal amount. The symp-
toms of the neurotic malady are the expression of the sexual
activity of the patients taken in the broadest, polymorphous-
perverse sense. Thus they originate not, as a mistaken conception
of the Freudian doctrine insists, only at the expense of the so-
called normal sexual instinct, but represent the converted expres-
sion of instincts which one must call perverse (in the broadest
sense).*® The neurotics have, in a certain sense, kept the infantile

"Compare W. Strohmayer, "Zur Analyse und Prognose psychoneu-
rotischer Symptome," Zeitschr. f. Psychotherapie u. med. Psychologie,
II, 2, 1910.

46 freud's theory of the neuroses

attitude toward sexuality or would go back to it, but with the
difference that with neurotics the sexual instinct is not expressed
consciously and actively but exists in repression, thus acting in
the unconscious and there finding expression only in the form of
inhibitions. The neurosis may thus be called the negative of the
perversion. With such a conception naturally disappears the con-
tradiction that there may be persons whose sexual life has ceased
who may yet contract a neurosis ; one should not forget that there
may be a number of perverse emotions, the deficient gratification
of which leads to a neurosis in the end.

The sexual instinct of the neurotic expresses itself before
everything else in a spontaneous sexual precocity which shows
itself in the interruption, shortening or abolition of the infantile
latent period. This precocity renders difficult the later control of
the sexual instinct and confers upon it a certain amount of obses-
sional character. It leads further to an excessive development of
the sexual instinct against which, on the other hand, the abnormal
(failed) repression stands opposed. Between the pressure of the
instinct and the counter pressure of the sexual denial, the malady
then makes its appearance as a way out which does not solve the
conflict but seeks to escape it by changing the libidinous tendencies
into symptoms.

These were the results which Freud had gained from psycho-
analytic investigation of adults and some isolated cases of observa-
tions of children. In an especially favorable and because of its
youthful age most suitable case, he succeeded later in confirming
directly this insight into the nature of child sexuality which had
been established retrospectively. Since the neuroses of adults
were to be traced back in every case to the same basic complexes
as those the child showed in complete distinctness and elaboration,
Freud could claim for this child-neurosis a typical significance.
This child analysis showed positively that the picture of the child's
mental life as it was presented from the observation of the little
patient by his parents was in complete accord with the description
which Freud had sketched in his sexual theory from psycho-
analytic investigations of adults and at that time only occasional
observations on children. In the boy's relation to his father and
mother, this case confirmed in every detail everything which Freud

THE SEXUAL INSTINCT 47

had asserted concerning the sexual relations of children to their
parents. The boy is a little CEdipus who would have the father
out of the way in order that he might be alone with the beloved
mother and sleep with her. Besides this typical CEdipus-complex**
of sensuous love for the mother with antipathy against the father
and wishes for his removal, the greatest influence on the psycho-
sexual development of the patient was exerted by the birth of a
sister when he was three and a half years old. This event had
intensified his relations to the parents, placed insoluble problems
in his thoughts and the observation of the nursing of the new-
born child revived the memory traces of his own earliest pleasur-
able experiences. This influence is also a typical one; in an
unexpectedly large number of life- and clinical histories, one
must consider this flaming up of sexual pleasure and curiosity which
is connected with the birth of the next child as the starting point
of the understanding. The desire for knowledge in children does
not in general awaken spontaneously but under the instigation of
the instinct of jealousy, when at about the end of the second year
they are met by the arrival of a new child. The justly feared
ending of the parental care has an awakening influence on the
emotional life of the child and stimulates his powers of thought.^"
Under the excitation of these emotions and troubles, the child
comes into contact with the first great problem of life and raises
the question whence come the children, which is usually couched
in the form: whence comes this particular disturbing child. If
the child, after his unavailing and unsatisfactory investigation,
turns to adults for information, he receives either no answer or
no sufficient answer or a rebuke for his unseemly curiosity or he
will be put off with the mythologically^^ important information
that the stork brings the children out of the water. As a rule,
the children give this stork fable no credence, since the pregnancy
of the mother seldom escapes their sharp observation. On the
contrary, they build false theories'^ of the generation and birth of

*" Concerning the expression of this complex in the dream, compare
Chapter V.

"The elder child often expresses his enmity against the new arrival
quite openly.

"See Rank, "Der Mythus von der Geburt des Helden" (Schriften
z. angewandten Seelenkunde, Part 5, F. Deuticke, Vienna and Leipzic,
1909).

"Compare Freud: "Uber infantile Sexualtheorien," Lit. No. 32.

48 freud's theory of the neuroses

this child which plainly grew in the body of the mother. Ignor-
ance of the female genitals enables a boy to form a theory whereby
the fetus is expelled as an excrement from the anus (cloacal-
theory) ; others suppose it comes out through the navel, to which
they can assign no other function. These theories naturally allow
the possibility, for they overlook the peculiarities of the female
genitals, of both sexes bearing children, which idea really plays a
great role in childish phantasy-life. In general, the still incom-
plete recognition of or disbelief in two different sexual appa-
ratuses furnishes the child a weighty problem for childish thinking
and investigation and is solved at first by the assumption that the
female sex possess a penis. The grievous later results of this
sexual theory have already been mentioned under homosexuality.
To- this misunderstanding concerning the external genitals is
joined a comprehensive generation phantasy, for example, the
maiden's phantasy that generation is accomplished by a mere kiss.
The children also often think of the condition of wedlock in a
childish naive manner as a pleasure-giving affair which pays little
attention to shame and disgust, most frequently in the form that
the man and woman unceremoniously urinate before each other
or show their posterior parts. Exceedingly often, the children
arrive at a sadistic conception of coitus and the boys usually con-
sider it a row to which the overhearing of the noisy accomplish-
ment of the act by adults, mostly the parents, with its loud breath-
ing, misleads them. It must be asserted that all these childish
theories are of still greater value within the neuroses themselves
and exert a determining influence on the formation of the
symptoms.

Thus, the content of the child's psycho-sexuality consists in
the autoerotic activity of the predominating sexual components,
in traces of love of an object and in the formation of that complex
which Freud has called the nuclear-complex of the neuroses which
embraces the first affectionate as well as hostile emotions toward
the parents'' and brothers and sisters. From the uniformity of

"The way in which the persons in authority in the family serve as
models for the whole character development and determination of the fate
of healthy as well as neurotic individuals can not be discussed in detail
here. Reference can only be made to the important works of Jung, " Die
Bedeutung des Vaters fur das Schicksal des Einzelnen," and Abraham,
" Die Stellung der Verwandtenehe in der Psychologie der Neurosen "
(both in Jahrhuch, I, 1909).

THE SEXUAL INSTINCT 49

this content and the constancy of the influences which later modify
it, the statement may be made that in general the same phantasies
concerning childhood are always formed. Thus, the neurotics are
not to be sharply differentiated from the normal and especially in
childhood are not always to be distinguished from those who re-
main healthy. On the contrary, it is one of the most valuable
results of psycho-analytic investigations that the neuroses are
shown to have no special characteristic mental content peculiar to
themselves, but that the neurotics, as Jung expresses it, are inca-
pacitated by the same complexes with which the healthy struggle.
The difference is that the healthy know how to control these com-
plexes without gross visible injuries while for the neurotics, the
suppression of these complexes is accomplished only at the price
of costly substitute structures, thus practically failing.

In still another respect was the case of that five-year-old
patient interesting. Namely, he showed in all distinctness what
Freud had then found and announced in a case of obsessional
neurosis," that a completely formed psychoneurosis can be met
with at an early age, about five or six years. The neurosis of the
little fellow showed itself as an anxiety-hysteria of the kind prop-
erly, classified as a phobia. These anxiety-hysterias are, according
to Freud's experience, not only the most frequent of all psycho-
neurotic maladies in general, but also the first to appear in life,
indeed the neuroses of childhood. Unfortunately, the finer
mechanism of this important malady is still insufficiently studied.
Doubtless now that attention has once been called to the neuroses
of children, the publication of similar cases will follow'" which
will confirm the former results and lead to a deeper understand-
ing of this so important and interesting pathological manifestation.

"Lit No, 36.

* Compare Jung, " Uber Konflicte der kindlichen Seele," Jahrb., II, I,
1910.

CHAPTER IV

THE UNCONSCIOUS

Consciousness and the Unconscious. Common Meaning of Uncon-
scious. Hypnosis and Double-Consciousness. The Unconscious in Hys-
teria. Resistance and Repression. Genesis and Content of the Real
Unconscious. The Complex. The Free Association. The Association
Experiment. Determination of All Mental Processes. Phenomena of the
Unconscious in the Psychopathology of Everyday Life. The Unconscious
in Wit and Dream Formation.

The basic presupposition for an intelligent penetration into the
secrets of hysteria is the recognition of the nature and activity of
unconscious mental life. As an obstacle to appreciating this,
stands preeminently the conception of the prevailing school-
psychology for which everything psychic is a priori only conscious,
hence the speaking of unconscious mental processes constitutes an
absolute absurdity.**® The observations of the psycho-analysts,
however, compel the recognition of the existence of unconscious
mental processes. The physician educated in psycho-analysis can
not do otherwise than reject the dogma of the psychologists that
consciousness is the indispensable characteristic of mental life and
hold fast to his conviction based on impressions gained from his
observations on patients. The results of psycho-analysis really
prove with every certainty possible in the field of psychology an
unconscious of wide scope and great intensity. Right here it
should be emphasized that this unconscious, as psycho-analysis has
revealed it, has nothing to do with the term unconscious as em-
ployed in ordinary speech usage. This conventional "uncon-
scious " signifies as much as " unintentional," " involuntary " or it
indicates psychic elements of which one has not just thought,
which, however, are accessible to consciousness and by the concen-

""This brusque opposition is really only the result of an erroneous
use of the word "conscious" for psychic, two terms whose meaning is
not identical.

50

THE UNCONSCIOUS $1

tration of the attention can every time be reproduced.'''^ Uncon-
scious, in the Freudian sense, on the contrary, means something
which one does not really know, while one is compelled in the
analysis by conclusive inferences to recognize it.

As already mentioned, it is chiefly the investigations on
neurotics which convince the analyst of the existence of the
unconscious. Nevertheless, there are certain other phenomena
closely related to the neuroses suited to demonstrate in a much
easier way the activity of the unconscious mental forces. Observ-
ers must recognize that there may be in one and the same indi-
vidual many mental groupings which can remain fairly independ-
ent of one another, knowing nothing of one another and alternately
splitting consciousness. Cases of this kind, which are called
double personality or multiple personality, occasionally come to
observation in patients spontaneously. If in such a splitting of
personality the consciousness remains constantly joined to one of
the two conditions, then this is called the conscious mental condi-
tion, the one separated from it, the unconscious. In the recog-
nized phenomenon of the so-called post-hypnotic suggestion, in
which a command given in the hypnotic state is later obeyed in
the normal condition, one has an excellent picture of the influences
which the conscious condition can experience from processes
unconscious to it; taking this as a pattern, one may classify the
experiences of hysteria. Freud made use of hypnotism in the
treatment of hysteria only at the beginning of his work with the
neuroses; since he soon discovered that only a portion of his
patients could be hypnotized, he decided to work with the normal
condition. iProceeding from the free associations of the patients,
he came, like Breuer in. his noted case by hypnoidal conditions, to
the discovery that those impressions which had been the occasion
of hysterical phenomena had remained in wonderful freshness and
with their full affect-tone for a long period of time without the
patient's being cognizant of these as he was of other affairs of his
life. On the contrary, these events are completely missing in the
memory of the patient in his ordinary mental state or are present
at most only in outline. By the aid of the Freudian psycho-
analytic technique, it soon appeared that the splitting of con-

*' Compare Bleuler, " Bewusstsein und Assoziation." Diagnostische
Assoziationsstudien, ed. by Jung, Vol. I, No. 5, Leipzic, 1906, J. A. Barth.

52 FREUD S THEORY OF THE NEUROSES

sciousness which is so frequent in the recognized classical cases
as double consciousness may appear in every case of hysteria in
the form of a mental dissociation. Thus resulted the necessity of
localizing somewhere else these ideas which were not present in
consciousness in the customary figurative language employed in
the description of mental processes. Freud has, therefore, in
accordance with Lipps,"** accepted the name " unconscious." We
speak here only of the narrower meaning of unconscious, as we
might say the Freudian unconscious or the unconscious of the
neurosis. The meaning of the same can only become clear when
one has recognized in what way the sum of its content was sepa-
rated from the conscious mental processes. The patient betrays
these pathogenic unconscious mental impulses only under great
resistance ; a force prevents their becoming conscious and compels
them to remain unconscious. One can only really appreciate the
existence of this force when one seeks in opposition to it to bring
the unconscious impulses of the patient into consciousness. On
this idea of "resistance" (Widerstand) Freud has founded his
conception of the mental processes of hysteria. The same forces
which to-day oppose as resistance the making conscious of the
unconscious, purposely forgotten, must at one time have accom-
plished this forgetting and forced the offending pathogenic experi-
ence out of consciousness. Freud named this process, which he
supposed dynamic, repression (Verdrangung), and considered it
as demonstrated by the undeniable existence of the resistance
(Widerstand)."' The repression came about by a psychic trau-
matic experience of special intensity and entire disagreement with
the mental character of the individual — or, as appeared later, even
a similarly established wish (instinct) impulse — becoming engaged
in a kind of struggle for existence with the ethical and esthetic
attributes of the personality and being thrust out of the con-
scious mental structure as you might say by an act of the will.""

" " Der Begriflf des Unbewussten in der Psychologic." Article at 3d
International Congress for Psychology, Munich, 1897.

"Compare Freud, "tJber Psychoanlyse," Lit. No. 37.

* A similar active process probably lies at the bottom of many appar-
ently purely automatic forgettings. Freud rightly asserts that it is not
so much the condition of memory in the earliest childhood which needs
explanation as it is the forgetting of all experiences of a time when the
child is perfectly capable of remembering. Compare in this connection

THE UNCONSCIOUS 53

There had been a short previous conflict, the end of which was the
repression of the unbearable idea. In the field of logic, something
like the rejection of judgment would correspond to this process.
The acceptance of the unbearable wish-impulse or a prolonged
duration of the conflict would have called forth a higher degree of
discomfort; this discomfort would be avoided by the repression
which acts as a kind of protective mechanism of the mental per-
sonality, as an expression of the instinct of self-preservation of
the psychic ego. The dissociation of the mind into conscious and
unconscious is explained not as an inborn weakness (Janet) but
as a dynamic result of the conflict of contending mental forces.
It may be mentioned here in advance that the repression tending
to form a neurosis is one which has failed in so far that the re-
pressed wish-impulse continues to exist in the unconscious and
waits, as it were, only for the opportunity to become active in the
form of a distorted and unrecognizable substitute formation for
the material repressed into the unconscious : the hysterical symp-
tom (compare Chapters VI and VII).

The hysterical repression has its prototype in that previously
mentioned organic repression*^ of the first instinctive impulses in
the child which normally brings to a close the earliest period of
polymorphous-perverse sexual activity. In this there occurs the
submersion into the unconscious not only of individual experi-
ences but of a whole period of development. The continuation of
certain instinctive impulses which were originally accompanied by
pleasure is brought by the necessary subordination to cultural
requirements into opposition to the goal ideas of the secondary
thought processes and now causes discomfort or pain instead of
pleasure. Just this change of affect constitutes the essence of
repression.'^ The material in repressed instincts, sexual activities,
wish-impulses and erotic phantasies forms the foundation, as you

what has been said on infantile amnesia and cover-memories. On the
purpose of forgetting in general, compare Freud's paper on the psychic
mechanism of forgetting (Lit. No. 12), where he shows that a part of
forgetting occurs automatically but that frequently automatism and tend-
ency (or purpose) work together.

*An explanation of the relation of this organic repression to the
psychological repression is still lacking.

*■ More recent treatment of this is found in Freud's " Traumdeutung,"
2d ed., page 375, also Brill's translation.

54 freud's theory of the neuroses

might say the oldest and deepest layers in the structure, of the
unconscious. A second part of the repressed material comes from
repressions in later life. This repression of later years comes about
through the attraction of the old nucleus of the unconscious,
while from the other side the repelling forces of consciousness
again seek to reject this definite material. These forces acting
from both sides aid the act of repression which when successful
is a normal psychological process. Through the domination of the
unconscious it can, however, easily fail; although for the indi-
vidual the repression succeeds here also since the repressed
material now expresses its pathogenic activity from the un-
conscious.

That sum of primary instinctive impulses which are killed by
the original repression, the real unconscious in the Freudian sense,
which furnish the stream both of the neurosis and the dream, is to
be distinctly differentiated from that popular " unconscious " men-
tioned in the beginning, the combination of automatic, half-
forgotten, unintentional mental processes. The psycho-analytic
" unconscious," on the contrary, contains nothing except repressed
instinctive impulses in the widest sense of the word, as well as
those psychic formations which appear as offspring of these
repressed impulses. Thus, the nucleus of this contains the sup-
pressed component instincts in so far as they were overcome and
discarded in childhood. The sexual disinclination of the hyster-
ically disposed individual causes all later sexual and erotic experi-
ences to sink into the unconscious and join the early originally
repressed material. The fundamental characteristic of the uncon-
scious is thus its sexual character, sexual taken in its broadest
sense. Only one who has completely comprehended the theory of
the neuroses is capable of understanding the whole life power and
indestructibility of the unconscious. The force of this is shown
most clearly in the eternally recurring dreams and pathologically
in the lasting productivity of the neurosis. The whole content of
the unconscious is, since it is indestructible, reproducible in full
vividness under appropriate conditions (psycho-analysis) ; in fact,
some prehistoric event of early childhood, long gone from con-
scious thought, occasionally appears so unchanged and undimin-
ished in intensity that one must characterize it as eternal. The

THE UNCONSCIOUS 55

task of psycho-analysis is to find the entrance to the unconscious,
which is also the only way to make conscious the unconscious.

The difficulty of representing what is included under the term
" unconscious " is especially conspicuous in the fact that when we
speak of the unconscious of a patient, we understand other things
besides the infantile unconscious. In reality, the later repressed
psycho-sexual material, as one encounters it in the patient, is not
to be sharply distinguished from the infantile unconscious mate-
rial. The more remote descendants of the original repressed
impulses may no longer lie at the bottom of the mass of repressed
material and can often crop up suddenly in consciousness. These
descendants constitute what might be called flitting transitions
from conscious to unconscious and would be about the material
which Freud calls " fore-conscious," something which the patient
either knows or wishes to know only momentarily, which with a
little effort, however, can be brought to memory. It has proved
expedient to call such groups of related elementary ideas possessed
of an affect, complexes, following the example of the Zurich
school (Bleuler, Jung and others). A definite complex is in
every case the occasion and content of the neurosis; it is the
ruling power in the diseased mind and from whatever point one
examines the patient, he comes upon derivatives which have be-
come conscious, the conscious substitute ideas of the repressed
complex, hence regularly upon the repressed material, since he is
controlled by the goal idea- of the treatment that the apparently
most innocent and arbitrary thing reported has some relation to
the pathological condition. Proceeding from this presupposition,
the analyst has merely to pay attention to the free associations of
the patient coming as it were from the psychic surface to reach
the repressed pathogenic complex.

If it seems to a critic arbitrary to consider the results obtained
from such unguided associations as at all valuable, attention must
be emphatically called to the empirically discovered phenomenon
which is of fundamental importance for the whole psycho-analytic
technique, namely, that there is no accidental course of association,
that there are no " free " associations, that in general, in mental
life, as elsewhere in nature, there is nothing accidental, arbitrary,
not related to a cause, but that every thought, every association,
every mental occurrence stands in relation to its cause, thus is

56 freud's theory of the neuroses

determined, or more exactly, as the dream investigation shows, is
determined from several sides, thus is over-determined. This
causal connection science has never denied; Freud's service con-
sists in having confirmed it by psycho-analysis. The Zurich school
later furnished*^ experimental proof of this truth discovered by
Freud, in the association experiments. The association experi-
ment inaugurated by the Wundt school for formal experimental
psychological investigations, which consists in calling out to the
person being examined test words and registering his involun-
tary answers (reaction words), was elaborated by the Swiss
school (Jung and others) in manner of application and utilized in
the sense of the psycho-analytic investigations, so that now both
meaning and content of the reactions are considered in relation
to the test word and to each other. From this resulted, besides
other interesting details, the fact that all reaction words which the
person being tested gives to happily chosen test words stand in a
close relation to one another and belong, especially in neurotics,
to the prevailing thought and emotional complex. This complex
manifests itself by quite definite tokens, while the reactions dis-
close it by the following peculiarities : lengthened reaction times,
false reactions, disturbances of reproduction in the repetition of
the experiment, accompanying motor phenomena, apparent con-
tradiction, incoherence between test word and reaction, etc.
These disturbances which the complex causes in the association
experiment are nothing else than the Freudian " resistances " of
the psycho-analysis."* It is even possible to carry out in this
field a physical control by the combination of the association
experiment with a mensuration of the fluctuation of an electric
current corresponding to the affect shown.''

The association experiment has thus confirmed the existence
of the unconscious, the activity of the complex, the specific con-

"* Compare " Diagnostische Assoziationsstudien," ed. by Jung, Vol. I,
1906, and Vol. II, 1910. Jung gives a comprehensive survey of the results
of the association investigation in the Apr. number of Amer. Journal of
Psychology, 1910,

•* Compare Jung, " Assoziation, Traum und hyst. Symptom." Diag.
Assoziationsstudien, Vol. II, No. 8, 1910.

• Compare L. Binswanger, " t)ber das Verhalten des psychogalvanischen
Phanomens beim Assoziationsexperiment." Diag. Assoz. Stud., Vol. II,
No. II.

THE UNCONSCIOUS 57

tent of the etiological complex in the neuroses and likewise brings
experimental proof for the determinism of the apparently free
associations which had been previously asserted by Freud. This
comprehensive and demonstrable determinism in all mental occur-
rences is one of the most important basic principles of the Freud-
ian psychology. It seems conceivable that there may be an uni-
versal human, as you might say normal, resistance against this
limitation of free will which may lead to a resistance against the
whole Freudian theory.

The psycho-analytic investigations aided by the association
experiment have shown with absolute certainty that in mental
phenomena there is nothing little, nothing arbitrary, nothing acci-
dental. In his book " Zur Psychopathologie des Alltagslebens "°'
( Psychopathology of Everyday Life) Freud has turned his in-
vestigations in this direction, namely, to certain mistakes, such as
forgetting, errors of speech, writing and action and the like, and
could point out that these insufficiencies of our mental perform-
ances as well as certain apparently aimless performances (symp-
tomatic acts) are regularly well motivated and determined by
motives unknown to consciousness; this is corroborated when
one subjects these unjustly neglected minor affairs to a pene-
trating psychological consideration. The reason that the motives
for such unintentional acts are hidden in the unconscious and can
only be revealed by psycho-analysis is to be sought in the fact that
these phenomena go back to motives of which consciousness will
know nothing, hence were crowded into the unconscious, without,
however, having been deprived of every possibility of expressing
themselves. These mistakes, in which an omission has the same
value as an error of commission, are thus the disguised expres-
sion of a mental impulse which has remained unconscious and thus
has a meaning that appears only in a kind of indirect representa-
tion. In similar manner, Freud could regularly point out behind
the wit^' which has a purpose, thought processes which make use
of this characteristic method of expression in order to half con-
ceal, half reveal impulses remaining unconscious.

The most imposing evidence and far-reaching explanations of
the unconscious psychic processes in man are afforded by the

-Lit. No. i6.

* " Der Witz und seine Beziehung zum Unbewussten," Lit No. 19.

58 freud's theory of the neuroses

penetrating study of the dream in the art of dream interpretation
elaborated by Freud. The scientific dream interpretation inaugu-
rated by the help of psycho-analytic methods produces the proof
of the unexpected fulness of unconscious activity and thought
formation in the mind and shows that all mental processes both
of simplest and most complicated character can go on uncon-
sciously. Everything conscious has an unconscious preliminary-
stage; the unconscious mental circle appears as the greater one
which includes the lesser one of consciousness (Lipps).

The speech of the unconscious is rich in means of expression
which are full of oddities for one who becomes acquainted with
them for the first time : dream, symptomatic act, wit, the peculiar
manners of reaction in the association experiment, the enigmatical
neurotic symptoms and finally the seemingly free association
which seems the more harmless and distorted the farther it is
separated from the repressed complex. All these phenomena owe
their complication or difficulty of interpretation to the circum-
stance that the unconscious can express itself only in a form
which has been censored by consciousness. Consciousness allows
no direct representation of the scandalous and since the indirect
(censored) representation contains so much that is novel, para-
doxical and curious for the uninitiated, so an intelligible resist-
ance is directed against psycho-analysis which unmasks this secret
speech. The resistance against this strange method of expression
of the unconscious gladly clothes itself in an intellectual denial of
the whole Freudian theory and is to be overcome only by repeated
experiences which convince one of the entire regularity of the
speech of the unconscious. Whoever brings the good intention to
take this explanation of his resistance succeeds best in the study
of his own dreams according to Freud's directions; he can thus
convince himself of the presence and power of his unconscious
mental impulses and thus succeeds in the best way in becoming a
psycho-analyst. Dreams are really the first member in the series
of abnormal psychic structures, the other members of which, the
hysterical phobia, the obsessional and delusional idea, occupy the
physician for practical reasons. Freud may thus rightly insist
that he who does not know how to elucidate the origin of the
dream picture will work in vain for a comprehension of the obses-
sional and delusional idea. Our nocturnal dream products are

THE UNCONSCIOUS 59

indeed compatible with full health of waking life but have also
the greatest external similarity and internal relationship to the
creations of the insanities. Thus the dream stands in the center
not only of the Freudian theory but also of the psycho-analytic
technique, and because of its fundamental importance will be
treated in the next chapter in detail as an introduction to the
theory of the psychoneuroses and analytic therapy.

CHAPTER V

THE DREAM

Chief Characteristics of the Dream: Wish Fulfillment, Sexual Erotic
Content. Dream Sources. Dream Distortion (Manifest and Latent Con-
tent). The Dream Making. Interpretation Technique: (o) by Symbo-
lism; (b) by Associations. Technical Rules. Typical Dreams.

Freud came to take up the scientific study of dreams in an
empirical way since neurotics who were undergoing psycho-
analytic treatment often related to him spontaneously dreams
which were still intensively occupying them by day. A closer
examination of the content of these dreams revealed the fact
that they stood in close relation to the agencies which caused the
malady and that here again the infantile sexual roots were exhib-
ited. In this way, Freud came to create the technique for the
interpretation of dreams corresponding in its main features to the
psycho-analytic method of investigation ; this has become an indis-
pensable part of the psycho-analytic therapy. The unconscious
which lies at the bottom of the neurosis betrays itself in the
dream, not undisguised to be sure, but in decipherable manner,
so that the dream becomes the chief entrance, you might say the
" via regia " to the patient's unconscious. How great significance
the solution of the ancient dream problem has for psychology
cannot here be gone into in detail ; our interest here is only in the
practical value of dream interpretation for the treatment of the
neuroses. All mechanisms which enter into the origin of neurotic
symptoms have also a share in the formation of the dream. The
incomprehensibility of the dream is therefore the same as that
of neurotic symptoms ; they are both the substitute expression for
the sexual material which has become unconscious through repres-
sion. In both cases, we have to deal with incompletely repressed
infantile sexual impulses and later sexual material which has
joined these. Besides the infantile and sexual matters which fur-
nish the real dream sources, there also come into consideration as
such sources, the unnoticed daily happenings (" Tagesreste ")

60

THE DREAM 6 1

with their numerous apparently indifferent details; to superficial
observation, these frequently seem to control the dream picture.
Somatic stimuli and external irritations should not be overesti-
mated as dream instigators ; they can indeed instigate the dream,
but always serve merely to clothe the unconscious wishes like all
other recent material.

After profound investigation of his own dreams and those of
neurotics, Freud, in the year 1900, could give in his "Traum-
deutung" a detailed account of the characteristics of the dream.
The most important discovery was that the dream regularly rep-
resents a wish-fulfillment, that is, it brings to representation in
dramatic form an unconscious wish of the dreamer represented
as fulfilled. In this an infantile wish is readily combined with
an actual one. The wish characteristic may be easily recognized
in isolated dreams if it is not apparent in the majority of the
dreams of adults. On the contrary, the dreams of healthy chil-
dren show as fulfilled their naive simple wishes which have been
active by day and remained unfulfilled. Numerous other dreams,
especially such as anxiety and fear dreams, seem at first to be an
argument against the universal validity of the wish theory.
Naturally Freud could not escape this, but he has pointed out
that the anxiety dream after being subjected to penetrating inter-
pretation likewise shows itself to be the representation of a sup-
pressed (repressed) sexual wish, the disguise of which has failed.
To prove this position, Freud has undertaken in his work the
analysis of a number of anxiety-dreams and shown the sexual
material in the dream thoughts. From these it was made evident
that the anxiety which we feel in the dream is only apparently
explained by the content of the dream ; it is only attached to the
accompanying idea and arises from other sources. Thus, the
anxiety-dreams not only exhibit a new side of the dream prob-
lem but are also important for the comprehension of neurotic
anxiety in general. The anxiety-dream belongs, therefore, to the
anxiety problem and will be further discussed in the diapter on
hysteria.

One must not represent the interpretation and arrangement of
the dream in the mental life of the individual as too simple.
What we remember in the morning ("the manifest content") is
mostly a highly phantastic, sometimes paradoxical, thought pic-

62 freud's theory of the neuroses

ture which even where it seems logically composed does not betray
the real meaning of the dream ("the latent content"). Only the
interpretation work which will be discussed in detail later can
show the "latent" thought content hidden behind this manifest
dream content, that is to say, the particular unconscious wish.
One must not be led astray by the fact that the dream is joined
in many ways to the events and impressions of the preceding day
or evening. These connections are only superficial and have only
loose, unimportant relations to the real dream-forming complexes.
The true foundation of the dream is furnished by the wishes of
childhood which have become unattainable and stored away in
the unconscious ; these have normally disappeared into the uncon-
scious because of psycho-sexual development. The particular
dream-forming wishes which are fulfilled in the dream and can
be disclosed only by the interpretation work show, in contrast to
the manifest content, a logical and intelligible as well as affectively
well-motived train of thought which is organically connected
with the rest of the mental life. The manifest dream remembered
in the morning, on the contrary, is often without affect, discon-
nected, unintelligible, as strange to the waking consciousness as
the delusions of the insane are to the normal consciousness. Thus
one comes upon the fact that the dream is the expression of those
old instinctive wishes later felt as painful (repressed), now re-
turned to life again distorted by a complicated mechanism. Freud
assumes that consciousness in the service of the repressing activ-
ity of the ego continues working in the dream as a kind of psychic
censor, not allowing those forbidden impulses to pass in full dis-
tinctness but only when disguised in speech and form. By this
cultural limitation the appearance of painful emotions which would
accompany the becoming fully conscious of the unconscious is
avoided as a rule (compare on the contrary the failure of this
dream tendency in the anxiety-dream) and undisturbed peaceful
sleep is protected. Thus, the dream proves — ^just the opposite of
the common opinion — the real protector of sleep, against which
the fact that it does not always accomplish this task (anxiety-
dreams) in no way militates. This tendency shows plainest in a
group of dreams which have always been cited in support of the
common theory that the dream pictures owe their origin merely to
certain physical irritations. In the sense of the Freudian concep-

THE DREAM 63

tion, a series of these dreams, the so-called satisfaction-dreams,
afford the best proof of two dream characteristics declared by
Freud to be universal, since these dreams represent a bodily need
which appears in sleep (for example thirst) as gratified and thus
serve to guard sleep. These dreams, like children's dreams, also
plainly show the wish-fulfilling characteristic.

It is nevertheless quite otherwise with that by far the greatest
group of dreams of adults, especially of neurotics, for the illumi-
nation of which a painstaking and complicated interpretation work
is necessary ; after this has been done, however, these dreams also
show the same characteristics. Now arises the question, what are
the mental processes which have transformed the dream thoughts
discovered by painstaking interpretation into the dream form so
incomprehensible to us at first. From the comparison of the
remembered manifest content of the dream with the discovered
latent content comes the term " dream-making " (Traumarbeit)
which has occasioned the dream distortion (Traumentstellung).

If one proceeds to get a closer view of the many-sided and
peculiar dream-making process, one is at once struck by a phe-
nomenon already recognized externally. The dream thoughts
discovered by analysis tremendously exceed in extent the remem-
bered dream content. This circumstance points to a great conden-
sation of the dream thoughts. Each element of the dream con-
tent really traces its source not to a single element of the latent
dream thoughts but to a series of such elements; on the other
hand, however, it is also a rule that a dream thought may be rep-
resented by more than one dream element in the dream. Thus,
the threads of association do not simply converge from dream
thoughts to dream content but criss cross and interweave promis-
cuously on the way. In this condensation process, certain like-
nesses which originally existed among the dream thoughts or have
been elaborated by the dream-making in a very keen and ingenious,
witty manner play the greatest role.

Besides the condensation, there is a second process suited to
add to our misunderstanding of the dream picture a strangeness
concerning the mental value of the same, while the complete inter-
pretation shows us well-ordered and ingenious trains of thought
which lie at the bottom of the dream in their proper mental accen-
tuation; almost always in the dream, something of secondary

64 Freud's theory of the neuroses

importance and insignificance is exhibited with a disproportionate
amount of affect. This displacement (Verschiebung) of the
mental values from important to insignificant serves mostly to
conceal the meaning of the dream and to render irrecognizable
the connection between the dream content and the dream
thoughts.®*

Besides the condensation and displacement, the two most im-
portant and for the dream-making most characteristic processes,
the attempt to present the material in dramatic form (Riicksicht
auf Darstellbarkeit) drives the dream, at first in verbal expression,
to very strange performances in order that the dream thoughts
may be presented in visible form ; to this aim, manifold distortions
and modifications must be brought about.

The dream thoughts which by the attempt to present them in
dramatic form and by the dream distortion practiced by the censor
have become irrecognizable and incomprehensible are finally sub-
jected to a final external arrangement which is carried out more
or less carefully in different dreams to give the dream pictures
which were originally intelligible but have become meaningless
through the dream-making, at least externally the appearance of
sense and connection. This procedure of the dream-making which
Freud has called "secondary elaboration" ("sekundare Bear-
beitung"), which really represents a concession to conscious
thinking, also serves on the other hand to further the aims of the
censor, since conscious attention, which in badly elaborated dreams
is diverted by the judgment : " foolish " or " dreams are nonsense,"
in dreams with well-composed fagades is reassured by this super-
ficial meaning whereby a penetration into the deeper meaning of
the dream is avoided.

The next most important fact concerning dreams after the
wish characteristic is the basic principle that the majority of
dreams of adults deal with sexual material and give expression to
erotic wishes. It is obvious that one can form an opinion on this
only when one considers not merely the manifest content but

** Condensation and displacement find expression not only in thought-
making, but also in the dramatization of details. Thus, objects, words
and persons can be made irrecognizable by combination; a person at first
apparently unknown to the dreamer is regularly a composite person.

THE DREAM 65

understands how to penetrate to the latent dream thoughts. The
explanation of the ubiquity of sexual erotic material in dreams is
to be sought in the fact that no other instinct has undergone so
much suppression from childhood on, as the sexual instinct in its
numerous components. Thus, the erotic wish- fulfillment forms
the essential content of the dream; still, it has never occurred to
Freud to make this characteristic of the dream exclusive, as is
best shown by his comprehensive book on dream interpretation
where justice is done to selfish and ambitious wishes.

The assertion that the majority of the dreams of adults betray
in their ultimate analysis a sexual content seems at first — ^just
like the wish- fulfillment theory — unproven, since the wording and
pictures of the dream, aside from the exquisite sexual (pollution)
dreams, seldom deal with sexual scenes, lascivious allusions and
the like but are mostly thrown together in a harmless, often poet-
ical manner from nature, family, society, travels, etc., forming
living pictures corresponding to the real family, vocational and
amusement life. At first it seems arbitrary to wish to read out
of this boundless picture gallery comprising the whole life in all
its phases a single definite tendency which would serve only one
instinct. Since we are dealing with an instinct of which everyone
is more or less ashamed and which he does not like to acknowl-
edge himself too much possessed by, it was this part of the dream
theory which aroused universal surprise and contradiction. Never-
theless, Freud has proven that the theme of sexuality does not
appear undisguised in dreams but is represented in a definite,
typical, regularly found symbolic manner of expression analogous
to pantomime.®® To a layman, who came across this theory for
the first time, it might seem grossly arbitrary to consider quite
innocent and apparently accidental pictures, objects, persons,
activities, plays on words, etc., in sexual and shocking sense. But
he who has learned to understand the speech of the neurosis
released from the repression will be easily convinced that the
dream as well as the pantomime of the neurosis can not disclose

**In a dream in two parts of a healthy person, the second part of
which — an undisguised pollution-dream — disclosed the apparently harm-
less symbolically clothed and sublimated introductory dream as grossly
sexual, Rank was able to substantiate the fundamental principles of the
Freudian dream theory as it were by the dream itself. Compare "Ein
Traum der sich selbst deutet," Jahrb., II, 2, 1910.

6

66 freud's theory of the neuroses

its real meaning undisguised. Where the manifest content of the
dream is accidently harmless, confused or indistinct (which is
frequently coupled with anxiety) one should always suspect
behind it an especially abundant repression of something valuable.
It is the censor which compels dreams to adopt the mystic lan-
guage of symbolism to secure the possibility of dramatization of
sexual material in dreams. If one has convinced himself of the
wide use of symbolism for the dramatization of sexual material
in dreams, he must have been struck by the question whether or
not many of these symbols appear like the characters of stenog-
raphy with a fixed meaning for all cases. In this connection, it
is to be noticed that this symbolism belongs not only to dreams
but also to the unconscious folk ideas and is found as completely
in folk-lore, myths, saga,"* sayings, maxims and in the current wit
of a people as in dreams.'^^ Among the symbols so used are really
many which regularly or almost regularly mean the same thing;
upon this, in greatest part, the general understanding and far-
reaching activity of these creations of the folk-mind depend.'^^
Still, one must always bear in mind the possibility that occasion-
ally an element in the dream content is not to be interpreted sym-
bolically but in its real sense; in other cases, the dreamer may
claim the right to anything possible out of special remembered
material as an individual sexual symbol which is not generally so
employed. Further, the customary sexual symbols are not in
every case limited to the one meaning.

After giving these limitations and precautions, Freud intro-
duces a series of typical sexual symbols: emperor and empress
(king and queen) usually stand for the parents of the dreamer,
prince or princess for the dreamer himself. All long objects such

''Compare Riklin, " Wunscherf iillung und SymboHk im Marchen."
Further, Abraham, " Traum und Mythus" and the works cited there by
Kleinpaul and others ; also Rank, " Der Mythus von der Geburt des
Helden." They all appear in Schriften z. angew. Seelenkunde.

"In regard to the skepticism which the symbolic interpretation en-
counters from so many, it is characteristic that the same men while
listening to the cynical tune at the Kneipe or the cabaret or reading the
humorous paper are suddenly sufficiently disposed to understand sexual
symbolism !

" Symbolism was already familiar in part to the old authors (Arte-
midorus) and also to the newer ones (Schemer, Volkelt and others).

THE DREAM 6/

as canes, limbs of trees, snakes, umbrellas (because when put up
they resemble an erection!) indicate the penis. A' frequent, not
readily understood symbol of the same is the nail file (because of
the rubbing and scraping?). Small boxes, band-boxes, caskets,
closets, ovens, wagons correspond to the female body. Rooms in
dreams are mostly ladies' rooms, the representation of the en-
trances and exits will not be misunderstood in this connection.
The dream of going through a series of rooms is a brothel or
harem dream. Tables, tables that are set and boards are likewise
women probably because of the contrast which here preserves the
body arches. Since board and bed make the marriage, in dreams,
the first is often placed for the last and so far as it applies, the
sexual idea-complex is transported to the eating complex. All
complicated machines and apparatus in dreams are with great
probability genitals, in the describing of which, dream symbolism
shows itself as untiring as wit-making. Landscapes often signify
female genitals ; the locality " in which one was once before " may
symbolize the mother's genitals. Children in dreams also often
signify the genitals as men and women are occasionally disposed
to call their genitals their " little one." Stekel, who has devoted
himself especially to tracing out dream symbolism,'^^ continues
further that left and right often mean wrong and " right " or are
then used in transferred sense for sensuous (sinnlich) and moral
(sittlich), normal and abnormal, male and female, etc.; further,
that death and thoughts of death in dreams are often to be taken
as repressed counterparts for life and riotous living. It is to be
expected that the scientific proof for the wide range and folk-
psychological basis of symbolism will soon be fully produced by
mythologists, linguists and students of folk-lore'^* and that thus
its paradox will be lost. He who does not understand the lan-
guage of dream symbolism will never completely interpret a dream
and can never carry through a completely successful psycho-
analysis. The symbolism is the first and most important tech-

" " Beitrage zur Traumdeutung " (Jahrb., I, page 458) and further in
the discussion of the " Angstzustande." Interesting data on dream symbol-
ism are also found in Maeder, " Essai d'interpretation des quelques reves "
(Archives de Psychologie, 1907, No. 24).

''* Compare " Anthropophyteia," ed. by F. S. Krauss, Leipzic, Deut.
Ver. Akgt.

68 freud's theory of the neuroses

nical aid to psycho-analytic dream interpretation. Therefore, a
knowledge of it is indispensable to the psycho-analyst because this
symbolism, so widespread in the history of races and forming such
a sure postulate for those living under the same cultural condi-
tions, still in isolated cases, especially in neurotics, may be an
unconscious one and therefore brings no associations to the
dreamer when he relates his dream. It is the task of the analyst
to bring the same into use and just where an element, through the
absence of associations, makes itself suspicious as a symbol.
Thorough familiarity with symbolism enables the physician to
disclose the deepest strata of the unconscious dream thoughts
with a high degree of certainty ; still, the discovery of the recent
experiences and the dream thoughts springing from actual con-
flicts can only be accomplished by the aid of free associations. In
this way only is it possible to arrange the special dream in its
proper psychic connection. This particular kind of analysis brings
to light some material which is not unconscious in the strict sense
of the word but may be called fore-conscious because it is not
directly inaccessible to consciousness but rather may be rendered
conscious without any especial difficulty.

Here, the technique of dream interpretation does not proceed
from symbolism but from the particular associations and spon-
taneous connections of the dreamer, the relation of which to the
sought-for thought complex may be proven by the already men-
tioned association experiment. If one wishes to interpret a dream
according to the method here described, it is best to analyze the
dream elements separately, according to the dream text noted
down from the fresh remembrance in the morning without any
attention to its eventual external connection (secondary elabora-
tion). If one devotes himself now to the free associations from
each of these elements taken at random out of its context of
ideas and memories, then he soon succeeds in apprehending a lot
of ideas and memories which not only possess an internal rela-
tionship to the dream content but also arrange themselves in a
connected and intelligible whole. The associations, whether free
or from test words, are distinguished in many ways by a super-
ficial connection, by clang association, plays on meanings of words,
temporal conjunctions, inner sense relations, in short by all the

THE DREAM 69

association ways which we are accustomed'^'' to observe in wit and
puns. No connection is too loose, no witticism too far-fetched to
have formed the bridge from one thought to another. The serious
and important utilization of these associations becomes plausible,
however, when one knows that every time a psychic element is
joined to another by a shocking and superficial association, a cor-
rect and deeper attachment exists between the two, which because
of the underlying resistance of the censor must be concealed be-
hind that superficial connection. The beginner who can hardly
make up his mind to adopt this rule will also not hear without
resistance that occasionally a part of a dream only becomes intel-
ligible after one has inverted'^^ individual elements either in con-
tent or temporal relationship. The inversion, change to the con-
trary,'^^ is one of the favorite means of dramatization in the dream-
making and capable of manifold application. It serves first of all
to furnish meaning for the wish- fulfillment in respect to a defi-
nite element. " Would that it had been different " is often the
best expression for the relation of the ego concerning a painful
bit of memory. The inversion becomes very valuable in the serv-
ice of the censor since it brings about a measure of distortion of
the material being dramatized which immediately interferes with
the understanding of the dream. Therefore, when a dream obsti-
nately refuses to yield its meaning to interpretation, one may
every time venture to try the inversion of the special parts of its
manifest content and often all becomes clear. Besides the inver-
sion of content, the inversion of time is also not to be overlooked.'*
Whoever wishes to take up the scientific interpretation of dreams,
must continually study the " Traumdeutung " of Freud's. Here

" That the ancients had a knowledge of such mechanisms which must
in general be considered as forerunners of psychological dream inter-
pretation is shown by the following example: Alexander while despairing
of the capture of the city of Tyre which he had besieged had his dream
of a Satyr dancing in triumph on a shield interpreted by the dream-
interpreter as being good fortune since o-d Tvpos meant your Tyre (Tyros)
(Artemidorus).

^'As a linguistic confirmation, compare Freud, "t)ber den Gegensinn
der Urworte," Lit. No. 40.

" Compare for example the symbolic dramatization of " secret " by
the presence of many persons or the whole family,

" The same technique serves many times to conceal the meaning of the
hysterical attack. Lit. No. 33.

70 freud's theory of the neuroses

can be given only some practical hints and the indispensable in-
structions. For example, everything which appears in the dream
at all striking, as spoken language, goes back to real language of
the dreamer or to speech which he has heard/* In this regard,
the analysis reveals that the dream combines most arbitrarily mere
fragments of these real speeches. Another means of the censor
is the forgetting of the dream which is in this manner withdrawn
from analysis. At the beginning of the treatment, this happens
often so completely that the patient in general brings no dreams
and also asserts that he dreamed none.*" In weakened form, this
tendency of the censor is shown in the forgetting of a part of a
dream, which, if it is afterwards remembered, must be appraised
very highly; it is easy to understand that for just this reason it
would be kept from the work of interpretation as long as possible.
A kind of failed forgetting is shown in isolated parts of a dream
being characterized as " confused or unimportant." These parts
are also especially important and will usually conceal something
strikingly surprising and shocking from the unconscious. For
interpretation work, it is important to remember that dreams of
the same night or now and then even of a series of nights have a
close relation as to content and especially that the dreams of a
single night are always to be considered as a whole.

In dream interpretation, it is a most difficult thing to con-
vince a beginner that his task is not completely performed when
he has a full interpretation of the dream in his hands, one which
is intelligible, connected and gives information concerning all the
elements of the dream content. There may be possible another
one besides, a further interpretation (over-interpretation) of the
same dream. The question whether every dream can be inter-
preted is for practical purposes to be answered in the negative.
It should not be forgotten that in dream interpretation one has
against one the mental forces which cause the distortion of the
dream. Thus it is a question of relative strength whether one can
become master of the inner resistances. Part way this is always

" Thus far, the only exception to this empiric rule is in certain dreams
of the obsessed which may bring the particular text of the obsessional
command in the form of spoken language, which text is known to them
in waking hours only as confused and distorted. Lit. No. 36.

" Perhaps the " not dreaming " which so many people assert is only
a "not paying attention to the dreams."

THE DREAM /I

possible, at least so far as to gain the conviction that the dream
is an intelligible formation and usually also to gain a hint of its
meaning.

Exactly in contrast to the freedom of the individual to elab-
orate his own dream world in personal strangeness and thereby
render its comprehension unattainable to others, there are a num-
ber of dreams which almost everyone has dreamed in the same
fashion, from which fact, it can be assumed that they have the
same significance for everyone. An especial interest attaches to
these " typical dreams " because they probably arise from the same
sources in all people, thus seem especially well suited to give us
some conclusions concerning dream sources. The typical dreams
of people would be worthy a penetrating investigation ; Freud in
his work only takes up in detail some samples of this class. One
of the most widespread dreams, the elucidation of which will be
earliest attainable to the laiety, is the so-called embarrassment
dream of nakedness, which happens also with the addition that
one was not at all ashamed, etc. Our interest is only due the
nakedness dream, however, when the dreamer feels shame and
embarrassment in it and wishes to fly or hide himself; in that
lies the peculiar inhibition that one cannot move from the place
and feels powerless to change the painful situation. Only in this
connection is the dream typical. As a rule, the defect in the toi-
lette is not so bad as to make the shame accompanying it seem
justified. Freud has learned to consider this nakedness dream as
an exhibitionist dream and traces it back to the active spontaneous
disrobing of children which gives them great pleasure and enjoy-
ment. Aside from this repetition of an infantile wish-fulfillment,
the repression also comes naturally to expression in the exhibition-
ist dream; the painful feeling in the dream (shame, etc.) is
indeed a reaction because the since abandoned content of the
exhibitionistic scene has therein succeeded in coming to repre-
sentation.

A second group of typical dreams which is especially character-
istic and important for the neurosis and the family conflict under-
lying it has for content that a dear relative (parent, brother,
sister, child, etc.) is dead. Also in these dreams, only those are
typical in which one feels deep grief over the death. According
to Freud's explanation, these dreams signify exactly what their

72 FREUD S THEORY OF THE NEUROSES

content says according to the fundamental principle of wish-
fulfillment: namely, the wish that the person in question really
was dead. This interpretation will probably excite a priori indig-
nant denial in everyone. Nevertheless, one must keep in mind
that the hostile death wish against a near relative need not be an
actual one. The dream theory is satisfied in the conclusion that
the dreamer has wished the death sometime in childhood; this
wish springs, as a rule, from the childish idea of life, in which
death has only the significance of a separation, an interruption
of the disturbing presence of a person, thus, a kind of journey
without return.*^

Among these dreams of the death of dear relatives, the dream
of male individuals of the death of the father assumes a special
significance since it occurs with these people frequently in con-
nection or alternating with the dream of having sexual intercourse
with the mother, a dream, the typical character of which was
already known to the ancients. This dream shows, therefore, the
sexual wish-fulfillment, in contrast to other dreams, so crass and
undisguised because it is usually a pollution dream. Corre-
sponding to this pair of dreams of male individuals is an analagous
pair with changed sexes but usually in veiled form occurring in
the female sex.*^ This group of typical dreams betrays that
" GEdipus-complex " of all people first pointed out by Freud
which has found its artistic expression in the celebrated tragedy
of Sophocles. As is constantly being more plainly shown, this
complex plays the leading part in the childhood mental life of all
individuals who later become psychoneurotics ; love for one, hate
for the other of the parents belong to the fixed condition of the
material in psychic impulses formed at that time so important for
the symptomatology of the later neurosis.

Recently (in the second edition of the Traumdeutung) , Freud
has treated exhaustively some other typical dreams. Thus, the
examination (proving) dream (maturity dream) which belongs to
the most frequent of typical dreams. These anxious dreams that

" For this childish idea of death compare Traumdeutung, page i8o and
"Analyse der Phobic eines fiinfjahrigen Knaben."

"The disguised forms of the CEdipus dream are as frequent as the
undisguised. Also this dream appears in hypocritical representation which
treats the rival tenderly.

THE DREAM 73

one must repeat the final examination (eventually a rigorous one)
or a school test always appear, according to Stekel's explanation,
when one anticipates next day a responsible task and the possi-
bility of a disgrace which relates mostly to the sexual tests
(matura-mature, potent). The dream is, in a way, a consolation,
since the dreamer says : you have also before the examination had
anxiety and yet it went off all right ; therefore, nothing will hap-
pen to you this time ! The following fact affords proof for this
conception: the dream is only dreamed by persons who have
passed that examination.

At the bottom of a great number of dreams which are fre-
quently accompanied by anxiety, which have as content the pass-
ing from narrow rooms or being in the water, lie phantasies of
the intrauterine life, the stay in the mother's body and the birth
act; one succeeds in interpreting them by inverting the facts
detailed in the dream, thus, instead of falling into the water, to
come out of the water, i. e., be born.^^

Robbers, nocturnal burglars and ghosts, of v^rhich one is afraid
in the dark, and which also occasionally visit the sleeper in dreams,
are sometimes memories of the nocturnal visitors who have at
that time awakened the child to set him on the chamber that he
might not wet the bed or to prevent onanistic acts. (Con-
cerning the robber-dreams of the anxiety-neurosis, compare
Chapter VI.)

Fire-dreams which refer mostly, on account of the association
with " playing with fire," to a frequent eneuresis^* are, however,
usually overdetermined by taking fire symbolically as standing
for passion.

Of the typical toothache-, flying- and other dreams, there are
in the Traumdeutung frequent explanations which facilitate the
elucidation of these dream pictures that are often so distorted:
toothache-dreams apparently correspond regularly to masturba-
tion; flying means sexual intercourse.^"

If the dream is in essentials a creation of the unconscious, still
one must not consider it as a product completely uncontrolled by

** Compare the proof of this symbolism as an universial folk one in
Rank, " Der Mythus von der Geburt des Helden."
"Lit. No. 21, page 93.
* Compare Lit. No. 39, page 59.

74 FREUD S THEORY OF THE NEUROSES

consciousness. Just as the subject of hypnosis has more power
beyond his orders than one commonly supposes, so the dream
stands under a certain control of conscious judgment which is
betrayed in the often radical interference of the psychic censor.
This explains, for example, how a dreamer starts up from a dream
at the right time to note the solution of a problem, the answer to
which had been sought in vain by day. Thus, one understands the
consolatory feeling so common in dreams that it is all a dream
(dream within a dream, Stekel).

It is obvious that the presentation given here cannot be a com-
plete and exhaustive review of the comprehensive work on dream
interpretation. Thus, concerning affects in dreams, concerning
absurd dreams, nothing much has been said; this is to be found
at first hand in Freud's fundamental work;®* in general, a close
study of this is indispensable for the scientific appreciation and
application of dream interpretation. The importance of the art
of dream interpretation for the psycho-analytic treatment of
psychoneurotics, Freud has shown in detail in his " Bruchstiick
einer Hysterieanalyse " where two dreams of a patient are inter-
preted and synthetically assembled and utilized psycho-analytically.

"An English edition of this book has been prepared by Dr. A. A.
Brill, of New York, and published by Macmillan Co., of New York, and
Geo. Allen, of London, 1912.

CHAPTER VI

HYSTERIA

Freud's Position in the Study of Hysteria. Repression and Conver-
sion. Sexuality and Infantilism. The Hysterical Mind. The Hysterical
Symptom: its Somatic and Psychic Foundations. The Hysterical Phan-
tasies. The Hysterical Attack. Nervous Disturbances. Neurotic Anxiety
(Anxiety-Dream, Anxiety- Hysteria, Phobia). Concerning the Psychoses.

Since the " Studien iiber Hysterie " which Freud published in
collaboration with Breuer in 1895, the essential features of which
were reviewed in the general theory of the neuroses, he has not
made a systematized presentation of the insight and progress since
gained in the subject; hence this chapter can afford no systematic
and well-rounded picture but only a cursory view.

. The psychogenic nature of hysteria which had figured as a
disease of the nerves until the time of Charcot is already gener-
ally recognized from the works of Janet, Breuer and Freud.
Although the French school, with P.. Janet a1^ its head, had already
accepted the conception of the dissociation of mind and of the
unconscious in hysteria. ^^till the view of^anet that tie cause o"t

the establishment of this mental dissociation was an inborn weak
ness of the mental synthesis was an unsatisfactory j)ne. llHiQ^
Breuer-Freudian view put this dissociation and the unconscious in
tHeir correct mutual relationship by mtroducmg a dynamic con-
ception: tne mental life is represented as a play 01 iih|^enniU'*Jind
inhibiting f^frpg anrl if in rtnp ff\'3e. a group of ideas remain in

tVip nnrnr[«;riQn<; an artivp rnvLfliri- Y{'^ih r^tViPr p-rnyp's of Meas llaS
caused t|]f icr>loti'r.n or>A fViP ii|^prfpsr.iniisnpss of the first group.
Thus, the peculiarity, of tl\s FremJiRji coacaptioft— lies -k^-theyl
^'Irepressipn." The analysis proves that such repressions play an |
extraordinarily important role in our mental life, that they may •
also frequently miscarry in the individual and that this failure of I
the repression is the prerequisite of the symptom formation.^
Psycho-analysis has not only enabled us in this manner to formu-
late the theory of the psychic conflict and the repression but also

75

76 freud's theory of the neuroses

to give the answer to the question, whence comes such a repression
compelling strife between the ego and individual groups of ideas.
It deals with that deep antagoni«^m hptw<^f>n tht^ i'ngfi'npf<^ w!l'^^
erve sexuality and the gaining of sexual pleasure and those other
instincts which have as a goal the constitution of the personalilv.
the.egQiiiigtincts. The ego feels itself thrpatpnpH hv tVip ^j^rn^nHg
oj the overpowering sexual instinct and seeks .lo ,£rptect itself
by repressipn. fMt^tJll foulrl show further that thp nltimatp "aiisp
of the neurosis arose in early childhood where the instinctive life,
strengthened under certain constitutional conditions,^' favors the
failure of the repression. The;; hvstpnVal repression finds its
analogue respprtingr i't<; p|-p^pq.i; "i liii p ■■ i i ny L^^yr-

p^nted out under sexuality of children, in the p^rmally appearing
"organic repression of the cfijld'*; ingti'nffi'vp and sexual~!r!e.
This repression is the preliminary ^pndifi'on of ih^t Jatef ^Y':^''-
ical repression whi(;;j] j^ nr^y /-^♦^pf'^v.^^pil^la tliTpiig-|^ j-j^P rimi"^~
kance tnat the individual already possesses a store of memories
which are withdrawn from conscious disposition 'SMd wiiieh-aow

'^"tthfi b""^*^'"^ aggoriation Ipavlngr tlipm fr^p' ffofri ronghrms-
pes^s to ^xercise thp; c^hUT^^'^g p^^'^*'^" ^^ thp_rpprp«;c;i'nn Thus,
/the sexually mature neurotic individual brings witlTKirrrTegularly
j some sexual repression from his childhood which comes into
I influence in the demands of real life and leads to conflicts. The
I flight from unsatisfying reality which is never without an imme-
I diate gain of pleasure for the patients, the return to earlier phases
I of the sexual life which at that time did not lack a certain satis-
I faction, thus as it were, an infantile condition of the sexual life
I is reestablished.

Only through the disclosure of the fundamental etiological
importance of the psycho-sexual development for the establish-
ment of the neuroses has hysteria ceased to be a " child of sorrow "
of medical science for all earlier theories have led to no solution
or to an only partially satisfactory interpretation and explanation
of this strange disease. Freud has both lifted the veil from the
hysterical mental condition and also shown the abundant and
widely ramifying psychic determination of the symptom. He has
uncovered the motives and the content of the hysterical symptoms
and of the attack as well as the phantasies lying at the bottom of
" Compare A. Adler, " tJber neurotische Disposition," Jahrb., I, 2.

y''^^

HYSTERIA "JJ

them. As you might say, Freud has brought method out of
madness. His results, in this his particular field of investigation,
have not sprung from speculation but from pure empiricism and
could not have been found earlier by any other way than that
of psycho-analysis. On the contrary, Freud's investigations have
not dealt essentially with that part of hysteria which the medicine
of the schools sees in hysteria and considers as important for
diagnosis, namely, the stigmata. Freud has always considered the
pathological phenomena of hysteria from their psychogenesis and
it is in just this field that psycho-analysis gaining its popular value
as therapy has shown its ideal value for investigation most splen-
didly. If in such a penetrating presentation of the mental proc-
esses, the clinical histories of hystericals read like novels, it lies
in the nature of the object, in the internal relationship between the
story of suffering and the disease symptom to which physicians
must accustom themselves.

Strange ideas concerning the pathological changes in the genital
sphere which might constitute the starting point for hysterical
troubles were held by the ancient Greeks and Romans. These
basic thoughts have been accepted in modified form in the last
decades by a number of scholars, Freud has taken all these indis-
tinct presentiments of the mystics and although he cannot avoid
admitting that somatic disturbances of the elaboration of the
sexual material in the ultimate analysis lie at the bottom of these
phenomena,^* still he has shown the predominant part of psycho-
sexuality in the pathogenesis of hysteria in widest measure. Th^?\
chief content of the mental structure of hystericals is, according \
to the results of psycho-analytic investigations, formed by the \
"love-life" in its broadest sense, together with its intensive 1
phantasies. Whoever is skeptical on this point nowadays plays I
a role scarcely tenable since the association investigation has /
provided exact proof for the fact that such emotionally toned /
erotic complexes .r^^*' ^^r fflf"^^^ pictufe^of '"Hysteflcalta. jThis I
chiefcontent of 'C^p- vnt^r\\^^^\^c\\\r^j^^^\^^'ex\c.'?\9, is rea'ilv often i
hidden from superficial, observation or sVmt)oIical'!v"' 1 ^'|J1 tjlatiiHed /

"If the reproach should be made against the Freudian theory that as /
a purely psychological conception it is unable to solve a pathological
problem, the same is not justified. No one can deny the sexual function
in the special relations of which Freud sees the essence of hysteria, the
characteristic of an organic factor.

I

78 freud's theory of the neuroses^

like sexual matter in the dream. INeverthelesSjKjifcJiJjiSifitical
TwiH is rnntrolled from childhood on by powerful TOTinterimpulses
agamst"~Ttieir abnoi null y ~5trong TiisHnctive impulses. Only Tig^'
who knows the romance of the hysterical can also bring the com-
prehension of the striking character chagges which stand in
closest connection to the fate of his eroticisnMIT|if nrpn^roi p;/^ti^|-o
of hvsteq'fj j'^ •^"'-^hft- ""^7 '"?mFrthtniii1iil9 rninn rnn han rrrn;;;;,
nized that the hysterical fulfills an unconscious wish with his
rnalady which should exemnt him from ihp- sninfion r>f fTT
\ momentous erotic conflict. On. this pointy ^!^,^f^ ^^ ^ certain ex-
i^V^ \ ternal similarity between Freud's conception and tKe cornmon

yieW to the extent that a rAr^kiai— tia;ipQt-;^r^/-o tynU^o |lip lat^nf

hysterical notoriously ill. Later inyy,sticratinn^ how£ver, pho^«
tnese recent experienrps \q hp rpgnlarly <^9pflirts of |he eroticism
(a disappointment in love, a compulsory or renounced gn^age-
ment, a sexual assault, a sudden sexual enlightenment), ^yd when
to. superficial observation, there seem to be other motives (nursing
the sick, deaih ot a relative, etc.). a .more penetrating investiga-
tion regularly reveals unconscious attfirTimpni-g hptwp^p these banal
''^Tntf '^"'^ '^'^^y'^] or>A ^'i^f^ntilp I'mpj-^^t^t^jong Thus, the hysteric'aT
patients Suffer from remj^r|]''i^<='"^pf Tl^p f]x^ti(;)n of certain mentar

ir?.prpccir^j^c I ' I ^ r n ViP^p^lif PnpH iVrjf oKili'tjr p|- |pnf]-

^ru^Y tP fi^-^^i'^" ■f^'- thf-ir impressiorif;— js onp of thp most im-
portant and practically significant charar^^ri5^|iVg r.f fViP npnrrxi^i^g t
The reaction to the recent experiences seems inappropriate
when one does not take into consideration as motives the real
reminiscences in the unconscious. Thus are explained the over-
powering or exclusive reactions to sexual excitations with feel-
ings of discomfort in which Freud sees a sure sign of hysteria
whether the person shows a somatic symptom or not. Doubtless
this peculiarity has the closest relationship as to content with the
previously mentioned abnormal constitutional forces of instinct
and the combative tendencies of these and further an historical
connection with the earlier repressions.

I^urther. the hysterical traits of being suggestible and easily

^ hypnotized seem to have found the"liitlierl:o laCRtflg g'XplanationIn

psvcho-fifialygig TTfoii^ believes that the essence of hypnosis is

to be found in the unconscious libidinous fixation on the person of

the hypnotizer and Ferenczi, in his study, " Intro jektion und

HYSTERIA 79

■Qbertragung " (Jahrb. I), has sought the proof of this phenomenon
at the bottom of the " parent complex."

If this pecuHar nature of hystericals may thus be understood
as coming from a special psycho-sexual basis, the origin of the
mysterious symptoms of hysteria must be correspondingly eluci-
dated. The theory of the pathogenesis of the hysterical symptoms
forms, as we have cursorily shown in the history of the develop-
ment of the Freudian theory of the neuroses (Chapter II), the
starting point for Freud's investigation of the psychoneuroses. , t\fT\C2
The disc'^Yf'^'^ w^1VV1 Prai.^^ ^^a^ ir^ 4-v.,><- p».««i;r.^ cr,^^^ ^f t^yoi '-"-"^

texia that somewhat analogously to the traumatic hysteria, thei
ordinary hysteria owes its symptoms to dream-like mental im-'.^^^^
pressions. was the startinp^ point of the theory of hvsteria lat^y hj^
elaboratefll^Y FrpnH The sexual traumatic experiences, sinc^e tl^i^ *
ideas which accompanied these had powerful affecti (sum oj
excitation^ which had not been abreacted by the normal reactlo.

of COmmr^j^rltiP" """^ ^^'^ r^r.rr^cp^nr^;r.gr pyprpccmr^ qf |>mnfi'r.r

might become the raiigp nf kiiatgrir^Lsvmntnms whpn th^s ac.car
panying affect, separated from the unbearable idea^ was appli^
to the formation of a physical symptom.^^ In part, tliese "pent-l
up" affects remain as lasting burdens of the mental life and!
sources of constant excitation to the same; in part, they accom-l
plish a transformation into uncommon physical innervations andU
inhibitions which manifest themselves as the physical symptoms i\
of the case. Breuer and Freud coined for the last process the
name " conversion." For the comprehension of this term, the
reference to the " expression of the emotions " which normally
betrays our mental excitement is of service; this the hysterical
conversion exaggerates as well as leads into collateral channels.
The psycho-physical tendency to conversion represents a part of
the hysterical disposition. Though the nature of conversion, the
transformation of psychic excitation into physical innervation is
still a problem, Erp^id has, nevertheless, thr^y^ji his ft^ff"^ invp.sti- J J ) '^^
gation been able to make important contributions concerning the "''' \^
direciiort Wflich ih^ 'i^Ori'iT''''''^" ^^Vfi ^" infllY^<^^^^ cases, now caus- ^Qr^^'
ing the paralysis of some particular part of the body, again an --'''''"

** Experience shows that the conversion does not follow immediately
the causative event but that a long interval may intervene before the
establishment of the symptom.

;

:^^^ f

P^

^ n

80 freud's theory of the neuroses

erical cough or vomiting, etc.'*' If his discoveries in the
psychological ItJlUl'lUiiij aiid^ determinations to be discussed "later is
1 to nbe dAflSiaSf^d as 1^'reud's greatest work, still, he has never
' / failed to'^phasize distinctly tliat eyfrv'TiycifprTrat cyrnprnm hfi'^
^not only a psychic oripn but also a somatic hasisand (;?^n on]vcQiTie
to expression wlieji n '-'^i-^-^'" ^^j^xy^-xt^i^ "p^^p-^f^rlnpco " (^" somatis-
ches Entgegenkommen") is at hand; this is provided by a normal
or pathological process in or on an organ of the body. This somatic
preparedness consists of numerous conditions: first is the way
already prepared by physical conditions of irritation of these
organs, for example, the establishment of an hysterical cough
from an acute catarrh. A much more important condition of
somatic preparedness is when the affected organ represents an
erogenous zone. In this connection, Freud ha'? i^nmtpr^ pnf fViat
iust as in children the erogenous peculiarity can be moved to any
favorite body zone so an analop^ous movability returns in the
iptomatology of hysteria."^ In this neurosis, the repression
concerns the actual genitals for the most part; these give their
irritaDiiity to the other zones which ordinarily possess little such
function and these latter then behave exactly like genitals. Thus
for example, an hysterical vomiting might arise in an individual
for whom the mouth zone was preeminently emphasized in child-
hood and yielded a pleasure (sucking) ; the later repression of
this pleasurable sucking, because of the close connection of the
mouth zone with the instinct of hunger, might encroach on the
latter. All of Freud's patients with disturbances of eating, hys-
terical p^lobus. jf^ftPrr ^'" ^^^ tll^^^^ ^If* yomitinp^ Ti^H h^^^n-pnpr-
jetic suckers in childhood. In this fashion, all hysterical abulias
come about, since tne organs or systems of orp^aiVH wliii li>.4»erv<^
these two instincts when they deny the erogenous function also
refuse to serve in their other junction, "inus arises, lor example,
an hysterical disturbance of the gait (abasia) if the motor move-
ment in a phase of childhood had received strong erogenous em-

•* Concerning conversion into anxiety, compare "anxiety-hysteria"
in latter part of this chapter.

•*With the typical symptoms, the so-called stigmata, formerly greatly
overvalued as signs of hysteria, Freud has not dealt closer than occasion-
ally to point out that the movability of the erogenous zones has also here
the greatest significance: erogenous and hysterogenous zones show the
same characteristics

HYSTERIA

8i

phasis which later became repressed.®^ That the disturbance can
turn to different organs rests on the fact that corresponding to the
component instincts and the perversions connected with them,
besides their regular organic functions, these organs also serve in
childhood the most diverse erogenous functions. The mouth
serves for kissing as well as for eating and the speech function
(hysterical vomiting, mutism) ; the eyes receive stimuli in order
to perceive not only the changes in the external world important
for the preservation of life but also the peculiarities of objects by
which these are raised to objects to be loved (hysterical disturb- ,

ances of vision). 'j)nES^

According to Freud, for the establishment of an hysterical
symptom, the displacement of sexual feeling also plays a role.
Thus, nausea may arise in a girl who perceives a genital sensation
on the occasion of a kiss ; by displacement, this sensation is per-
ceived as a feeling of discomfort in the mouth and digestive zone.
The same girl suffers from an hysterical pain in the breast since,
during an embrace, she felt the pressure of an erect penis against
her thigh. Thus, here we have to deal with the displacement to
the breast of a tactile impression on the thigh converted into an
hysterical pain.

More important than the reference to the somatic conditions
of the symptom and Freud's particular masterpiece, is the dis-
covery of the symptom's psychic roots. The psychic determina- '
tions afp Tin<" gimpl/^ Knf mcf^^ f-nmpljcated. Determination plays
animportant role through a comprehensive and widespread sym-

bolism analo£[ous to that of dream life. Thus, for example, m a
female~p^^i'='"ti tb** ""/^»"g'^'<">iig pVian^^f^y i}^_J^^ erect male organ
mayserve as model for a stiff arm ; at the same time, however,
this symptom was the punishment tor an intended sexual aggres-
sidn With" tKeTiand. As a rule, the hysterical symptom does no?
have merely a single meaning but several meanings at the same
time (overdetermination) ; these, it does not possess from the
beginning but rather gains from the thoughts striving to find ex-
pression. Since the origination of a symptom is difficult and
joined to a series of favoring somatic conditions, it is evident that
an hysterical symptom, once formed, is retained to give alternate
expression_tQ-dUifiCS£Ji3ieafli]3gs.

** Compare also the agoraphobia later in chapter.
7

82

FREUD^S THEORY OF THE NEUROSES

m

Just as certain presuppositions are necessary for the establish-
ment of the symptom, so later circumstances appear in this con-
nection which at the beginning of the malady were not present and
had no share in the symptom formation; only upon the later
appearance of these is the disease fully established : tliese circum-
s^nces are the motives for the malady. Wherever a train of
thought finds it convenient to use a symptom, this becpmes a
secondary function and appears fixed in the mental life.fThe pur-
pose of the disease is often to gain afifection, indulgence or other
advantage from the surroundings ; frequently a desire for revenge
is one of the strongest unconscious motives for the further estab-
lishment of the symptom and naturally a great hindrance to the
treatment. Nevertheless, there are also cases with purely internal
motives such as, for example, self-punishment, repentance and
peniten^tfjl

According to the original view, it was only the sexual trau-
matic experiences which by their intensity and unbearableness gave
occasion to the repression; deeper psycho-analytic investigation
has disclosed the fact that it is much more the phantasies (inven-
tions of memory) of the patients, intensively elaborated mostly
in the years around puberty which interpose themselves between
the infantile processes and the symptoms, the content of which
can, under certain conditions, join the infantile repression of
instinct and be withdrawn into the unconscious. So long as these
fftlfint^''''^'' ^^*^ ^r>p<;rir>ii«;. -\|vexall them day-dreams; tlicil' [JU!.Sf»-
bility for b^iny rporesspd. tht^ir becoming unconscious rests on

tjieir close relation to the sexual life of the persons m quest

The phantasy, after it has become unconscious, is really identical'
with the (conscious) phantasy which the person has indulged in
for sexual gratification during a period of masturbation. The
act of masturbation (in widest sense, i. e., onanistic act) is com-
posed at that time of two parts, the production of the phantasy
and the active performance of the self-gratification. This com-
bination displays, however, a line of cleavage : originally the action
was a purely autoerotic attempt to gain pleasure from a definite
erogenous zone. Later this action blended with the wish idea
from the circle of lovable objects and served as a partial realiza-
tion of the situation to which this phantasy pointed. If then, the
person renounced this kind of masturbation-phantasy-gratification.

HYSTERIA 83

the action would be stopped but the phantasy would pass from a
conscious to an unconscious one. If no other kind of sexual
gratification took its place, the person remained in abstinence and
was unable to sublimate his libido, that is, divert the sexual excita-
tion to higher aims, the condition was just right for the uncon-
scious phantasy to come to life, grow luxuriantly and constitute
itself with the whole force of the sexual appetite at least in one
part of its content as a disease symptom. For a whole series of
hysterical symptoms, unconscious phantasies of this kind are the
nearest psychic prototypes. The hysterical symptoms are nothing
else than unconscious phantasies brought to representation through
conversion and in so far as they are somatic symptoms they were
often enough borrowed from the circle of real sexual feelings
and motor innervations which originally accompanied them when
they were still conscious phantasies. In this way, the giving up
of onanism becomes really retrograde and thereby the final ulti-
mate aim of the whole pathological process, the recovery of the
sexual gratification at that time primary, is never attained but
always approximated. The interest of the student of hysteria
soon turns from the symptoms themselves to the phantasies from
which these were first derived. The psycho-analytic method has
made it possible to investigate these ultimate unconscious disease-
producing phantasies of people and in Freud's analysis of a child
neurosis (see lit. No. 35) these could be directly pointed out in
statu nascendi. In this analysis, it was revealed that these
phantasies which intensively occupy the dreamy, neurotically pre-
disposed child choose for their objects at first the parents and the
immediate surroundings of the child, that in this connection,
pregnancy- and birth-phantasies as well as infantile sexual
theories®^ which the unenlightened child elaborates for the expla-
nation of these mysterious processes, play an important role.
Since at this time the activity of the normal sexual zone does
not yet stand in the foreground, the child being thus still poly-
morphous-perverse, these phantasies serve the most diverse erotic
desires and as the difference in sex is still also a problem for the
child, these phantasies are also bisexual. The fact that in general
the same phantasies concerning childhood are always formed
without regard to how much or how little actual material real life

"Lit. No. 32.

84 freud's theory of the neuroses

has added to them, is explained by the uniformity of the child's
sexual life and the later modifying influences.®*

Psycho-analytic investigations of neurotics plainly reveal the
fact that the growing individual seeks to eflface in his phantasy-
formations concerning his earliest childhood the memory of his
autoerotic activity, at the same time raising his reminiscences to
the stage of love-of-an-object. Hence, the superabundance of
seductions and outrages in these phantasies, where often enough
the reality is limited to autoerotic activity,*" a distinction which
in forensic cases must occasion the judge the greatest difficulties.
The correct distinction between the phantasies, afterwards sexual-
ized, and the actual, as a rule banal events of childhood, is ren-
dered very difficult by the fact that in the neurosis, thought-reality
and not actual reality has value.

Freud has enunciated" a series of formulae which attempt to
treat exhaustively and progressively the nature of the hysterical
symptom. These do not contradict one another but correspond
in part to more complete and sharper delineations, in part to the
use of different points of view :

1. The hysterical symptom is the memory-symbol of certain
actual (traumatic) impressions and experiences.

2. The hysterical symptom is the substitute created by con-
version for the associative return of these traumatic experiences.

3. The hysterical symptom is — ^like other psychic formations
— ^the expression of a wish- fulfillment.

4. The hysterical symptom is the realization of an unconscious
phantasy which serves the wish-fulfillment.

5. The hysterical symptom serves the end of sexual gratifica-
tion and represents a part of the sexual life of the person (corre-
sponding to one of the components of his sexual instinct).

•*In individuals especially constituted by their heredity, hysteria may
break out in childhood from these conditions, usually in the form of
anxiety-hysteria.

"It must be constantly borne in mind that the hystericals are in-
clined in their phantasy-life to produce injurious dreams and to conceal
them because of the accompanying pleasure gained. Abraham, "Das
Erleiden infantiler Sexualtraumen als Form der infantilen Sexualbetati-
grung," Zentralhlatt f. Nervenh. «. Psych., 1907. A series of dreams com-
ing to light in the analysis may, nevertheless, be traced back to a later
phantastic elaboration of autoerotic sexual experiences. Jahrh., I, page
393.

-Lit. No. 28.

HYSTERIA 85

6. The hysterical symptom corresponds to the return to a kind
of sexual gratification which was real in infantile life but has
since been repressed.

7. The hysterical symptom arises from a compromise between
two opposed affective and instinctive impulses by which the one
brings a partial instinct or component of the sexual constitution
to expression, the other seeks to suppress the same.

8. The hysterical symptom can become the representative of
different unconscious non-sexual impulses but cannot be without
a sexual meaning.

Among these definitions, it is the seventh which most exhaust-
ively expresses the nature of the hysterical symptom, as realiza-
tion of an unconscious phantasy. When one in this manner, by
means of psycho-analysis, succeeds in recognizing the component
of the sexual instinct which is controlling the individual, one
comes upon the unexpected discovery that for many symptoms
the solution by the original unconscious sexual phantasy is not
sufficient, but that one needs for the solution of the symptom two
sexual phantasies, of which one has a masculine character, the
other a feminine, so that one of these phantasies arises from an
homosexual impulse. Thus,

9. An hysterical symptom is the expression, on the one hand
of a masculine, on the other hand, of a feminine unconscious
sexual phantasy.

Freud believes, however, that no universal application can be
made of this occurrence of two opposite sexual tendencies in one
symptom as in the other formulae, important though it is theoret-
ically and also not to be underestimated in practice. A counter-
part of this hermaphrodism of the hysterical symptom is shown
by certain hysterical attacks in which the patient plays both roles
at the same time in the underlying sexual phantasy. This contra-
dictory synchronism conditions in large part the incomprehensi-
bility of the situation otherwise so plastically represented in the
attack and is thus suited for disguising the actual unconscious
phantasy.

Freud has really shown that the attack,®^ this most imposing
symptom of hysteria, is also nothing else than a phantasy trans-
lated into motor phenomena, projected into motor activity,

•^Lit. No. 33.

86 freud's theory of the neuroses

represented in pantomime and that by witnessing this, it is pos-
sible to recognize the phantasy dramatized in the attack; this
procedure alone succeeds only rarely. As a rule, the pantomimic
representation of the phantasy has undergone under the influence of
the censor, distortions quite analogous to the hallucinatory ones of
the dream, so that both alike have become incomprehensible for
the patient's consciousness and for that of the observer as well.
The hysterical attack may thus undergo the same important
elaboration that we see in nocturnal dreams. Thereby, one is
easily convinced that not only the forces from which the distor-
tion proceeds and the purpose of this distortion are the same but
also the technique is the same as that which we have recognized
in the interpretation of dreams.

The hysterical attack is rendered incomprehensible, indistinct,
distorted and misleading :

1. By condensation of several simultaneous phantasies, for
example, a recent wish and the revival of an infantile impression.

2. By multiple identification when the patient undertakes to
carry out the activities of both persons appearing in the phantasy.

3. By the antagonistic conversion of the innervation which is
analogous to the change of an element to its opposite practiced in
the dream-making, for example, if in the attack, an embrace
would be represented, the arms would be drawn backwards con-
vulsively. As far as possible, the recognized " arc de cercle "of
the great hysterical attack is nothing else than such an energetic
denial through antagonistic innervation of a position of the body
suitable for sexual intercourse.

4. By the inversion of the time sequence in the phantasy rep-
resented, which again finds its counterpart in many dreams which
begin with the end of the action in order to conclude with its
beginning. The outbreak of the hysterical attack follows easily
understandable laws. Since the repressed complex consists of
libido and content of ideas (phantasy), the attack can be occa-
sioned by : ( I ) Associations, when the complex ( sufficiently deep
rooted) is touched upon by something of conscious life; (2)
organically, when from somatic causes and from psychic influ-
ences from without, the amount of libido is increased beyond a
certain measure; (3) in the service of the primary tendency, as
expression of "the flight into sickness" when reality becomes

HYSTERIA 87

painful or dreaded, thus, for consolation; (4) in service of the
secondary tendencies with which the disease has united so that
by the production of an attack, an advantage to the patient is
gained.

The investigation of the childhood history of hystericals
teaches that the hysterical attack is also used as a substitute for
autoerotic gratification once practiced and since renounced. In
a great number of cases, this gratification (masturbation by
rubbing or pressing the thighs together, sucking the tongue, etc.)
also returns in the attack during a relaxation of consciousness.
The involuntary micturition should certainly not be considered
inconsistent with the diagnosis of hysterical attacks ; it can repeat
the infantile form of impetuous pollution. Further, one can also
encounter the biting of the tongue in undoubted hysteria.

The loss of consciousness,®^ the "absence" of the hysterical
attack proceeds from those transitory but unmistakable failures
of consciousness which are to be detected at the height of every
intense sexual gratification (also in the autoerotic forms). In
the origination of the hysterical "absences" from pollution-
attacks of young female individuals, this development may be fol-
lowed most clearly.

The arrangement which opens the way for the repressed libido
to find an outlet is that already present reflex mechanism of
coitus present in every man and also in women which we see
become manifest in its unrestricted devotion to sexuality. The
ancients used to say " coitus is a little epilepsy." We may alter
this to " the hysterical convulsive attack is a coitus equivalent."

In conclusion of the symptoms of hysteria, the so-called
" nervous disturbances," which play a great role in practice, may
also be discussed.

If one overlooks the ill-defined classes of "being nervous,"
the nervous disturbances according to Freud belong in the field
of sexual neuroses. The description of the true neuroses included
already a wide array of psychic and somatic nervous disturbances
for which a toxic cause is assumed : nervous anxiety, irritability,
nervous palpitation, headache, stomachache, sweating, trembling,
diarrhea, vertigo and many others.

"Compare Abraham, "t)ber hysterische Traumzustande," Jahrb., II,
I, 1910.

88 freud's theory of the neuroses

Opposed to these neuroses of the heart, intestine, " vasomotor
neuroses," etc., or associated with them are very often in indi-
vidual cases psychogenic symptoms which, when isolated, appear
as mono-symptomatic hysteria. Thus, for example, a nervous
nausea, nervous vomiting, dyspepsia ("stomach neurosis") has
the same mechanism of origin as the same symptoms in the course
of an hysteria.*® When a nervous vomiting seems apparently to
be determined by a recent event and a somatic preparedness
(Entgegenkommen), indeed if occasionally a cure by abreaction
of recent experiences seems to have been effected, nevertheless,
behind this, a determination from childhood is to be discovered
under which in the ultimate analysis lies an erogenous strengthen-
ing of the mouth-digestive zone.

The same applies to psychic impotence in which, often a
recent experience, a single failure, seems to inhibit later results
by anxiety, while in reality the hindrance comes from unconscious
infantile complexes, such as the family-complex (unconscious
fixation of the libido upon mother or sister) which prevents the
transference of the libido to the later sexual object. Of course an
organic weakness of the sexual system or a true neurosis may
share in this as Steiner and Ferenczi could show.^°" Although
the psycho-analytic treatment is effective in psychic impotence,
still the share of the actual conditions is likewise to be taken into
consideration.^"^

In women, the condition corresponding to this is sexual
anesthesia which very frequently accompanies hysteria but is
also otherwise so enormously widespread that one must connect
it with our all too Puritanical system of female education. Freud
was able to trace this sexual anesthesia back to the following
condition: after the irritation of the clitoris by masturbation
which occurred in childhood, the normally occurring transference

"•Here belong the disturbances of appetite in children which are so
important in practice and often last for months. Idiosyncrasies against
certain foods are likewise often of psychogenic origin.

*•" Steiner, "Die funktionelle Impotenz des Mannes und ihre Behand-
lung," Wiener Med. Presse, 1907, No. 42. Ferenczi, "Analyt. Deutung
und Behandlung der psychosexuellen Impotenz beim Manne," Psychiatr.-
Neurolog. Wochenschr., No. 35, 1908.

*•* A cure attained by other means, as suggestion, cannot be considered
as an argument against a complicated psychogenesis.

HYSTERIA 89

of the excitability of the clitoris to the adjoining female parts
(vagina), as is necessary for the sensibility in the normal sexual
act, is retarded or is prevented altogether. Further, this trans-
ference normally demands a certain length of time, during which
the young woman is anesthetic. It is recognized that this anes-
thesia of women is frequently only an apparent and local one.
They are anesthetic at the vaginal entrance but in no way unex-
citable at the clitoris itself or in other zones. To these erogenous
causes of the anesthesia, are added the psychic ones likewise con-
ditioned by the repression. The psychogenic part is removable by
psycho-analysis during the first years of married life.

The nervous disturbances have an eminently practical impor-
tance for general medicine and, according to Freud's conception,
are very productive for the most diverse specialties outside of
neurology, for example, internal medicine, eye, ear, etc., which
employ so often the term " nervous." It is evident that no physi-
cian can do without a knowledge of psycho-analysis and especially
the viewpoint of psychogenesis and sexuality for the differential
diagnosis. The most diverse neuralgias, tics, dyspepsias, cases of
nervous asthma, vaginismus, many cases of hyperemesis gravi-
darum, etc., seem to be psychically conditioned and subject to
psycho-analytic influence. There are already works on these dis-
eases which point to the psychogenic etiology (compare Drey-
fuss,^"^ Walthard,^°3 h. E. Miiller)i°* while TreupeP*'^ and
Wegele^"" lay more stress on the agencies of the true neuroses.

In this field, there must come about a decision or rather a
compromise between the standpoint represented by the internists
of all kinds that for example, bronchial asthma (nervous) is an
intoxication corresponding to an exudative diathesis and the
psycho-analytic disclosure of its psychological connections. Thus,
cases of bronchial asthma and conditions like migraine, vaso-
motor edema and others which can occasionally stand for it, are

^""tJber nervosa Dyspepsie," G. Fischer, Jena, 1908.

^ " Die psychogene Atiologie und die Psychotherapie des Vaginis-
mus," Miinchn. mediz. Wachenschr., 1909, p. 1998.

*** " Beitrage zur Kenntnis der Hyperemesis gravidarum," Psychiatr.-
Neurolog. Wochenschr., loth year.

^^"tJber Herzneurosen," Miinchn. mediz. Wochenschr., 1909.

iM « Uber den Zusammenhang zwischen Affektionen der Genitalorgane
mit Storungen der Magen- und Darmverdauung," Med. Klinik, 1910.

9© FREUD S THEORY OF THE NEUROSES

often plainly psychically conditioned. Asthma is an important
symptom of anxiety-hysteria and for the anxiety-neurosis as well.
In the works of Stekel/" Stegmann/*** and others there apxpear
valuable disclosures concerning its psycho-sexual nature and its
relief by psychic means, both of the individual attack and the dis-
ease in general. One thing is certain, the toxic conditions are
especially well suited for psychogenic complications. Still, there
is the difficult question as to how the organic, toxic and psycho-
genic share in the causation of the symptoms as well as the sharp
differentiation of the still confused terms " hysterical," " psycho-
genic" and " (toxic) -neurotic."

In this connection, Freud has pointed out in a recent article^"'
on the elucidation of "psychogenic visual disturbances" certain
disturbances which have an organic-toxic foundation besides the
psychogenic. When an organ which serves both fundamental
instincts, the ego- and the sexual-, increases its sexual role, it is
generally to be expected that this will not disappear without
changes in the excitability and innervation. When we see that
an organ which otherwise serves the sense perception, for
example, the organ of vision, by the raising of its erogenous
value, immediately takes on the function of a genital organ, we
will also not consider toxic changes in it improbable. For both
classes of functional disturbances resulting from strengthened
erogenous significance both of psychological and toxic origin,
Freud would, for want of a better term, retain the old unsuitable
name neurotic and call them sexual-neurotic disturbances.

In the framework of an attempt at a comprehensive represen-
tation of hysteria, the treatment of the anxiety problem also has
a place. Anxiety as the cardinal symptom of a true neurosis we
have already encountered in the presentation of the anxiety-
neurosis, where according to Freud it was explained that the
mechanism of the anxiety-neurosis is to be sought in the sepa-
ration of the somatic sexual excitement from the psychic which

i« " Nervose Angstzustande."

^ Stegmann, " Zur Atiologie des Asthmas bei Kindern," Med. Klinik,
1908, 29. Same, " Psychotherapie bei Asthma bronchiale," Milnchn. med.
Wochenschr., 1908. Compare also Sanger, Brugelmann, Goldscheider.

*- Lit. No. 38.

HYSTERIA 91

causes an abnormal employment of this excitement. We have
here to deal with an anxiety which does not have a psychic deri-
vation. Clinically, the cases of anxiety-neurosis are often seen
mixed with anxiety derived from psychic sources. .This brought
about the creation by Freud of the term "anxiety-hysteria," a
clinical phenomenon to which Stekel has devoted the greatest part
of his book on anxiety conditions and their treatment, which is
especially important for the practitioner. In these cases, the
anxiety arises not only from somatic sources but from a part of
the ungratified libido which embraces unconscious complexes and
through the repression of these gives rise to neurotic anxiety. As
the mind normally reacts to impending danger from without by
anxiety, so one might say that in neurotic anxiety, the ego is
defending itself against internal enemies. In these cases, we have
a psychic mechanism which is identical with that of hysteria ex-
cept that it does not lead to conversion into physical symptoms
but into the development of anxiety. Anxiety is likewise the
only symptom into which the psychic excitement is converted in
this case. In cases as they occur in practice, this anxiety-hysteria
may be mixed in any degree with the conversion-hysteria : there
may be conversion-hysteria without any anxiety as well as pure
anxiety-hysteria which expresses itself in feelings of anxiety and
phobias. Freud has already in his work on anxiety-neurosis
pointed out the frequent combination of hysteria with anxiety-
neurosis. This is explained by the fact that very often besides
the somatic diversion of the libido, a part of the same may strike
back to the unconscious complexes and bring these to life again.
It is, therefore, not chance when hysteria and anxiety-neurosis so
frequently combine, and experience shows that in many cases
which look exactly like anxiety-neurosis one finds a bit of hysteria
as well. In this sense, Freud says anxiety-neurosis may be called
the somatic partner of hysteria. Here as there, is an accumula-
tion of excitation in which perhaps the similarity of the symptoms
is founded. Here as there, a psychic insufficiency which comes
into existence in consequence of abnormal somatic processes.
Here as there, in place of mental elaboration^ a diversion of the
ij_lliliiiii iiilii 1I11 nnmil''- ^rllffi 9la9e; the distinction lies
.in the fact that the excitation, in the displacement ot wliich
the jieurosis iinds HpiLSSiuii, ij, in Uit uuAiLl| iiLUiumiupa purely

92 FREUD S THEORY OF THE NEUROSES

somatic one (the snmptir covimi ovp;fo»v.or,fy in the hysteria, a
psychic one (through the conflicts aroused).

Ihus, there is an hysterical anxiety which is psychically divert-
ible. In these cases, a psychic libidinous excitation, a phantasy,
suppressed in the struggle with the ego-instinct, finds its way back
by regression to pathogenic infantile unconscious material which,
however, is not converted as formerly into physical symptoms,
but is plainly changed in a way prepared in infancy into anxiety.
Neurotically increased anxiety we frequently find in children.
We see what you might call a normal anxiety arise in them in
the darkness when they miss the beloved person. A neurotic
anxiety arises in children if they suddenly come in contact with
the sexual problem without being able to master it psychically.
The most frequent pathological expression of this anxiety of
children is the pavor nocturnus as the foundation for which a
sexual experience in the broadest sense of the word may regularly
be proven. When one searches in these children for the content
of their horrible dreams or phantasies and investigates the mean-
ing of what you might call the somnambulistic condition, the
repressed material regularly appears. The most frequent neurosis
of childhood is anxiety-hysteria^^" which is to be considered in
general the most frequent of all psychoneurotic maladies. As an
essential characteristic of the anxiety-hysteria it may be asserted
that it always tends more and more to develop a phobia; in the
end, the patient may become free from anxiety but only at the
price of inhibitions and limitations to which he must submit. In
anxiety-hysteria, from the begirming on, there is a progressive
psychic attempt to join the free anxiety psychically (to something)
but this work can neither effect the reversion of this anxiety into
libido nor join it to the same complexes from which the libido arose.
There remains nothing left for it but to stop every possible oppor-
tunity for the development of anxiety by a psychic screen of a kind
of foresight, an inhibition, a prohibition, and it is these pro-
tective structures which appear to us as phobias and constitute the
nature of the malady for our perception. The variety of this
inhibition whether it is, for example, a disturbance of gait or a
disturbance of the mouth zone (disturbance of eating or speak-

"• Compare Freud's " Analyse der Phobic eines fiinf jahrigen Knaben,"
Jahrb., I, and Jung, " Uber Konflikte der kindlichen Seele," Jahrb., II, I.

HYSTERIA 93

ing), etc., will depend on what organic function, constitutionally
emphasized and erogenously strengthened, the anxiety attaches
itself. The anxiety leads to a phobia, you might say, when it
gets firmly fixed on a particular complex. The most frequent of
hysterical phobias is the agoraphobia (Platzangst) for which it
is characteristic that it leads to no absolute inhibition but only to
preventing the patient from going alone, though he can walk when
accompanied by specified persons. Often an attack of anxiety
on the street is the occasion of the origin of the agoraphobia; the
symptom is thus constituted to prevent an outbreak of anxiety;
the phobia is erected as a frontier fortress against the anxiety.
At the bottom of the agoraphobia seem to be various sexual and
covetous wishes which have been repressed into the unconscious.
These are mostly erotic desires which in men are also accom-
panied by covetous phantasies. The symbolic meaning of certain
figures of speech as "to bring it far," "to come to something,"
"to stand on your own feet," etc., frequently play an overdetermin-
ing role ; similarly also in the wish " to go through." Recently,
Freud has called attention^^^ in an aphoristic observation to the
deeper connections of such cases of neurotic disturbance of gait
and " spatial anxiety " to the original pleasure in motion of chil-
dren which is joined to sexual excitations and voluptuous sensa-
tions. Another anxiety-hysterical disturbance already connected /
to superficial observation with sexual etiological agencies is the \
erythrophobia at the bottom of which frequently lies the self- \ ^
reproach of shame over masturbation or the experience of syphilis.^'->^^^\
Also, premature sexual knowledge, secretly obtained from obser-^ \ Y^
vation of the parents and imperfect interpretation of this, seem
to play a role. Likewise, feelings of being slighted and anger ma
enter in (Adler). If this anxiety over red leads to inhibition
in the life activities, for example, if it prevents mingling in society,
it becomes a phobia.

Concerning vocational anxiety-neuroses, stage fright, examina-
tion-anxiety, psychic impotence depending on anxiety, etc.,
Stekel has sought to give in his book psycho-analytic explanations
with detailed casuistic material.

Without the meaning of neurotic anxiety as having originated

*" Concerning muscular activity as a source of sexual excitement in
childhood, compare " Drei Abhandlungen zur Sexualtheorie," Lit. No. 20.

94 freud's theory of the neuroses

from the repression of libidinous impulses, the anxiety-dream, an
almost universal experience, which is also a frequent symptom of
the neurosis, cannot be understood. The theory of the anxiety
dream does not belong to the problem of the normal dream but to
the anxiety problem. The anxiety-dream seems at first to con-
tradict the dream-theory that every dream represents a wish ful-
filled. When one has clearly shown, however, what lurks behind
the manifest dream content of the anxiety-dream and penetrated
to the latent psychic content, the objection to the wish theory falls
to pieces. The interpretation work shows that the anxiety which
we feel in dreams is only apparently explained by the content of
the dream. The anxiety is, as already remarked, only attached to
the accompanying idea and springs from other sources. The
interpretation of such dreams regularly reveals their true content
to be a repressed sexual wish, the distortion of which in the dream
has failed. To the breaking through of the sexual in the dream
which is also apt to awaken the sleeper, the dreamer can only
react like the neurotic in waking life, namely, by anxiety. In this
sense, the representation of the unconscious in the anxiety-dream
would be an especially successful one. The anxiety in these
dreams is thus mostly a psychoneurotic one arising from psycho-
sexual impulses whereby the anxiety corresponds to repressed
libido. Then, this anxiety has, like the whole anxiety-dream, the
significance of a neurotic symptom and we stand on the boundary
where the wish- fulfilling tendency of the dream fails.^"

Anxiety-dreams are of frequent occurrence in anxiety-neurosis
and anxiety-hysteria, where they show the following character-
istic content.^^^ The dream picture accompanied by anxiety rep-
resents the patient (usually female) oppressed by a great and
dangerous beast which threatens to throw itself on the dreamer;
characteristically, it is often a stallion or a bull, thus, animals
which have ever stood as symbols of the potent strength of animal
masculinity. It is easy to see in these animal figures the symbol-
ized givers of sexual gratification forbidden by conscious thinking.

*** In other anxiety-dreams, the feeling of anxiety is somatically caused,
as for example, in lung and heart diseases and is then made use of to bring
to fulfillment in the dream of suppressed wishes in individuals whose
dreams had already had anxiety from psychic motives.

"' Compare in this connection Ferenczi, " The Psycho-analysis of
Dreams," Atner. Jour. Psychology, Apr., 1910, as well as Stekel's cited work.

HYSTERIA 95

A still plainer symbolism aiming at this end appears in dreams of
burglars who, armed with revolvers, daggers or similar instru-
ments, press in upon the dreaming lady. The starting up from
sleep because of such anxiety-dreams,^^* one finds frequently in
widows and ungratified women as a characteristic kind of dis-
turbance of sleep. Stekel"^ especially emphasizes the dream of
the death of the child who stands in the way of breaking the mar-
riage or prevents the divorce; in general, dreams of death and
funerals, especially of near relatives, are typical for the anxiety-
neuroses.

For want of clinical material, Freud had relatively little oppor-
tunity to deal with the outspoken psychoses; still, he considered
these within the scope of his investigations. The few cases to
which he himself has applied the insight gained from the psycho-
neuroses have yielded highly important disclosures and really
incited the Zurich clinic to splendid work. Through the dogma,
insanities are brain diseases, and through scientific work chiefly
devoted to nosography, the psychological way to the understanding
of the psychoses was little used. Freud joined Griesinger who
ascribed to the psychic causes the predominant role in the causa-
tion of the psychoses. Freud divided the cases analyzed by him-
self into "overpowering psychoses" and "defence-psychoses."
Under the former, he classed those cases in which the unconscious
had completely and violently overcome the conscious. Freud re-
ported one such case, met with in the course of an hysteria, of an
hallucinatory confusion (of which he had seen a few) in which
the person (in sense of Griesinger) represented the fulfillment of
her repressed wishes in hallucinatory manner, while she awaited
in vain an appointed day with her lover, suddenly had hallucina-
tions, hastened to meet him, greeted him and for two months
lived in the happy dream that he was there, always near her, etc.
Thus, the patient has warded off the unbearable idea of remaining
away from a longed-for lover in energetic and in a certain sense,

*** Recently Ernest Jones has sought to elucidate the nightmare from
Freudian standpoint, " On the Nightmare," Amer. Jour. Insanity, Jan.,
1910.

"*This repressed wish can express itself as an obsessional impulse
to injure or kill the child. Compare Lit. No. 6.

96 freud's theory op the neuroses

successful manner, while the ego rejects the unbearable idea
together with its affect and behaves as if the idea had never
occurred to it. But in the moment in which this succeeded, the
person is already in a psychosis which one can classify only as
hallucinatory confusion. Thus, the ego tears itself loose from the
unbearable idea; this is inseparably connected with a piece of
reality however, and while the ego accomplishes this task, it has
separated itself in whole or in part, from reality. According to
Freud, this is the condition in which hallucinatory vivacity, amid
its own ideas, is to be judged.

In contrast to this overcoming en masse, the analogy to
hysteria in the defence-psychoses (paranoia, dementia paranoides)
is complete so that in the initial stages of these cases, they often
cannot be sharply differentiated from hysteria and other neuroses.
In these cases of defence-psychosis, the whole previous history,
course of development, genesis, complexes and infantile repres-
sion are the same as in cases of hysteria. It seems that the differ-
ent clinical pictures of the defence-psychoses are characterized
only by different repression mechanisms which come into play
later, concerning which, however, nothing definite is known. The
libido may have suffered a quite special fate in this. Thus, in
dementia praecox, there seems to be a characteristic withdrawal
of the libido — the term taken in its broadest sense — from the
objects of the external world. Therein, lies an exquisite contrast
to hysteria to which Abraham has referred.^^" While in hysteria
there is much free floating libido for the use of the object, in cer-
tain cases of the psychosis it seems to be fastened to the ego
complex and thus leads to ideas of grandeur. Thus is also
explained the inner connection between persecution mania and
delusions of grandeur in the paranoiad forms.

Freud has described in detail a case of hallucinatory para-
noia^^'^ analyzed by him, in which he shows that a group of cases
which belong to paranoia arise just like hysteria and the obses-
sional neurosis from the repression of painful memories and that
the symptoms of these are determined in form by the content of
the repressed material. Further, in this case, the repressed

"• " Die psychosexuellen DifFerenzen zwischen Hysteric und Dementia
praecox," Zentralhlatt f. Psych, u. Neurol., July, 1908.

*** Perhaps more correctly called dementia paranoides. Lit. No. 3.

HYSTERIA

97

material was revealed as a sexual experience of childhood
(phantasy), the content of which, however, does not have to be
recovered by the tedious way of analytic interpretation work but
which the patient, as in all cases of paranoia, expressed quite
undisguised. In paranoia, much pushes into consciousness which
we proved to exist in the unconscious of normal and neurotic
individuals only by psycho-analysis. Thus, the phantasies of
hystericals which have to be made conscious by analysis hide
themselves from sexual and cruel maltreatment, for example,
occasionally as far as in individual cases the complaint of para-
noiacs, " persecuted." It is worthy of note, but not incomprehen-
sible in the light of the Freudian sexual theory, that the identical
content meets us as reality in the arrangements of perverts for
the gratification of their appetites.

For the periodic melancholia, Freud asserts that these cases
appear to dissolve in unexpected frequency into obsessional ideas
and obsessional affects, a perception which is not of indifferent
importance therapeutically. The individual attack of ill humor
may be favorably influenced psycho-analytically even if further
attacks may not always be prevented.

In this relatively small casuistry Freud has been able to show
that sense and logic may be demonstrated in delusions, as also in
the peculiar variety of unconscious thinking, and has, thereby,
brought the cause and content of mental disturbances into psycho-
analytic investigation. The Zurich school, with Jung at its head,
has busied itself according to the clinical material at its command,
with especial attention to dementia prsecox. Jung's painstaking
labors in the analysis of every expression of a very averse dement
succeeded in showing the same psychic mechanisms which Freud
had found in the neuroses also present here in demonstrable form,
so that no more doubt can exist that at the bottom of dementia
praecox lies a repressed erotic complex,^^* The dulling of the
affect is only apparent and, according to Jung, explained by its
absorption by the ruling complex.^^^ The psycho-analytic study
of these conditions has yielded still more. It showed that the

"*Jung, "Uber die Psychologic der Dementia praecox." K. Marhold,
Halle, 1907.

'^" Compare also Bleuler-Jung, " Koraplexe als Krankheitsursachen bei
Dementia praecox," Zentralb. f. N ervenheilkunde u. Psychiatric, 1908.

8

98 freud's theory of the neuroses

apparently absurd symptoms of dementia prgecox prove on
analytic investigation to be symbolic figures of intelligible and, in
the mental life of the person, highly important trains of thought
and impulses.^^" Abraham has brought out, beside the article
already mentioned on the withdrawal of the libido from the
external world which is so especially characteristic of dementia
praecox, also another article on the significance of dreams of
youth for the symptomatology of dementia praecox ;^^^ Maeder^^*
has dealt in detail with the delusional structures of the paranoiad
conditions. Riklin published a " contribution to the psychology of
cataleptic conditions in catatonia."^^* Freudian mechanisms could
also be shown in various other psychoses. Thus Bleuler,^^* in his
work on " Freudian mechanisms in the symptomatology of the
psychoses," furnished a series of interesting examples. Otto
Gross considered "the Freudian idiogenesis agency and its sig-
nificance in manic depressive insanity of Kraepelin" (Leipzig,
1907). In this work appears also a reference to the psycho-
genesis of kleptomania.^^^ Finally, there follows a short reference
to some published works of Jung: "A Case of Hysterical Stupor
in a Prisoner Under Trial," further " Concerning Simulation of
Insanity."^^" On the psychology of hysterical twilight states,
Riklin"'^ and Schwarzwald"* have published contributions. " On
Obsessional Psychoses " Warda^^® has written. Stekel has under-

"•Jung, "Der Inhalt der Psychose," Schr. z. angew. Seelenkunde, 3,
1908.

^ Zentralblatt fur Nervenheilkunde und Psychiatric, 1907.

^ " Psychologische Untersuchungen an Dementia praecox-Kranken,"
Jahrb., II, i, 1910.

"* Riklin, " Beitrag zur Psychologie der kataleptischen Zustande bei
Katatonie," Psychiatr.-Neurol. Wochenschr., 1906, No. 32.

^ Bleuler, " Freudsche Mechanismen in der Symptomatologie der Psy-
chosen," Psychiatr.-Neurolog. Wochenschr., 1906, Nos. 35-36.

^ Compare also Stekel, " Die sexuelle Wurzel der Kleptomanie," Zeit-
schrift f. Sexualwissenschaft, 1st year.

^ Jung, " Ein Fall von hysterischen Stupor bei einem Untersuchungs-
gefangenen," and " t)ber Simulation von Geistesstorung," Journal f. Psy-
chologie u. Neurologic, 1902 and 1905.

^Psychiatr.-Neurolog. Wochenschrift, 1904.

^^ Journal f. Psychologie u. Neurologic, 1909.

"•Warda, "Uber Zwangsvorstellungspsychosen," Monatsschr. f. Psy-
chiatric und Neurologic, 1902.

HYSTERIA 99

taken an analysis of a case of melancholia.^^" Jones reports on a
case of hypomania/^^ Maeder^^^ on a psycho-analysis of a melan-
cholic depression and Riklin^^^ on prison psychoses.

From this enumeration, which does not pretend to be complete,
it may be recognized how much promise for psychiatry is held
out by the Freudian theory of the neuroses.

"" Compare " Die Angstzustande."

^ " Psycho-analytic notes on a case of hypomania," Amer. Jour. In-
sanity, 1910.

"^ " Eine Psychoanalyse bei einer melancholischen Depression," Zentral-
blatt f. Neurologic u. Psychiatric, 1910, page 50.

^^ tlber Gefangnispsychosen," Psychiatri.-Neurol. Wochenschr., 1909.

^

CHAPTER VII

THE OBSESSIONAL NEUROSIS

Relation to Hysteria. Substitution Instead of Conversion. Charac-
teristic Obsession. " Nature and Mechanism of the Obsessional Neu-
rosis" (1896). "Remarks on a Case of Obsessional Neurosis" (1909).
Significance of Instinct in Life (Sadism). Love and Hate; Obsession
and Doubt. Mechanism of Distortion. Some Mental Peculiarities of
the Obsessed.

As a result of Freud's work, the obsessional neurosis has
received an important elucidation and the treatment of this afflic-
tion, which is often so severe as to undermine every happiness of
life, seems to warrant a much better prognosis. To be sure, those
suffering from this neurosis, the symptoms of which often appear
in childhood, must come under treatment early. The explanation
of this complicated clinical picture is accompanied by much
greater difficulties than the interpretation of hysteria, and Freud
himself admits that even he has not yet succeeded in completely
elucidating a case of obsessional neurosis ; still, there has recently
appeared a most illuminating work by Freud which utilizes the
results of his investigations during the past years, especially
regarding the nuclear-complex and instinctive life, in explaining
a case of obsessional neurosis.

In the exposition of the theory of the psychoneuroses, the
fact has already been repeatedly mentioned and emphasized that
the presuppositions of the obsessional neurosis are in part the
same as in hysteria and that their origin likewise rests on the
unsuccessful repression of psycho-sexual factors. The differ-
ences are due to the fact that here a different repression mechan-
ism and, because of the breaking through of repressed material,
a different kind of symptom formation comes into existence. The
affect of the painful idea does not become transformed into
physical symptoms as in hysteria (conversion), but affixes itself
to other ideas, not in themselves unbearable, thus producing by
this false relationship, obsessions (substitution). Characteristic
of obsessive ideas and, in a broader sense, of obsessive mental

100

THE OBSESSIONAL NEUROSIS lOI

processes in general, is that paradoxical feeling of compulsion or
obsessiveness (Zwang) in which absurd or quite harmless ideas
stand in the foreground of consciousness and resist dislodgment
by logic, even proving completely refractory to it. This arises
from the fact that the contents of these obsessive mental processes
are only false labels, carriers of affects which do not really belong
to them. Conscious logical effort exerts itself in vain inasmuch
as it only reaches a sphere of mental activity where it can accom-
plish no useful end. The displacement of the affect onto the sub-
stituted idea thus attains the end of making the real connection
unrecognizable and the work of logic fruitless. Only when by
the aid of psycho-analysis the true relation of the obsessive ideas
to the infantile material is made conscious can the obsession be
removed. The analytic therapy proceeds, therefore, upon the
following assumption, which is also demonstrable elsewhere in
mental life: where there occurs a mesalliance between an idea
and an affect, hence between the intensity of a self-reproach, for
example, and the occasion for the reproach, the laity would say
that the affect is too strong for the occasion, hence excessive and
the deduction drawn from the reproach is therefore false. The
psycho-analyst, on the contrary, has to say: no, the affect is justi-
fied, the consciousness of guilt is not to be criticized; it belongs
to another, unknown (unconscious) content which must be
uncovered.

J^s already mentioned, infantilism and sexuality possess a fun-
damental etiological significance for the obsessional neurosis as
vvell as for hysteria, although in the obsessional condition these
exhibit certain peculiarities. The sexual activities of childhood
are manifested in a particularly active manner; without exception,
these are children who even in early life betray very intense
aggressiveness. In contrast to hysteria, this characteristic of
precocious sexual activity is absent in no case of obsessional
neurosis. With this difference is connected another, namely, that
in this neurosis the male sex seems to have the preference. In
general, the obsessional neurosis shows much more clearly than
hysteria that the agents causing the neurosis are to be sought, not
in the actual but in the infantile sexual life. The necessary
infantile basis of the obsessional neurosis, in distinction to that
of hysteria, is not always completely lost in amnesia ; in particular,

102 FREUD S THEORY OF THE NEUROSES

the idea which is separated from its affect is frequently present
and treated as of no consequence by the patient's consciousness.
Etiologically, these two neuroses stand close together and fre-
quently appear in combination. At the bottom of an obsessional
neurosis, the analysis often reveals a bit of hysteria.

The first detailed work of Freud's on the obsessions^'* con-
tains the most important features of the analysis of this clinical
picture but was later found by Freud himself to require improve-
ment in certain particulars. Nevertheless, for the student, this
work, because of its schematic presentation of this clinical picture
with its most complicated psychology, is an especially good guide.

According to Freud's original exposition, the typical course
of a case of obsessional neurosis would be something as follows :
In a first period — period of childish immorality — the events con-
taining the seed of the later neurosis occur. In earliest childhood,
the acts of sexual aggression take place against the other sex
which later appear in actions symbolizing reproach. This period
is brought to an end by the appearance of sexual maturity, often
self-induced. Now a reproach becomes joined to the memory of
those sensual acts, this is repressed and replaced by a primary
defence symptom. Scrupulousness, shame, self-distrust are such
symptoms, with which the third period, that of apparent health
but really successful defence, begins.

The next stage, that of actual sickness, is characterized by
the return of the repressed material, that is, by the failure of
the defence. The revived impulses and memories as well as the
reproaches formed from them penetrate consciousness but never
in unchanged form, always as obsessive idea and obsessive affect
and the pathogenic memory substituted for the conscious life;
thus are formed compromise formations between the repressed
and repressing ideas, so that the repressing material may again
be identified in the symptoms alongside some of the repressed.

In the further course of the development of the neurosis two
forms of the disease can be differentiated according as only the
memory content of the act symbolizing reproach forces an

''*"Weitere Bemerkungen iiber die Abwehr-Neuropsychosen " (1896),
Lit. No. 8. Earlier compare under "Die Abwehrneuropsychosen " (1894),
Lit. No. 53. "Obsessions et phobies; leur mecanisme psychique et leur
etiologie" (1895), Lit. No. 6.

THE OBSESSIONAL NEUROSIS IO3

entrance into consciousness or is accompanied by the reproach-
affect. The first case is that of the typical obsession in which the
content attracts the patient's attention accompanied by only an
indefinite feeling of discomfort as affect, whereas only the affect
of reproach would be suitable for the content of the obsessive idea.
In the second form of obsessional neurosis the reproach-affect
can, by a psychic addition, change itself into any other unpleasant
affect; if this has happened, then nothing more stands in the way
of the substituted affect's becoming conscious. Thus the reproach
(of having carried out some sexual acts in childhood) is easily
changed into shame (if another becomes aware of it), into hypo-
chondriacal anxiety (because of the injurious physical conse-
quences of those reproachful acts), into social anxiety (fearing
punishment by society for that offense), into religious anxiety,
into the delusion of being observed (fear of betraying those acts
to others), into fear of being tempted (justified distrust in their
own power of resistance) and' so on. Therewith, the memory
content of the act symbolizing reproach can be present in con-
sciousness or entirely absent, which greatly complicates the
diagnostic difficulties. Many cases which a superficial examina-
tion calls general (neurasthenic) hypochondria belong to this
group of obsessive affects; especially do the so-called "periodic
neurasthenia" or "periodic melancholia" (cyclothymia) seem in
unexpected frequency to resolve into obsessive affects or obsessive
ideas, a perception which is not of slight therapeutic importance.
Besides these compromise symptoms which signify the return
of the repressed material and thereby a failure of the originally
achieved defence, the obsessional neurosis forms a series of other
symptoms of a totally different origin. The ego seeks to defend
itself against those descendants of the initial repressed memory,
and in this conflict produces symptoms which Freud has grouped
together under the name " secondary defence." These are without
exception protective measures which have performed good service
in the struggle against the obsessions and obsessive affects. If
these aids in the defence process really succeed in repressing a«ew
the symptoms of the return of the memories originally repressed
by the ego, then the obsession is transferred to the protective
measures themselves and produces a third form of obsessional
neurosis, the obsessive acts. These seem to be seldom primary;

^

104 FREUD'S THEORY OF THE NEUROSES

they never contain anything except a defence, never an aggres-
sion. Psycho-analysis demonstrates that in spite of their peculi-
arity and diversity, these acts in every case may be fully explained
in this manner. It is found that these obsessive acts, which often
seem so silly and senseless, have a meaning in all of their pecu-
liarities without exception; they serve the most vital interests of
the personality and bring to expressions^" experiences which are
still active as well as thoughts tinged with affects from the latter ;
this is effected by direct or symbolic representation. The obses-
sive acts are, therefore, to be interpreted either as historical or
symbolic.

The secondary defence of the obsessions can be accomplished
by a strange diversion to other thoughts of possibly contrary con-
tent ; hence in case of success, the obsessive reasoning is regularly
concerned with abstract and transcendental subjects, because the
repressed ideas always occupied themselves with sensuality. Or
the patient attempts to become master of each individual obsessive
idea by force of logic and appeal to his conscious memories ; this
leads to obsessive thinking, obsessive testing and doubting mania.
In these testing measures, the superior power of the obsessive idea
over the actual memory at first impels the patient and later com-
pels him to collect and preserve all objects with which he comes
in contact. The frequently grotesque and quite unintelligible
content of the obsessions is made clear by the explanation that
these ideas, in contrast to the content of obsessional acts of child-
hood, are distorted in a twofold manner: (i) An actual occur-
rence is put in the place of a past experience; (2) something
sexual is replaced by something analogous non-sexual, both
processes due to the ever-present tendency to repression. This
displacement onto another idea goes forward only gradually as
the idea becomes little by little more disparate and unrecognizable.
The obsession finally appears, devoid of motive and senseless,
quite like the wording of our nocturnal dreams, and the first
task which it imposes is to give them meaning and position in the
mental life of the individual, so that they may become intelligible
and indeed even obvious.

** According to a later statement of Freud's, the unconscious model
for certain obsessive acts which is always imitated in the course of the
disease may be the original sexual act which was later repressed. Lit.
No. 36.

THE OBSESSIONAL NEUROSIS IO5

The secondary defence against the obsessive affects develops
a still longer series of protective measures, which are readily-
changeable into obsessive acts. These can be grouped according
to their tendencies : penitential measures, irksome ceremonials,
observation of numbers, measures of protection (all kinds of
phobias, superstitions, pedantry, aggravation of primary symp-
toms of scrupulousness), fear of betrayal (paper-collecting,
diffidence), narcotization (dipsomania). Among these obsessive
acts and impulses, the phobias play the greatest role in restricting
the life activities of the patient. The phobias which appear in the
course of an obsessional neurosis are the expression, not of fears
but of prohibitions.

To give a systematic and well-rounded exposition of the obses-
sional neurosis on the basis of Freud's works is impossible ; only
recently, his first publication has been succeeded by a second which
brings out much that is entirely new and valuable, though only
devoted to the exposition of a single case of severe obsessional
neurosis without pretending to have elaborated an exhaustive or
universally applicable theory of the subject. For a presentation
which is intended to be merely a summary, the long interval
between the two works as well as the differences in their content
are well suited to illustrate the important progress and growing
depth of the Freudian doctrines. These " Remarks on a Case of
Obsessional Neurosis "^^* (1910) give extracts from a detailed
analysis of a common type of severe obsessional neurosis and, in
accordance with the modern status of the theory, trace the etiol-
ogy in widest measure to infantile sexual life and instinct, at the
same time showing in particular the connection of the obsessional
neurosis to the sadistic component of the sexual instinct. In addi-
tion, the new work contains statements on the genesis and finer
mental mechanism of obsessive thought in general, communica-
tions which, since they bear on the exposition of the psycho-
genesis of the obsessions thus far given, will be reviewed first.

In his first work, Freud had defined obsessions in the broadest
sense collectively in the following words: they are in every case
transformed reproaches which have escaped from the repression
and are always connected with some pleasurably accomplished

"•Lit. No. 36.

io6 freud's theory of the neuroses

sexual act of childhood. This definition is not discarded in the
later work but the greatest accent is placed on the word " trans-
formed." Freud's most recent work now goes into the manner
and mechanism of this transformation in exhaustive and detailed
fashion with special attention to the psychological refinements in
the formation of the neurosis. Freud starts by asserting that it is
more correct to speak of obsessive thinking than of obsessive ideas
(obsessions), at the same time emphasizing the fact that the obses-
sional structure may have the value of the most diverse kinds of
mental processes. They may be felt as wishes, temptations, im-
pulses, reflexions, doubts, commands and prohibitions. The
patients, however, strive in general to weaken this definiteness
and to consider the thought-content robbed of its affect-index
only as a mental process, as an obsession. When a psycho-analyst
comes into opposition to a person suffering from such an obses-
sional neurosis, there appears as already mentioned the paradox-
ical emotion of obsessive force attached to a very indifferent
content and it is only after much effort that he succeeds in pene-
trating to the original content to which this affect rightly belongs.
The mechanism and distortion which the patient has brought into
use in this defence conflict are not so simple as originally thought.
The value of the correctly recognized distinction between primary
and secondary defence conflict becomes limited in an unexpected
manner by the discovery that the patients for the most part do not
know the wording of their obsessions and only in the psycho-
analytic treatment become aware of their true meaning, especially
by the aid of dreams. During the analytic investigation of the
patient's history, the conviction is forced upon one that the obses-
sions which appear successively, although not expressed in iden-
tical language, are at bottom one and the same. The obsession
which has been happily gotten rid of once now returns again in a
more distorted form. The original form is the correct one,
which often allows its meaning to be clearly recognized. After
one has patiently worked out an unintelligible obsessive idea, he
often hears the patient say that such a temptation, idea or wish
really did appear at one time before the obsessive idea, but did
not remain. The typical characteristic obsession carries thus in
its distortion against its original wording traces of the primary
defence conflict. The distortion allows them to find expression

THE OBSESSIONAL NEUROSIS lO/

by compelling consciousness to misunderstand them, just as the
dream content, which is likewise a compromise and distortion
product, is misunderstood by the waking consciousness.^^'^

The distortion makes use of various mechanisms. The sim-
plest is the distortion through ellipse, which finds such special
application in wit,^^* but also does duty in the neurosis as a means
of protection against the correct recognition of the obsessive idea.
One of the favorite obsessive ideas of the patient whom Freud
took as paradigma in his publication is expressed as follows : " If
I marry Madame X misfortune will befall my father (in the other
world)." If we insert the connecting links which are omitted in
this expression and only brought to consciousness by the analysis,
the train of thought takes a more intelligible form : " If my father
were alive, he would become greatly enraged over my intention of
marrying Madame X, just as he did that time he flogged me as a
child, and I would again be angry at him and wish him all evil,
which the omnipotent power of my wishes cannot help bringing to
fulfillment upon him." This elliptical distortion technique seems
to be typical for the obsessional neurosis. Alongside the distor-
tion which the obsessive thought has undergone before becoming
conscious, there is seldom lacking a separation of the individual
obsessive idea from the occasion of its origin in which in spite of
the distortion it would be most easily accessible to the understand-
ing. In furtherance of this purpose, an interval is interposed
between the pathogenic occasion and the resulting obsessional
idea which leads consciousness astray in its search for a cause
and correspondingly disturbs the interpretation of the obsessional
idea when it is again attempted to ascertain its temporal relation-
ship to the event in the experience of the patient by discovering
when the individual obsessive idea first appeared and under what
external circumstances it usually reappears. In addition to this
temporal displacement, the content of the obsessive idea is almost
regularly freed from its special relations by generalization. In
this connection, Freud brings forward, as an example, a patient
who had the obsessive prohibition of wearing any jewelry what-

""This misunderstanding by consciousness is observable not only in
the obsessive idea itself but also in the products of the secondary defence
conflict, for example, in the protective measures.

'** Compare Freud's " Der Witz, etc.," Lit. No. 19.

/

lo8 freud's theory of the neuroses

ever, although the occasion for the prohibition went back to a
particular piece of jewelry which she had envied her mother and
which she hoped would one day come to her by inheritance. A
further frequent characteristic of the mental processes of the
obsessional neurosis is the mechanism of displacement which
Freud first discovered in the dream formation and later proved
to be also an essential factor of the technique of wit. Especially
in the obsessive acts is it most evident how by a dfisplacement
from the thing of real importance onto a substitute of little im-
portance, the symbolism and detail of the process (the cere-
monial) come to expression. It is this tendency to displacement
which is constantly changing the clinical picture of the disease
and finally succeeds in making the apparently most trivial things
seem the weightiest and most urgent.

Finally, one can separate from the distorted content the am-
biguous and indefinite wording which serves as a protection of
the obsessive idea against the conscious attempt to solve it. The
further amplifications or replacements by the obsessive force
become joined to this misunderstood wording instead of to the
correct context. These processes, in contrast to the distortion
technique of the content, belong to the secondary defence conflict,
the symptomatology of which receives a new increase from the
so-called deliria, under which term Freud places mixed conditions
between purely rational considerations and the obsessive thought
processes to which these are opposed ; and indeed these thoughts
do incorporate some of the presuppositions of the obsession which
they combat and by the aid of reason take their place in the
pathological thought. Into these deliria also enter the previously
mentioned misunderstandings; still, it can be observed that the
deliria are always striving to gain new relations to the content and
expression of the obsession which are not appreciated by con-
sciousness. In the recent description of the secondary defence
conflict, Freud also points out the genesis of the so-called pro-
tective obsession which signifies nothing else than the reaction,
repentance and penitence, to an opposite impulse.

The obsessive acts often show an alternating course in which
the first tempo is set in opposite to the second. We do not exactly
understand this second part of the obsessive act if we consider it
only as a critical aversion to the pathological act which he would

THE OBSESSIONAL NEUROSIS IO9

like to give up. The obsessive acts represent the conflict of two
impulses of opposite but equal value, chiefly the opposition between
love and hate, which plays a great role in the genesis of the
obsessional neurosis and also finds expression in its symptoms.
These alternating obsessive acts claim an especial theoretical
interest because they disclose a new type of symptom formation.
Instead of finding a compromise, as regularly happens in hysteria,
which satisfies both opposing forces in one representation, the two
opposing forces are here satisfied individually, first one, then the
other, naturally not without the attempt being made to produce
between these two hostile forces a kind of logical union, often with
the destruction of all logic.

The most important thing in the new work of Freud's on the
obsessional neurosis is, as mentioned, the proof of the funda-
mental significance of original instinct. Characteristic of a later
obsessional neurosis is the appearance of a special aggression and
activity in childhood which expresses itself chiefly in an intensive
activity of the impulse to peek (Schautrieb) and to know (Wiss-
trieb). Instinct has been especially abundant and powerful in
childhood and succeeds in being of extraordinary significance in
the genesis of the obsessional neurosis through the most intensive
elaboration of the emotions of aflFection and hostility toward the
parents,^^® brothers and sisters which, in conjunction with infantile
sexual curiosity regarding sex and birth processes, forms the
nuclear-complex of the neurosis. We find, however, in the symp-
tomatology of the obsessional neurosis a continual conflict be-
tween love and hate, a chronic existence side by side of these two
feelings toward the same person and indeed both emotions in
highest intensity, a phenomenon which is calculated to astonish
us when we always find it in these patients. Such a continuance
of contrasts is possible only under peculiar psychological condi-
tions and through the cooperation of the unconscious condition.
Love has not extinguished hate but only succeeded in repressing
it into the unconscious, where, protected from elimination through
the aid of consciousness, it can exist and even grow. Under these
conditions, conscious love attempts by way of reaction to expand
to an especially high intensity in order that it may meet the con-
stantly imposed task of holding its opponent in repression. A

*™ Compare the already mentioned " Odipuscomplex."

no FREUD S THEORY OF THE NEUROSES

very early separation of these two opposing feelings occurring in
the earliest years of childhood, with the repression of one of them,
commonly hate, seems to be the foundation of this strange constel-
lation of the life of love. Although the connection between the
negative factor of love to the sadistic component of the sexual
instinct is not explained, Freud believes that he can give out the
provisional opinion that in these cases of unconscious hate, the
sadistic component of love may have been especially strongly
developed constitutionally and have received a premature and all
too profound suppression; thus, the phenomena of the neurosis
are derived, on the one hand, from conscious affection highly
developed as a reaction, on the other hand, from the sadism con-
tinually active in the unconscious.^*" This sort of constitutional
hate component is accidentally supported by the traumata received
from prohibitions imposed mostly by the parents (father) which
attain a great significance in the genesis of the obsessional neu-
rosis. Thus, a vigorous punishment on account of sexual activity
or childhood fault in connection with this, becomes a strong sup-
porting measure of the hate which originally sprang from the
parent-complex. The occasion for such punishment soon arises
for a definite type of patient who is later afflicted with an obses-
sional neurosis, shows even in childhood voluptuous wishes to
which, of course, uncomfortable expectations and tendencies to
protective acts are joined. Thus, a conflict is present in the men-
tal life of these little voluptuaries; beside the obsessional wish
stands an obsessional fear intimately connected with the wish.
Thus, a sexual instinct and a rebellion against it, a wish (not yet
obsessive) and fear (already obsessive) striving against it, a pain-
ful affect and the compulsion toward protective acts, the inventory
of the neurosis is complete. This infantile preliminary stage of
the neurosis is regularly present and often becomes manifest in
the child as disease.^**

The next result of this noteworthy connection between love
and hate which is demonstrable in every case of obsessional neu-

**" This connection also explains the frequent and enigmatical obses-
sional laughing on occasions of sorrow which betrays the unconscious joy
at the suffering or downfall of the unconsciously hated person.

^" Thus beside the anxiety-hysteria, the obsessional neurosis is a second
type of neurosis of childhood.

THE OBSESSIONAL NEUROSIS III

rosis, is a partial weakening of the will, an incapacity for resolu-
tion in all actions for which love should be the compelling motive.
The irresolution, however, does not long remain limited to this
group of acts, but, by means of the already mentioned mechanism
of displacement, gradually spreads over the whole range of the
person's activity. Thereby is created the sway of obsession and
doubt as it is exhibited in the mental life of the obsessional
patients. The doubt corresponds to the inner appreciation of the
irresolution which as a result of the inhibition of love by hate
takes possession of every voluntary act of the patient and can
spread further to all acts, those already completed, those not yet
related to the love-hate complex and to the whole past. This is
really the doubt of the power to love which should be subjec-
tively the greatest certainty. It is the same doubt which, in pro-
tective measures, leads to uncertainty and continual repetition
which finally makes these protective acts become as impossible of
attainment as the original inhibited love resolution. The uncer-
tainty of the patients finds expression also, for example, in their
prayers imploring the sparing of the life of another which uncon-
scious phantasies incessantly interrupt; these phantasies contain
for the most part the impulse which is in direct contradiction to
the petition voiced in the prayer.

The obsession becomes now a " search for the compensation for
the doubt " and for a correction of the unbearable states of inhibi-
tion to which the doubt refers. If the patient, by the aid of the
displacement, has succeeded in bringing any one of the inhibited
intentions to a decision, this demands immediate execution; it is
indeed no longer the original energy belonging to the intention but
the pent-up energy which now finds occasion to escape by the
substitute act. It thus finds expression in commands and prohi-
bitions according as it is now the affectionate, now the hostile
impulse which gains the way of escape.

By a kind of regression, further preparatory acts take the
place of the final resolution, thought replaces action and some
sort of mental preparation for the act is carried out by obsessive
force instead of the substitute act itself. According as this regres-
sion from motor function to ideational is more or less complete,
the case of obsessional neurosis assumes the character of obsessive
thinking (obsession) or obsessive act in the narrower sense. The

112 FREUD S THEORY OF THE NEUROSES

point in question is in what stage of the continual progress of the
defence conflict the breaking through of the repressed instinct
takes place and which impulse is in control. This acceptance of
a thought as a substitute for an impulsive act makes possible the
following formula for the psychological characteristic which
gives the products of the disease its obsessional attribute: those
processes tend to become obsessions which, on account of an
opposing inhibition at the motor end of the nervous system, have
taken to themselves a fund of energy of a quality and quantity
otherwise used only for motor functions, that is to say, thoughts
which necessarily represent regressive acts.

This displacement of the accent from the motor process to the
thought process shows the obsessional neurosis to be in general a
misuse of thinking. The pathological exaggerations of the obses-
sonal neurosis, if investigated more closely, might afford great
profit for the understanding of the intellectual life in general.
In this way, Freud was able to derive something typical from the
mental peculiarities of his case. Thus, the peculiar relation to
superstition, death and reality, which is different in those suffer-
ing from obsessional neurosis. These peculiarities have their
ultimate foundation for the most part in instinct. Especially does
the strange conduct toward the subject of death and the intensive
occupation with this problem attract the attention of the physician.
Those obsessed often sympathize warmly in all cases of death and
piously take part in the funerals. This strange characteristic of
the patients rests on the fact that as children they came into con-
tact with the problem of death through their evil, vengeful wishes;
as compensation for this, there then appears their intellectual and
emotional occupation with this subject, thus this complex is also
a root of their phantasies of the future life (superstition). Their
superstitious tendencies have for the most part absolutely no other
content and in general have perhaps no other origin. Before all,
however, and here we touch on one of the motives for the illness,
they need the possibility of death as a solution of the mental con-
flicts which they find insoluble by themselves. Their essential
characteristic is indeed that they are incapable of decision, espe-
cially in matters of love. Thus, in every life conflict, they look
for the death of one who is important to them, usually of a loved
one, it may be a parent, a rival or a lover, between whom their
affection wavers.

THE OBSESSIONAL NEUROSIS II 3

Through the overvaluation of the product of their mental
processes, for example, the possibility of causing death by their
thoughts (wishes), such obsessed patients gradually come to
believe in the omnipotence of their thoughts. On the one hand,
there is also in this belief a piece of the old childish delusion of
grandeur. Another mental need which has a certain relationship
to the one already mentioned is that of uncertainty in life or doubt.
The bringing about of uncertainty is one of the methods which the
neurosis adopts to draw the patient away from reality, to isolate
him from the world, which is indeed the tendency of every psycho-
neurotic disturbance. The predilection of the patients for uncer-
tainty and doubt becomes a motive for them to fasten their
thoughts chiefly on those subjects where uncertainty is common
to all the race and where our knowledge or our judgment must
necessarily remain exposed to doubt. Such subjects in particular
as paternal parentage, duration of life, life after death and the
reliability of memory.

An especially strange trait of a patient with obsessional neurosis
who has otherwise a fairly high degree of intelligence, is the above
mentioned superstitiousness. This belongs to their suflferings but
not to their personality; it does not indeed permeate all their
thought. The patient may be superstitious during the illness but
otherwise enlightened and a freethinker. In this connection, they
often have two opposed convictions, not one incomplete opinion.
Between these two convictions, they oscillate in the most obvious
proportion to their suffering. This superstition is thus no real
conviction with the patients but has an obsessive character. From
the analysis of cases of obsessional neurosis, a deep insight into
the psychology of superstition may be gained; it can here be
recognized that superstition springs from suppressed hostile and
cruel impulses. Superstition is in great part expectation of mis-
fortune, and he who has frequently wished another evil, but on
account of being trained to kindness has repressed such wishes
into the unconscious, will find it especially easy to anticipate mis-
fortune threatening him from without as punishment for such
unconscious wickedness.

CHAPTER VIII

PSYCHO-ANALYTIC METHOD OF INVESTIGATION AND
TREATMENT

Its Peculiarity (Specific Therapy). History of the Development of
the Method. General Technique. Art of Interpretation. Indications and
Contraindications. The Transference. Refutation of the Objections to
the Method.

Freud has expressed himself repeatedly both orally and in
writing concerning his psycho-analytic technique, which has com-
pletely replaced the original cathartic and hypnotic methods;
nevertheless, there is still lacking a detailed and systematic rep-
resentation especially of the technical rules and devices founded
on painstaking empiric procedure. In spite of this, a number of
students and adherents, who in great part are in close touch with
Professor Freud, practice the therapy according to his directions
and their own auto-didactic studies and experiments. In the
hands of a physician not sufficiently versed in the subject, the
therapy can easily work harm. Psychotherapy of other kinds has
nothing in common with psycho-analysis, which differs from
hypnosis as well as every kind of suggestion and utilizes the
associations as well as the dreams of the patient to lay bare his
unconscious. Psycho-analysis proceeds from the "psychic sur-
face" and seeks from there in narrative-like penetration to set
free the repressed complexes and thereby the instinctive impulses.
The superiority of this over the methods of treatment previously
used in the treatment of nervous disorders shows best in the fact
that while acting as a specific, it reveals the etiology of the case.
Thus it is to be considered as theoretically the ideal psychotherapy
of psychogenic maladies. Freud does not mean at all that it is
always and in all cases and under all conditions the only possible
or necessary therapy and has never asserted that all cases of
neurosis are therapeutically accessible or that all can be cured.
The psycho-analytic therapy is, however, shown by experience to
work the most impressively, carry the farthest and accomplish

114

METHOD OF INVESTIGATION AND TREATMENT II 5

the most intense changes in the patients. Quite apart from the
therapeutic view-point, we are indebted to this irreplacable method
for such unexpected enHghtenment on the theory of the neuroses
as more than compensates for the only occasional bad result which
no therapy escapes. In any case, psycho-analysis is the most
interesting of all psychotherapies because it alone teaches us
something of the origin and relations of the disease manifesta-
tions. As a result of the insight into the mental mechanism of
mental diseases which it opens to us, it alone is in a position to
lead us on and show us the way to still other kinds of thera-
peutic influences.

The particular method of psychotherapy^*^ which Freud prac-
tices and calls psycho-analysis has come from the so-called
cathartic method on which he at one time collaborated with J.
Breuer in a book " Studien iiber Hysteric." The cathartic
therapy was a discovery of Breuer's by the aid of which he had,
about a decade previously, restored an hysterical patient to health,
thereby gaining an insight into the pathogenesis of her symptoms.
At the personal suggestion of Breuer, Freud then took up the
method and tested it on a large number of patients.

The cathartic method presupposed that the patient is hypno-
tizable and rested on the extension of consciousness which ap-
peared in hypnosis. He set up as a goal the removal of the dis-
ease symptom and attained this by transferring the patient back
to the mental state in which the symptom first appeared. Then
there came to the hypnotized patient memories, thoughts and
impulses which had previously escaped from consciousness and
if he communicated these mental processes under intense expres-
sions of affect to the physician, the symptom was overcome and
its return prevented. This apparently regularly recurring experi-
ence the two authors explained in their book by the fact that the
symptoms stood in place of suppressed psychic processes which
could not appear in consciousness, thus represented a change
("conversion") of the latter. The therapeutic efficacy of their
method they explained as a discharge of an affect dammed up,

"^The following review of " Freudsche psychoanalytische Methode"
is in some points an enlarged repetition of the article of Freud's by the
same name. Lit. No. i8.

ii6 freud's theory of the neuroses

as it were, which had remained from the suppressed mental
processes (abreaction, Abreagieren). This simple scheme of
therapeutic attack was complicated nearly all the time, however,
by the fact that not a single " traumatic " impression but usually
a complex series of such impressions shared in the origin of the
symptom.

The chief characteristic of the cathartic method, which puts it
in contrast to all other methods of psychotherapy, lies in the fact
that in this procedure the therapeutic efficiency does not depend
on a suggestive command of the physician. It anticipates rather
that the symptoms will disappear if the attempt, which appeals
to certain presuppositions concerning the mental mechanism,
succeeds in bringing the mental processes into different channels
than they have previously followed in the formation of symptoms.

The modifications of the cathartic method undertaken were
at first changes in the technique; these brought new results and
have necessitated a different though not contradictory conception
of the therapeutic work.

As the cathartic method had already abandoned suggestion, so
Freud took the further step of also giving up hypnosis. Since the
hypnotization, in spite of every skill of the physician, interferes,
as is known, with the free will of the patient and a great number
of neurotic persons cannot be hypnotized by any method, thus
through the abandonment of hypnosis, the applicability of the
method was extended to an unlimited number of patients. On the
other hand, the extension of consciousness was omitted which had
furnished the physician just that psychic material in memories
and ideas by the help of which the transposition of the symptoms
and the freeing of the affect was accomplished If no substitute
were to be provided for this deficiency there could be no such
thing as therapeutic influence.

Such an entirely sufficient substitute, Freud found in the
associations of the patient, that is, in the involuntary thoughts
which are mostly perceived as disturbing ones and therefore under
ordinary circumstances disregarded; these involuntarily press to
the psychic surface in the " recital "of the patient to the physician
and betray the disease complex."' Thus, at that time the work

*^**The experimental confirmation of this presupposition of the Freu-
dian method of treatment has, as already mentioned, been afforded by the

METHOD OF INVESTIGATION AND TREATMENT II /

proceeded from the symptoms and set up the solution of the same
serially as a goal ; Freud has since given up this method because
he found it entirely unsuited to the finer structure of the neurosis.
He now allows the patient himself to determine the theme of the
daily work and by this means proceeds from the complex which is
present in the foreground of the patient's mind. Thus, one
receives all kinds of material which belongs to a solution of the
symptom, broken into fragments, interwoven in different connec-
tions and distributed over widely separated periods of time; in
spite of this apparent disadvantage the new technique far sur-
passes the old.

In order to strengthen these associations, Freud uses the fol-
lowing outside means of assistance. He has the patient recline
comfortably on a couch while he sits on a chair behind and out of
his line of vision. He does not insist upon the eyes being closed
and avoids any touch as well as every other procedure which
might lead to hypnosis. Such a seance goes along like a conver-
sation between two similarly awake persons of whom one is
relieved of every muscular tension and every distracting sense
impression which might disturb the concentration of the attention
upon his own mental affairs. Before he proceeds to details, he
urges them often for several sessions to sketch a general picture
of their whole illness and most intimate family and life surround-
ings,^** to tell him everything which comes into their heads
whether they think it important, irrelevant or nonsensical. With
special emphasis, it is asked of them that no thought or association
be omitted from the communication because this telling might be
shameful or painful. In taking pains to collect"^ this material
from associations which would otherwise have been pushed aside,
Freud now made the observations which have become determin-

association experiments undertaken by the Zurich school which many
psycho-analysts use to gain associations from patients.

*** It is not recommended that the psycho-analyst undertake an investi-
gation of the somatic conditions himself but where possible to have this
done by a specialist in that line.

^** Freud warns expressly against taking up the time of the treatment
itself with making notes of the conversation of the patient because this
would awaken a mistrust on the patient's part and confuse the physician
in the appreciation of the material produced. Notes made afterwards are
nevertheless indispensable.

ii8 freud's theory of the neuroses

ing for his whole conception. Already in this narration of the
patient's history, there appear defects of memory; perhaps actual
occurrences are forgotten or temporal relations twisted or causal
relations distorted so that incomprehensible effects result. No
neurotic clinical history is free from amnesia of some kind. The
psycho-analyst can only wonder how the smooth and exact clin-
ical histories of hysterical cases are produced by other authors.
Only in the course of the treatment does the patient bring forth
what he has held back or what has not occurred to him, although
he has always known it. When one urges the narrator to fill in
these breaks in his memory by concentrated attention, one dis-
covers that the interrupted associations are held back from him
by all the means of critique until the patient finally feels direct
discomfort if the memory has really stopped. From this experi-
ence, Freud concluded that the amnesias are the result of the
process which he has described as repression (Verdrangung).
The psychic forces which have caused this repression are to be
detected in the resistance which sets itself against the revival of
the memories. To seek out and overcome these resistances is the
most important part of the therapeutic work.

The agency of the resistance has become one of the funda-
mentals of the Freudian theory. He considers the associations
side-tracked under all sorts of pretexts, as descendants of the
repressed psychic structures (thoughts and emotions), as dis-
tortions of the same by the opposition of the resistance against
their reproduction. Further, the associations of the patient are
quasi-symptoms, new, artificial and ephemeral substitutions for
the repressed material but already so much distorted that they
have only the remotest resemblance to the repressed material. If
the resistance is not too intense, it may be possible to guess from
the association the desired concealed material. The greater the
resistance, the more pronounced the distortion. In this relation
of the undirected associations to the repressed psychic material,
rests its value for the therapeutic technique. If one possesses a
method which renders it possible to discover the repressed mate-
rial from the associations, the things distorted from the original,
then one can, without hypnosis, make attainable to consciousness
the earlier unconscious material in the mental life.

In this regard, Freud has elaborated an interpretation tech-

METHOD OF INVESTIGATION AND TREATMENT II 9

nique. that accomplishes this task; this might be described as
recovering from the ore of unguided associations the metal con-
tent of repressed thoughts. The objects of this interpretation
technique are not merely the associations of the patient but also
his dreams which afford^*® the most direct entrance to the uncon-
scious, his unintentional acts such as aimless acts (symptomatic
acts) and the mistakes^" of his performances in everyday life
(misstatements, misunderstandings, etc.). According to Freud,
there is a series of empiric rules which enable the analyst to con-
struct the unconscious material from the associations of the
patient; instructions concerning what one is to understand if the
associations of the patient contradict and examples of the most
important typical resistances which appear in the course of such
a treatment.

Although as yet Freud has published no collected representa-
tion"* of the details of this interpretation and translation tech-
nique, still there are in his " Bruchstiick einer Hysterieanalyse "^*^
some preliminary references to the overcoming of certain difficul-
ties which appear regularly in every psycho-analytic treatment;
these may be removed only by an exact knowledge of their
psychic motives and the communication of this to the patient.

If it would seem at first that one might rely on the flow of
associations, on the interpretation of which the treatment depends,
even a short investigation teaches every time that, as it lies in the
nature of the whole method of treatment and its presuppositions,
the analysis is often interrupted by the resistances combating the
laying bare of the repressions. The removal, that is, the exposing

*** Freud shows the value of the technique of dream interpretation in
the psycho-analytic treatment in a book entitled " Bruchstiick einer Hys-
terieanalyse" (Lit. No. 31). One must not expect that every dream right
at the beginning of the treatment may be completely interpreted before
one is oriented in relation to the most important complexes of the patient.

^*' The interpretation technique of mistakes is in " Psychopathologie
des AUtagslebens," Lit. No. 16,

"*The comprehensive work on dream interpretation ("Traumdeu-
tung") is to be considered a precursor to such an introduction to the
technique.

*" Those of the following rules which are not derived from this
analysis are taken from Freud's lectures on " Methodik der Psycho-
therapie" delivered in the winter semester 1908, the publication of which
is in preparation.

I20 freud's theory of the neuroses

of these resistances, is the chief task of the technique ; after this
has been accomplished, the material necessary for the uncovering
of the complexes reveals itself. The physician must be prepared
for these resistances which clothe themselves in the most varied
forms and lead to pauses in the associations of the patient. The
pauses have, as experience gained from numerous analyses shows,
certain typical and, for the skillful physician, readily transparent
causes. Thus, a gross sexual memory, the communication of
which to the physician may be withheld contrary to the conditions
of the treatment, keeps constantly recurring to the patient against
his will and regularly leads to such a break in the associations.
Similarly, works a disturbance of the relation to the physician : it
may be the feeling of an especially intense antipathy or sympathy
which will not be betrayed by the patient. Further, the material
side of the treatment, an impatience over a relatively long dura-
tion of the treatment can interrupt the flow of associations. The
resistance also frequently expresses itself in the fact that the
otherwise copious dream reports stop or flow in such fulness and
extent that the placing of them in the framework of the treatment
becomes impossible. The skillful psycho-analyst will explain to
the patient how the resistance stands in the way and the motive
for his denial of associations from case to case whereby the anal-
ysis can almost always proceed more rapidly since every time,
through the elimination of the resistance, the entrance to new
unconscious material becomes free which this resistance really
only serves to conceal.

As already described, besides the associations and dreams of
the patient, the so-called symptomatic acts have great importance
for the explanation of the unconscious mental life. Under this
term Freud understands those actions which a person carries out
as they say " automatically, unconsciously, without thinking about
them, as if playing," to which they would deny any significance
and if questioned about them explain as indifferent and accidental.
Careful observation shows that such acts, of which consciousness
knows nothing or wishes to know nothing, give expression to
unconscious thoughts and impulses which are valuable and illumi-
nating as unpermitted expressions of the unconscious. Besides
the unlimited number of possibilities for individual and specific

METHOD OF INVESTIGATION AND TREATMENT 121

symptomatic acts^^° certain typical forms regularly take a hand m
the psycho-analysis. Thus, the patient's tardiness in coming to
the treatment often indicates a secret resistance against his com-
ing on this day; still more clearly does the remaining entirely
away from the appointment speak for an ordinarily very weakly
motivated ground for the prevailing powerful resistance. Just as
important as symptomatic acts are all those first communications
of the patient especially at the beginning of the treatment and
also the first expressions sometimes made at the beginning of each
consultation hour. In similar indirect manner as the patient com-
municates to the physician by means of symptomatic acts, the
direct expression of which is not possible or painful to him, so
also the next dream may bring to expression the same material in
veiled terms.

Besides these aphoristic communications of a general nature,
Freud has given in their practical application, in his published
pamphlet on an analysis of a case of hysteria, some of the rules
of interpretation gained empirically. Especially in some illumi-
nating references to reactions of the patient to certain instruc-
tions or communications of the physician which reveal uncon-
scious processes. Among these reactions of the patient, the one
called by Freud the " unconscious yes " is especially to be noticed ;
under this term, Freud understands associations which contain
something corresponding to the assertion of the physician but not
directly confirmatory. A further indirect confirmation that the
veiled unconscious material has become manifest to conscious
perception is an accidental laughing by the patient in the treat-
ment which occurs when the content of disclosed material in no
way justifies it. Other forms of affirmation are a failure to under-
stand things which come from the unconscious ; in general, there
is no " unconscious no." From this standpoint, " no " which one
is accustomed to hear from the patient after one has first laid bare
the unconscious thoughts to his conscious perception, is to be
received only as a continuation of the repression ; its resoluteness
likewise lacks the strength of the same. If one considers this
"no" not as the expression of an impartial judgment, of which
the patient is not capable, but passes lightly over it and continues

^^ Examples of these may be found in " Bruchstuck einer Hysteric-
analyse " as well as in the " Psychopathologie des AUtagslebens."

122 FREUD S THEORY OF THE NEUROSES

the work, the first evidence soon appears that " no " in such a
case has the significance of the expected yes. In a similar sense
is also to be considered the very frequent manner of the patient
in seeking to reject some information which has come up out of
the repressed by replying to a hint of the physician concerning
this with " I knew you would say that ! " A further rule which
has been derived empirically from psycho-analytic technique is
that an inner but still hidden connection is indicated by the con-
tiguity, the temporal relationship of the associations, just as a and
b in script placed beside each other mean that the syllable ab
should be formed. A further experience teaches that in cases
where the narrator is doubtful in expressing an opinion, one
should entirely overlook this uncertainty and consider the opinion
in the affirmative sense. Between the two forms of a wavering
presentation one should consider the first given as the correct one,
the second as a product of the repression. Based on this experi-
ence is the device of the interpreter of dreams of having a dream
related a second time and beginning the work of interpretation
at the places which have been changed as the least assured.

From this highly incomplete and unsystematized information
concerning the technique of the psycho-analytic method, one
might conclude that the originator of the system had caused him-
self an excessive aijiount of trouble and done wrong in giving up
the less complicated hypnotic methods. But on the one hand,
the technique of psycho-analysis is much easier to practice, once
it has been learned, than a description of it would indicate; on
the other hand, no other way leads to the goal, hence the round-
about way is the shortest. Hypnosis is to be rejected because it
covers the resistance and thereby obstructs the physician's view
of the play of mental forces. It does not remove the resistance,
but only evades it, gives incomplete information and only tem-
porary results.

The task which the psycho-analytic method is called upon to
solve may be expressed in different formulae which are, however,
essentially equivalent. It may be said, the object of the treat-
ment is to abolish the amnesias. If all the gaps in the memory
are filled out, all enigmatical effects of the mental life explained,
a continuance, indeed a recurrence of the suffering is rendered
impossible. The condition may be put differently : to trace back

METHOD OF INVESTIGATION AND TREATMENT 123

all repressions; the mental condition is then the same as that in
which all amnesias are filled. Far more important is another con-
ception: to make the unconscious attainable to consciousness,
which comes about through the overcoming of the resistances.
Thereby a piece of educational work is accomplished and for
such a reeducation for the overcoming of the deviations of child-
hood, one can conceive a very general application for the psycho-
analytic treatment. One must not forget, however, that such an
ideal condition does not exist among normal people and that only
seldom does one have the opportunity to conduct the treatment
so far. Just as health and sickness are not separate entities but
are only divided by practical definite boundaries, so one will never
set up as a goal for the treatment anything but the practical heal-
ing of the sick, the restoration of their power to work and love.
In an incomplete treatment or incomplete results of the same, one
gains especially an important improvement of the general mental
condition while one or another symptom, but with diminished sig-
nificance for the patient, can continue without branding him as
an invalid.

Aside from certain modifications which the representation of
a special therapy demands, the therapeutic method remains the
same for all the clinical pictures of the many varieties of hysteria
as well as for all manifestations of the obsessional neurosis. Of
the unlimited applicability of the same, there is no question. The
nature of the psycho-analytic method imposes indications and
contraindications both in regard to the persons to be treated and
also to the clinical picture. Most favorable for psycho-analysis
are the chronic cases of psychoneuroses with few violent or dan-
gerous symptoms; thus, all kinds of obsessional neurosis, obses-
sional thinking or obsessional acts and cases of hysteria in which
phobias and abulias play the chief roles ; further also all somatic
expressions of hysteria except those, such as anorexia, where a
rapid amelioration of the symptoms is the chief task of the physi-
cian. In acute cases of hysteria, one must await the appearance
of a quiet state; in all cases in which nervous exhaustion is the
prominent symptom, one should avoid a method which itself
demands an effort, makes only slow progress and for a long time
can pay no regard to a continuation of the symptoms.

Concerning the persons on whom psycho-analysis can be

124 FREUD S THEORY OF THE NEUROSES

undertaken with profit, there are several conditions to be observed.
First of all, they must possess a normal mental condition from
which the pathological material can be gained ; in times of mental
confusion or melancholic depression, though of hysterical type,
nothing can be accomplished. Further, a certain degree of natural
intelligence and ethical development is necessary; with worthless
persons, the interest of the physician which strengthens him for
delving into the mental life of the patient soon wanes. Outspoken
defects of character, traits of actual constitutional degeneration
exhibit themselves in the treatment as sources of resistances which
can scarcely be overcome. In general, the constitution sets a limit
for the effectiveness of psychotherapy. A too mature age, in the
neighborhood of the fifth decade, imposes unfavorable condi-
tions for psycho-analysis. The mass of psychic material is then
no longer amenable to change, the time required for a cure becomes
too long and the possibility of making psychic processes attain-
able begins to diminish.

In spite of all these limitations, the number of persons suited
to psycho-analysis is extraordinarily large and the increase of our
therapeutic power by this method is very considerable. Freud
demands a long period of time, from a half to three years, for
an effective treatment ; he says, however, that so far he has applied
his treatment, because of circumstances easily guessed, to very
severe cases, persons with maladies of many years duration and
complete incapacity for work, who having tried all treatments
came to his new and much disputed treatment as a last resort.
In cases of less severity, the duration of the treatment might be
correspondingly shortened and an extraordinary gain be made for
prevention in the future. This applies especially to the neuroses
of children, the frequency and importance of which is not yet
sufficiently appreciated; according to the results obtained so far,
they are very favorable cases for psycho-analysis. For the treat-
ment of these, it is recommended that besides the personal obser-
vation of the child, his involuntary expressions be observed by a
trustworthy and suitable person (preferably when possible, the
parents) who can keep him under observation the whole time.
As a means of combating the insanities, the method is not yet
correspondingly elaborated and modified; still, isolated cases of
investigation undertaken by the Zurich school seem to justify the

METHOD OF INVESTIGATION AND TREATMENT 12$

expectation that the psycho-analytic method may prove thera-
peutically effective up to a certain point in some forms of insanity,
such as dementia praecox and paranoia.

The art of psycho-analytic treatment as described, which
places the greater share of work on the patient, might awaken
the idea that we are dealing with a technique easily learned and
applied. If it be granted that its practice by a skilled physician
suited to it, with sufficient time to give to it, offers no difficulties,
still, the acquirement of the technique demands great perseverance
and patience especially from beginners. First of all, the patient's
associations, which are the foundation of the treatment, do not
always flow as freely, fully and in the desired clearness as is nec-
essary for a perceptible progress of the treatment. The very
nature of the neurotic malady and the processes of repression at
work causing it makes certain that the different psychic inhibi-
tions can be removed only under a resistance, the size of which
corresponds to the forces which had shared in the repression.
The patient, because of the malady, applies all the means of the
censor, concealment, disguise, symbolism, to render inaccessible
the object of the search, the repressed unconscious sexual root.
Thus, the treatment progresses under a constant struggle against
the ever-appearing resistance. The disclosure of the uncon-
scious mental life is of necessity accompanied by discomfort and
hence always retarded by the patient. One can estimate the
difficulties of the process by considering that the treatment only
approaches its end when all the strata of the mental life have
been penetrated and all gaps in memory (amnesias) of the patient,
even to the earliest childhood, have been filled out. The great
abundance of experiences which after decades of sickness finally
become inexhaustible as well as the necessary resistances under
which the actual rendering conscious of the unconscious proceeds
are the circumstances which sorely try the patience of patient and
physician and can protract the treatment many months and even
years. This demand on the patience of the patient diminishes in
contrast to the patience which the continuance of the pathological
phenomena requires of him.

In the end, it is the content of infantile repression which con-
tains the pathogenic material which cannot be at all clearly

126 freud's theory of the neuroses

obtained from the patient but must be in part guessed by the
physician on the ground of his previous experience and arranged
so that the patient's consciousness will perceive his unconscious
wish-impulses. We attain this by bringing before his conscious-
ness in our own language the unconscious complexes which he has
given hints of possessing and which the art of interpretation has
assisted in revealing. The similarity between what he has heard
and what he seeks will penetrate consciousness in spite of all resist-
ance and put him in a position to find the unconscious. The
physician is a little ahead in comprehension, the patient follows
in his own way until both reach the goal aimed at. Beginners in
psycho-analysis seek to change these two points and to consider
the time, at which they recognized an unconscious complex of the
patient, the same as that at which the patient perceived it. They
expect too much if they would heal the patient by communicating
this knowledge, for he can only use the communication as an aid
in finding the unconscious complex in his unconscious where it is
fixed. With this part of the analysis, that purely expectant atti-
tude of the physician which was formerly laid down as a condition
of the treatment finds a limitation. It is important here that the
skillful physician should not leave his patient imprepared and as
a rule he has to ask from him not enlightenment but merely con-
firmation of his suspicions. The psycho-analysis of a patient is
no aimless scientific investigation but a therapeutic procedure; it
wishes to prove nothing, merely to change something. Every time
in the analysis, the physician gives the patient the conscious ideas
expected, by the help of which he will be in position to recognize
and comprehend the unconscious. What the physician communi-
cates to the patient comes from other anal)rtic experiences and it
is really proof enough if by the aid of this medical intervention
the connection and solution of the pathogenic material is attained.
The best way to introduce these expected ideas is by giving the
patient on suitable occasion a view of the meaning and procedure
of psycho-analytic therapy as well as its psychological presupposi-
tions, for example, by explaining to him the importance of the
psychological distinction between conscious and unconscious, con-
cerning infantilism, etc., and wherever possible allowing him to
find and comprehend it from his own material.^''^ Nevertheless,

*" The reading of published articles by the patient is not advantageous
to the treatment.

METHOD OF INVESTIGATION AND TREATMENT 12/

it should never be the aim of such discussions to convince. They
should introduce the repressed complexes to consciousness, insti-
gate the strife with them on the floor of conscious mental activity
and render easier the appearance of new material from the uncon-
scious. Conviction comes only after the material won from the
unconscious has been elaborated by the patient, and so long as he
is wavering one must consider the material as not exhausted.

Without having won an intellectual conviction, however, the
patients indulge in that peculiar cessation of authoritative belief
and of the need of instruction from the physician and on the con-
trary show an emotional interest in these things and through this
to gradually participate intellectually in the theory. We come
here upon a highly important agency of the psycho-analytic treat-
ment, namely, the condition of "transference" ("Ubertra-
gung")^^^ as Freud has called that peculiar psychic dependence and
respectful sympathy which the neurotic brings to the physician
whom he trusts, and without the appearance of which, as occa-
sionally happens because of uncongenial personalities, the treat-
ment terminates spontaneously soon after its beginning.^^^ This
so-called transference is at bottom nothing else than what occurs
in every psychic influencing, indeed one can say that in general no
medical treatment is possible without a certain degree of confiding
sympathy from the sufferer. According to Freud's experience,
it is especially certain that, for example, the sanitarium treatment
also depends only on such a subordination of sympathetic emo-
tions to the authority of the esteemed physician. Now, neurotics
are really much richer in free movable craving for love (libido),
the quantity of which is constantly increased by the analytic
breaking down .of inhibitions, so that it is no wonder that this
sympathetic relation to the physician becomes more intense and
emotionally toned than in patients with organic disease. What is
more obvious than that this free floating libido (in widest extent
of eroticism) freed from the repression in the way of sublimated

"'A comprehensive presentation of the "transference" is deferred
until the title "general therapy" is reached. As preliminary, compare
Freud (Lit. No. 21) as well as Ferenczi, "Introjektion und Ubertragung "
(Jahrb., I, page 422).

"* Striking results right at the beginning of the psycho-analytic treat-
ment rest merely on transference and are mostly only temporary apparent
results.

128 freud's theory of the neuroses

homo- or heterosexuality should be transferred to the attending
physician whose intimate and prolonged deahng with the mental
life of patients is the most favorable soil for such seeds. Thus,
transference is not a specific result of psycho-analytic therapy but
it appears here most clearly because of the conditions under which
the treatment is carried out. Sentimental critics need not, how-
ever, get angry at the thought that the physician could use or
abuse this relation in any way. On the contrary, the real effect-
iveness of this most important aid in the psycho-analytic treat-
ment consists just in the fact that one has to continually release
the patient from his transference by explaining to him that his
whole intense interest in the person of the physician is only a
transference of previous emotional impulses originally directed
toward other persons. The productivity of the neurosis is really
not interrupted during the psycho-analytic treatment, although
the new formation of symptoms ceases, but busies itself in the
creation of a special kind of thought formations, mostly uncon-
scious, to which the name transference is given for the reason
that they are new editions, later expressions of impulses or phan-
tasies which have been awakened during the progress of the anal-
ysis and should be made conscious. These transference-phantasies
show themselves by a characteristic replacement of an earlier
person by the person of the physician. To put it differently : A
whole series of earlier psychic events becomes active again, not
as something which has happened, but as an actual relation to the
physician. To use Ferenczi's apt comparison from chemistry, the
physician plays the role of a catalytic ferment, which in the
process of setting free affects, draws them to itself. There are
transferences which in their contents are to be distinguished from
their prototype in absolutely nothing. Thus, they are special
reprints, unchanged new editions. Others are artfully created
and have undergone a toning down of their content, a sublima-
tion, and thus resemble new works. The transference is a neces-
sary part of every psycho-analytic treatment and one can easily
convince himself in practice that it is in no way to be avoided and
that this last phenomenon of the malady has to be combated like
all the earlier ones. This part of the work is by far the hardest
because one must guess the transference, independently, without
any help from the patient, in insignificant stopping points and

METHOD OF INVESTIGATION AND TREATMENT I 29

without making himself guilty of arbitrariness. To avoid it, how-
ever, is impossible, since it is applied for the origination of all the
obstructions which render the material inaccessible.

One will be inclined to consider it a great disadvantage of a
method otherwise inconvenient that it still increases the work of
the physician through the creation of a new kind of pathological
psychic product, indeed perhaps may work injury to the patient
by the analytic treatment through the existence of the transfer-
ence. Both would be erroneous. The work of the physician is
not increased by the transference; it may be indifferent to him
whether the resurrected impulse of the patient has to be overcome
while it is attached to himself or to another person. Further, the
transference in the treatment imposes no new task upon the
patient which he would not otherwise have performed. If recov-
eries from the neuroses also come about through other influences,
still, it is possible only because of such a latent working transfer-
ence. The difference is on?.y that the patient ordinarily merely
produces affectionate and friendly transference in his recovery.
In the psycho-analysis, on the contrary, all impulses corresponding
to a change in motivation, even hostile ones (negative transfer-
ence), are awakened, transferred to the physician and by being
made conscious aid the treatment ; thus the transference is always
destroyed for good. The transference which is destined to
become the greatest hindrance to psycho-analysis is the mightiest
means of help when one succeeds in detecting it immediately and
translating it to the patient. One should not conclude that the
transference is a sort of lasting attachment of the patient to the
physician, as, for example, has been the reproach of hypnotic
therapy. On the contrary, it has already been asserted that the
patient must be constantly informed of it and that the physician
should meet the patient with a certain cool aloofness and must
really endeavor^^* at the close of the analysis to leave him as much
a stranger to the patient as he was before the treatment began;
in this way, not only the genuine cure of the patient but also his
own independence is attained The one or another symptom
which still persists often disappears entirely and for good only
after the complete dissolution of the transference-relation.

"*A similar transference on the part of the physician (reversed trans-
ference) is to be avoided by self -analysis.
10

130 FREUD S THEORY OF THE NEUROSES

Against this method of Freud's loud dissenting voices have
repeatedly been raised, characteristically though only by those who
have never used the method at all or only with unsatisfactory
results. For everyone who has gained by continued contact with
neurotics an intimate insight into the hysterical mind must have
been thereby convinced of the effectiveness of the Freudian
therapy. No one can escape the convincing evidence of the erotic
complexes always active in the foreground nor the accompanying
powerful resistances against these becoming conscious. The
justice of these empiric impressions is suited to banish the last
doubt of the existence of the unconscious and its specific content.

The objections of the critics arise not so much from intimate
knowledge as from a priori dislike of the subject of sexuality
which must inevitably be dealt with in the etiology of these patho-
logical conditions. These same opponents are also quite unjustly
indignant over the therapy in respect to the fear that it may accom-
plish the seduction of the patient and by dealing with sexual
themes and a subjectivmus which can only injure them. This kind
of pretended suggestion is, however, nowhere so impossible as in
psycho-analysis itself, where the free-flowing associations of the
patient show the way for the progress of the treatment. On the
contrary, the psycho-analyst knows that the analytic work stops
immediately the moment the physician seeks to suggest a wrong
or forced solution. The skillful psycho-analyst will in general
limit himself as far as possible to the passive role of listener.
Then the neurotic patient himself often brings forward his sexual
and erotic phantasies and one needs only once to see the feeling
of relief on the patient's part who has for the first time accused
hunself before a judge who understands, in order to be certain
that there can be no question of suggestion. Freud has never
insisted, as some superficial reviewers believe, upon forcing a
free indulgence of the sexual appetite. He asserts, rather, that
the recommendation of sexual activity to psychoneurotics is mostly
to be considered bad counsel, because in the mechanism of the
neurosis not merely the sexual need and deprivation come into
play. The other just as important and indispensable factor which
is all too readily forgotten is the sexual disinclination of neurotics,
their incapacity for love, that psychic trait on which the repres-
sion rests; it is from the conflict between these two tendencies that

METHOD OF INVESTIGATION AND TREATMENT I3I

the neurotic malady develops. The psycho-analytic treatment
aims not at all at freeing the instincts from the repression, so
that they may be indulged unhampered, but has in view the bring-
ing of the patients to the point where they can control the same,
partly by conscious mental forces, partly by conducting it to a
higher and therefore unobjectionable goal (sublimation). The
fear occasionally expressed that the unchaining of the suppressed
evil instincts may bring injury becomes groundless through the
experience that the psychic and somatic power of such instinctive
impulses is only weakened by bringing them into consciousness.

If it is further objected that there is a danger to the indi-
vidual as well as to society in discussing the sexual theme in its
widest extent and in all detail during the psycho-analytic treat-
ment, that the physician has no right to penetrate into the sexual
secrets of his patients, that he may wound their modesty — espe-
cially of the women — through such gross examination, that his
awkward hand may disturb family peace, that he may destroy the
innocence of young persons and encroach upon parental authority,
acquire disturbing knowledge of private affairs of adults and dis-
turb his own relation to the patients, it may be answered : This is
the language of an unworthy prudery of the physician which
imperfectly covers his incompetency with bad arguments. If
agencies from the sexual life are recognized as really causing
disease, then the development and discussion of these agencies
hereby falls without further thought into the duty of the physi-
cian. The wounding of modesty of which he may be guilty is
no different and no worse than he would inflict if in order to heal
a local affection of the female genitals he made a digital or visual
examination which the school imposes upon him as a duty.

Occasionally one also hears the objection to the psycho-
analytic treatment, which must be classed as almost malevolent,
that the psycho-analytic treatment oftener than any other injures
the patient, indeed may occasion suicide. So far as it is not direct
personal hostility which dictates this reproach, it is the resistance
against something new which forgets that hydrotherapy and other
therapeutic methods sometimes treat as a neurosis, conditions
which are really beginning psychoses. Also, one will judge other-
wise if one has got in the habit of charging to the treatment
everything which happens during the treatment of a case of dis-

132 FREUD S THEORY OF THE NEUROSES

ease. Occasionally, apparent retrogressions in the neurotic patho-
logical condition will appear through acute conditions in no way
chargeable to the treatment but which are in most cases necessary
and healthful eruptions of the unconscious, strong reaction
phenomena, under which the deviation from the normal is cor-
rected, the mental obsession is broken. In general, the state of
health during the treatment is no standard of measure for the
final results.

The resistance against this novel and not easily acquired
method of treatment manifests itself also in a certain mischievous
joy which is shown when occasionally results are not immediately
forthcoming or are absent altogether. Now it happens often as
related that the result does not follow immediately on the termina-
tion of the treatment but that the condition of the patient only
first approaches health some time after the end of the analysis
and indeed from the time at which the relations to the physician
are completely and smoothly dissolved. The delay in the cure or
improvement seems in general to be essentially conditioned on the
earlier described transference-relation. Moreover, the results in
the treatment of the neuroses are often shattered by affairs in the
external life of the patients, the healthful changing of which lies
beyond the power of the physician. Against the recovery, stand
many kinds of unconscious motives, since the patients fled to the
neurosis and thus many a symptom, in spite of an analysis which
has progressed far, is not to be got rid of because of this obstinacy
of such a "secondary function" in mental life which nourishes
such a mental disturbance. He who wishes to make the patient
well stumbles to his astonishment upon a great resistance which
teaches him that the patient is not sincere in wanting to get rid of
his suffering. In the battle of these disease motives, as Freud
calls them, lies quite generally the weakness of any therapy and
also of the psycho-analytic. Thus, for example, when a neglected
wife, or one who feels herself neglected, knows how to gain
through sickness sympathy, attention and love from her husband
which she lacked, by the relinquishment of which, the previous
dull married life would begin again. In general, it is a pre-
requisite of every possibility of cure that the patient suffers from
his symptoms or better said suffers more than what he gains from
his sickness. An homosexualist, a fetichist, a pervert will as a

METHOD OF INVESTIGATION AND TREATMENT 1 33

rule absolutely refuse to give up his pathological tendencies.
Whether this case occurs from external or internal causes, how-
ever, taking into consideration the least influenced cases as well
as the most favorably influenced, one must still consider the
psycho-analytic therapy the method of choice in such abnormal
conditions. It should be expressly mentioned that a psycho-
analytic treatment, though incomplete, may show relatively good
results by making the patient cheerful and capable of work and
play. And even if the patient is not completely restored to health,
still he has usually learned to partially diminish his symptoms by
self-interpretation and to control his unconscious.

From all this, one sees that the method of psycho-analysis
makes high demands both on the patient and the physician ; from
the former, it demands the offering of complete sincerity, a con-
siderable amount of time and hence a good deal of expense; from
the physician, it also demands much time and therefore makes
desirable, as well as because of the tediously learned and difficult
technique, a specialization in this field. It is therefore intelligible
that one might prefer methods which promised cure more con-
veniently and in shorter time. At first there came into the hands
of the psycho-analyst mostly patients who had already sought all
other methods in vain and had spent years in sanitaria. These
patients, however, are in about the condition of sufferers from
tuberculosis who have cavities in their lungs; treated as light
catarrh of the apices, they would have yielded dazzling results.
It should not be said that psycho-analysis cannot heal severe cases
of neurosis — the technique has been founded and proven on just
such cases — nevertheless, these cases must come at the right time
into the hands of suitable psycho-analysts. There is still lacking
and will be for a long time a sufficiently widespread recognition of
the nature and significance of psychoneurotic maladies, both
among medical circles and the laity, and herein lie the essential
difficulties which now oppose the psycho-analytic method and not,
as is still always supposed, in the thing itself. The psychoneuroses
as a class are not at all mild diseases, as in greatest part the physi-
cians and more yet the laity suppose ; the latter is firmly convinced
of the superfluousness of all these disease phenomena and there-
fore neither brings a patience for the course of the disease nor a
special readiness to sacrifice to the therapy. The sincerity of the

134 FREUD S THEORY OF THE NEUROSES

physicians and the accommodation of the laity will be established
for the psychoneuroses when it shall be known that a severe
neurosis, in its importance for the afflicted individual, is not one
whit behind any of the feared general diseases and that the resto-
ration from years of incapacitating sufferings, corresponding in
degree to their energies, is not to be expected in a few weeks nor
from a treatment which causes no inconvenience. The psycho-
analytic therapy has the triumph of having made permanently
capable of existence a gratifying number of all the severest cases,
and against these results all objection is insignificant. Hence it is
obvious that the analytic treatment in the mild periodically appear-
ing maladies or in the initial stages of severer cases can obtain
brilliant and often surprisingly rapid and lasting results; it is
only a question of time and of the increasing knowledge of these
maladies when psycho-analysis will be able to prove its great
cultural and social importance as a real prophylactic method
(education, enlightenment).

CHAPTER IX

GENERAL PROPHYLAXIS OF THE NEUROSES
Cultural Sexual-Morality. Sexual Education, Sexual Enlightenment.

Physicians are accustomed to being unsatisfied with the mere
curing of a disease and to seek the ideal condition in its preven-
tion. This important point must be discussed : How do the new
facts concerning the etiology of the neuroses affect their prophy-
laxis? Freud has expressed himself in detail on some of these
points in his article " Die kulturelle Sexualmoral und die modeme
Nervositat ""^ (Cultural Sexual-morality and Modern Nervous-
ness) and come there to the consoling opinion that the frequency
of nervous maladies in our time is not due to the progress of
civilization and the acquisitions of technical science nor to the
complex and rushing manner of life of civilized men, as has been
generally held. It is not so much that this widespread view is
erroneous as that it is inadequate to explain the peculiarities of
the phenomena of the nervous disturbances and leaves out of
account the most important of etiological factors. If one looks
away from the more indefinite kinds of "being nervous" and
limits his attention to the genuine forms of nervous maladies, he
finds the injurious influence of civilization really narrowed down
to the injurious suppression of the sexual life of civilized people
(or classes) through the prevailing cultural sexual morality. The
Freudian investigations have shown that culture has been quite
generally built upon the suppression of the instincts. Experience
teaches, however, that for most people there is a limit beyond
which their constitution cannot follow cultural demands. It is one
of the most manifest social injustices that the cultural standard
should demand of all persons the same conduct of the sexual life
which is possible for some on account of their organization with-
out trouble, while on others it imposes the greatest mental hard-
ship. Really, in this way, the relatively large number of perverts
is occasioned. Many idealistic reformers would even sharpen still

«' Lit. No. 30.

135

136 freud's theory of the neuroses

more the sexual morality by demanding from individuals of both
sexes abstinence before marriage and lifelong abstinence for all
who cannot enter into a legitimate marriage. To such an one, we
may answer in opposition that the task of conquering such a
mighty impulse as the normal sexual instinct can take all the
strength of a man. The conquering through sublimation, the
transference of the forces of the sexual instinct from sexual ends
to higher cultural aims, succeeds in only a minority ; most of the
others either become neurotic or come to other injury. Experi-
ence shows that the majority of persons composing our society
are not constitutionally adapted to endure abstinence. Those
who would become ill under a more liberal sexual limitation
become sick just so much earlier and so much more intensely
because of the demands of our present-day cultural sexual moral-
ity, for against the menace of a normal sexual impulse through bad
heredity and disorders of development, we know no better secur-
ity than sexual gratification itself. The more anyone is predis-
posed to a neurosis, the worse he bears abstinence. The dammed-up
libido is really placed in a condition to hunt out any weak place
which is seldom lacking in the sexual life, there to break through
into neurotic substitute gratification in the form of symptoms.
He who knows how to penetrate into the conditions of nervous
maladies soon becomes convinced that the increase of nervous
diseases in our society arises from the increase of sexual limita-
tions. In the vast majority of cases, the struggle against sen-
suality saps the available energy of character, and this just at a
time when the young man needs all of his powers to win his lot
and place in society. On the other hand there is the onanism,
often continued into the adult years, and when treating the
question of abstinence, one distinguishes much too little two
forms of the latter: the refraining from all sexual activity and
the refraining from sexual intercourse with the opposite sex.
Many persons who boast of abstinence from the other sex have
accomplished this only by the aid of masturbation. Further, this
corresponds in no way to the ideal demands of cultural sexual
morality and therefore drives the young man into the same con-
flict with the educational ideal which he would escape through
abstinence. It further ruins the character in more ways than
one, chiefly however, because the sexual activity of a man is a

GENERAL PROPHYLAXIS OF THE NEUROSES 1 3/

model for his whole way of reacting in the world (psycho-sexual
parallelism). To one who has energetically won his sexual object,
we give credit for similar reckless energy in the pursuit of other
goals. On the other hand, he who for various reasons renounces
the gratification of his strong sexual instinct will also be rather
conciliatory and resigned than energetic in other affairs of life.
Even as complete an abstinence as possible during adolescence is
not a young man's best preparation for marriage. The suppres-
sion of everything sexual, this applies especially to the strict edu-
cational rules for girls, as Freud has expressed it, is frequently
so well accomplished and carried so far that the sexual instinct,
after being released, seems to have suffered lasting injury.

Further, the sexual intercourse in legitimate wedlock offers
no full indemnity for the limitations before marriage, chiefly
because that very frequently from cultural and material reasons,
the marriage must be satisfied with a limited number of concep-
tions, hence after a few years, the marital intercourse is limited
by all those measures directed at the prevention of pregnancy, the
sexual satisfaction is spoiled, the finer sensibilities of both parties
disturbed or where an intolerance against these measures exists,
the health suffers. It is especially the woman who, under such
marriage conditions, may become most severely ill and endure for
life the saddening neurosis. Marriage has thus, under present
cultural conditions, long ceased to be a panacea for the nervous
diseases of women; and if we physicians still always recommend
it in such cases, we know that on the contrary, a girl must be really
healthy to stand marriage and strongly advise our men patients
against marrying a girl who has been " nervous " before marriage.
For it is also a grievous discovery for the man to get a constantly
anesthetic woman in marriage, a very frequent result of the
present generally approved strict and over-moral education of
girls. The undersensitive wife and the husband, because of
chastity and masturbation of little potency and especially fre-
quently suffering from ejaculatio praecox, make a picture of a
modern " nervous " marriage where the incomplete sexual gratifi-
cation brings on that nervousness and irritability which destroys
the family life. The neurotic wife, ungratified by her husband,
is as a mother overaffectionate and overanxious toward the child
to whom she transfers her craving for love, thereby awakening

138 freud's theory of the neuroses

in him sexual precocity. The bad agreement between the parents
excites the emotional life of the child and causes it in its tenderest
years to feel intensely love, hate and jealousy. The strict edu-
cation which tolerates no kind of expression of the early awakened
sexual life assists the suppressing power and the conflict at this
age contains everything necessary for the causation of a lifelong
nervous invalidism.

Individual prophylaxis must be instituted in earliest childhood
as the whole etiology of the neuroses teaches ; according to Freud,
this is a self-evident fact. The child cannot be too carefully
guarded from every evil influence from other children as well as
from adults, especially nurses, who are often guilty of abuse and
seduction of little children. A constant oversight of the child
and an environment in no way precarious must be most emphat-
ically recommended. That the parents themselves in their igno-
rance, by excessive aflfection,^"^ boisterous caresses, all too fre-
quent taking the child into bed with themselves, prematurely
awaken his instincts and thereby bring injury upon him may be
again asserted. That excessive masturbation must be combated
at the right time has already been emphasized.^**^ This should,
however, not convey the impression that the avoidance of sexual
experiences which finally bring enlightenment can by itself pre-
vent the formation of neuroses. It must much rather be expressly
emphasized that it is of decisive importance for the prophylaxis
that no too rigorous demands for repression be imposed on the
children, especially on those with bad heredity. For the relaxa-
tion of the repression at the right time corresponding to the
demands of life renders continuance in health possible. In this
sense, Freud is a supporter of a systematic enlightenment of
children.^''^ The necessity for this lies in the fact that children
often show great interest and understanding in the affairs and
problems of the sexual life. This finds expression not only in the
instinct for sexual investigation of children which leads to the
already mentioned, sometimes very disastrous birth and creation
phantasies but also in masked form in their untiring questioning,

"•Compare A. Adler, "Das Zartlichkeitsbediirfnis des Kindes," Mo-
natshefte f. Pddagogik u. Schulpolitik, 1908.

'"Compare the detailed discussion of the problem of onanism under
neurasthenia (Chapter II).

"'Lit. No. 26.

GENERAL PROPHYLAXIS OF THE NEUROSES 1 39

which education has to satisfy intelligently. The fear that the
child may be enlightened prematurely is entirely ungrounded;
for when the child once begins to inquire, it has already busied
itself a long time most intimately with the sexual problem ; experi-
ence teaches that it is injudicious either to wish to silence or lead
into false channels this interest of the child once it is awakened.
To wish to hold back the sexual instinct of the child through
such concealment could only lead to his later learning to condemn
everything sexual as something vulgar and abhorrent. If one
seeks to deceive them through false information as the stork
legend, etc., then when they penetrate behind this untruthfulness
of the parents or teacher, they lose trust and respect for them and
can often receive mistrust as a character trait for their whole
lives. The manner of sexual enlightenment Freud has repre-
sented as a gradually progressive and really uninterrupted instruc-
tion for which, in place of the parents who are as yet unqualified
for such a task, the school must take the initiative. The most
important point in this is that the children should never get the
idea that one wishes to make the affairs of the sexual life any
more of a secret for them than anything else which is not yet
comprehensible to their understanding. That there is opportunity
for the public teacher and indeed for the clergy to make use of
the Freudian knowledge for the good of their adherents is shown
by the publications of the Zurich pastor Pfister.^^^ Unfortunately,
the parents as well as the teachers of to-day still lack the neces-
sary knowledge of sexual matters, especially in relation to neurotic
disturbances. Especially do our parents and educators lack the
candor to discuss the sexual problem from which they in great
part openly suffer with the children; consequently they lack the
possibility of guarding the latter against sexual injuries and of
explaining to them in sufficient manner all allied themes. A child

"* Oskar Pfister, " Psychoanalytische Seelsorge und experimentelle
Moralpadagogik," Protestantische Monatshefte, 13th year, part i, M.
Heeksius, Leipzic, 1909. Same, "Ein Fall von psychoanalytischer Seel-
sorge und Seelenheilung," Monatschrift " Evangelische Freiheit," 9th year,
Tubingen, J. C. B. Mohr, 1909. Same, " Die Psychoanalyse als wissen-
schaftliches Prinzip und seelsorgerliche Methode," Ebenda, loth year,
1910. Dr. A. Muthmann also sought to interest the clergy in an article
" Psychiatr.-theolog. Grenzf ragen," Halle a. d. Saale, Karl Marhold, 1907.

I40 FREUD S THEORY OF THE NEUROSES

who is ignorant of sexual matters will have quite a different fate
from one who has been instructed in these things. We perceive
therefore, that the education in the affairs of sex is of great
importance not only in the prevention of the neuroses but also
for the whole character development of the child. Therefore,
sexual education^*" is essentially the fundamental problem of
education and cannot be separated from the question of sexual
enlightenment. How the education should begin or how to avoid
injurious results which have already occurred is a subject on
which Freud has not expressed himself in detail, since he con-
sidered his field to be rather investigation and therapeutics than
pedagogy and reformation. The three following chief view
points for sexual education in general may be deduced from
Freud's works : In a first period, the education should vigorously
aid the suppression of the normally occurring instinctive impulses
and the repression of wrong (perverse) impulses of the growing
child, thus preventing wrong tendencies and disturbances of de-
velopment ; in a later period, it would have to interfere positively
and educate the child chiefly through love; in a third period, the
grown up child would with the aid of his own parents free him-
self from their authority and establish his psychic and social
individuality.

If the prophylaxis, however, is to become effective and far-
reaching, wider circles must be interested in the problem. For in
affairs of prophylaxis, the individual is almost powerless. The
whole body of citizens must acquire an interest in the subject and
give their consent to the creation of generally observed regula-
tions. At present, we are far removed, however, from a condition
which would promise a remedy and can therefore justly make our
civilization and cultural morality answerable for the spread of the
neuroses. There must be a great change of mind. The opposition
of a generation of physicians who no longer recall their youth
must be broken. The haughtiness of the fathers who do not
gladly descend to the level of ordinary mortals in the eyes of their
children must be overcome, the foolish bashfulness of the mothers
must be combated, for whom it now seems like an inscrutable and
undeserved decree of fate that their children have become nerv-

^'* Compare A. Adler, "Das sexuelle Problem in der Erziehung," Die
neue Gesellschaft, 1905.

GENERAL PROPHYLAXIS OF THE NEUROSES I4I

ous. " Before everything else, however, there must be opened in
the general thought a chance for the discussion of the sexual
problem; one must be able to speak of these things without being
pronounced a disturber of the peace or a delver in the vulgar
instinct. And there remains enough work here for a century in
which our civilization must learn to live according to the demands
of our sexuality.""^

"'Lit. No. II.

CHAPTER X

APPLICATION OF PSYCHO-ANALYSIS

Importance of Psycho-Analysis for Medicine. Importance for the
Psychology of Normal Individuals and for Normal Psychology (Uncon-
scious, Dream, Wit). Psychopathology of Everyday Life. Elucidation of
the Psychology of Psychopaths, Criminals, Artists, Poets and Geniuses
(Characterology). Importance for the History of Culture and Folk-
Psychology.

It is an indisputable service of Freud's to have elaborated
psycho-analysis to a method which is not only able to disclose the
pathogenesis and content of mental disorders but is also valuable
for their treatment. It cannot be rejected as Utopian to believe
that when the fundamental principles of the neuroses as revealed
by Freud shall have become for the general good a part of medical
knowledge and thereby indirectly a part of universal knowledge,
the frequency of the neuroses may be lessened.^'^ The psycho-
analytic recognition of the nature of these maladies, of their
psycho-sexual root as well as the means of prophylaxis to which
they point, will likewise work together to allow the neuroses to
appear only in plain form. Individuals of neurotic disposition
will have to renounce the representation of their symptoms after
the origin and symbolism of these shall have become trans-
parent.^®^ Perhaps indeed, psycho-analysis may succeed in
destroying the germ of the neurosis in childhood when the
teacher, entrusted with the chief points of the theory, aids in the
prevention. Psycho-analysis is not, however, merely a method
for investigating disordered minds but seems to be destined to
become perhaps the most influential method of mental investiga-
tion in general. Psycho-analysis yields such far-reaching expla-
nations of the mechanism of mental functioning that in contrast
to a certain stagnation in the official psychology of the universities,

*" Compare Chr. v. Ehrenfels, " Sexuales Ober- und Unterbewusst-
sein," Polii.-anihropolog. Revue, II, Part 6.

""Compare Freud, "Die zukiinftigen Chancen der Psychoanalyse,"
Lit. No. 41.

142

APPLICATION OF PSYCHO-ANALYSIS 143

it allows an especially hopeful outlook. The " hopelessness of all
psychology,"^** which P. J. Mobius has proclaimed, can with a
certain degree of justification be applied only to the prevailing
"consciousness-psychology" (Bewusstseinspsychologie), while the
method for investigating unconscious mental processes inaugu-
rated by Freud affords an outlook which is full of promise for the
future. The precise psycho-analytic method can replace the
speculations of metaphysics which have remained essentially
unchanged for centuries as a kind of " metapsychology." Psycho-
analysis has brought forward such new and fundamental prin-
ciples regarding forgetting and mental obsession (Zwang), which
is so closely connected with the theory of the will, and in particular
has placed the determinism of all mental processes on so broad a
basis"^ that from this point an especially productive scientific
period will take its origin. It has already placed the fundamental
facts of mental processes in a new light. Thus, of prime impor-
tance, are revealed the eternally acting wishes of the mind, the
ever-compelling instinct and the continual striving after pleasure
as the primary tendencies of the mind. Alongside these are the
mechanisms of repression, condensation and displacement dis-
covered by Freud; these arise from the entirely new conception
concerning the investment of ideas with affects and that the two
are separable ; further the substitute formations and the sublima-
tion which is so important in the history of culture, all these
afford valuable building stones in the most diverse departments
of psychology. Freud has thrown light into isolated departments
of general psychology by his detailed investigations into the
psycho-pathology of everyday life, the technique of wit formation
and the mechanism of dream origin. He has solved that ancient
enigma of the dream and, in opposition to the consciousness-
psychology, has brought about the enthronement of the uncon-
scious. The original perception of Freud's of the close connection
of the development of culture to the suppression and sublimation
of instinct has so much significance in the history of evolution of
humanity and of individual peoples that in this field also, much
work and fruitful knowledge is yielded by psycho-analysis. The

*•*?. J. Mobius, "Die Hoffnungslosigkeit aller Psychologic." Mar-
hold, Halle a. d. Saale, 2 ed. 1907.

'"Compare the numerous references to the association experiment.

144 FREUD S THEORY OF THE NEUROSES

fact that besides the life instinct of the ego, the love-instinct has
a far-reaching primordial force, which cannot fail to injure the
individual if it succumbs in the conflict of these two fundamental
instincts, is likewise of great significance for the development of
culture. It must sound very consoling to men to hear that degen-
eration and nervousness are not inevitable results of cultural
progress but avoidable and only excrescences of the same. A
healthy optimism and a broad conception of life remaining natural
in spite of all spiritualization and refinement which will not com-
pletely exclude all sensuousness follow naturally this enlighten-
ment. The results of Freud's investigations sound a warning to
civilized man of to-day that the original animal part of his nature
is not to be completely neglected and that he must not forget that
the attainment of pleasure for the individual is not to be elimi-
nated from the aims of our culture."" If the suppression of the
sexual instinct through its peculiar possibility of sublimation, that
is to say, through the substitution of a more remote and socially
more valuable cultural aim for its original goal promotes culture,
still, a certain part of its impulse has a right to a direct gratifica-
tion, for an excess of repression compels a turning away from
reality and thereby the establishment of the neurosis. It should
be here expressly stated that Freud is perfectly clear on the point
of the decisive role played in life and also in the neurosis by the
egotistic or ego instincts alongside of the sexual instinct. The
Freudian doctrines emphasize the hitherto neglected point of view
of the unconscious mental life and the libidinous impulses. The
detailed investigation of the ego instincts which is still to be done
in exhaustive fashion would afford supplementary explanations of
the neuroses, especially of the symptom formation.

The hysterical mind has unveiled itself through psycho-
anal)^ic investigation as merely a distorted image of the normal
mind, for he who remains healthy has to struggle with the same
complexes that cause the neurotic to fall ill (Jung). As under
certain combinations of conflicting forces, the neurosis is the
outcome of the struggle, so under other relations of these mutually
warring forces, other results may ensue; these are especially the
antisocial types of psychopaths and criminals as well as the socially

*" Compare the popular book of P. J. Muller, " Geschlectsmoral und
Lebensgliick." Copenhagen, Tilge, 1909.

APPLICATION OF PSYCHO-ANALYSIS , I45

superior, as artists, poets and men of genius. The character
analysis of the gifted, especially of artistically inclined persons,
reveals every degree of combination between capability, perver-
sion and neurosis. The psychology of criminals has not yet been
elucidated but appears to offer a favorable field of investigation
by this method.^*^ Psycho-analysis, especially in the form of the
association experiment, has already been seriously applied in legal
practice as a means of determining the condition of facts in the
detection of a guilty conscience.^'^ The meaning of different
peculiar types of men (odd characters, saints, reformers) ^^' and
many psychopathic individuals^''" is explained by this side of
psychological investigation, often in surprising fashion. Like-
wise, an illumination of occultistic^''^ and hypnotic^'^^ phenomena
is afforded respecting the persons who are interested in these
things. That the genius is named here cannot seem strange to
one who has already gained an inner understanding of these things.
The psycho-analytic investigations seem to justify the dictum
that the genius represents the noblest outcome of the overcoming
of an abnormal hereditary tendency, whence he derives his close
relationship to the neurotic. Rank has, in a brief paper,^''' sought
to show the relations of the artistic temperament to the neurosis
and came to the conclusion that especially the poet, both in the
mechanism and also in the ultimate tendency of his creations,
stands very near the psychoneurotic and only by the aid of his
artistic talents protects himself from the neurosis. Stekel^'^* and

*" Compare Wulffen, " Der Sexualverbrecher." Berlin, 1910.

'"Freud, " Tatbestandsdiagnostik und Psychoanalyse," Lit. No. 24.
Jung, " Die psychologische Diagnostik des Tatbestandes," Jur.-psych.
Grenzfragen, 1906. Other literature in E. Rittershaus, " Die Komplex-
forschung," Jour. f. Psych, u. Neur., Vol. 15, 1910.

*•• Hitschmann, "Die Werbekraft der Naturheilkunde," Wr. klin.
Rundschau, 1910.

'"*Otto Gross, "Uber psychopathische Minderwertigkeit." Vienna,
Braumiiller, 1909. O. Pfister, " Die Frommigkeit des Graf en Ludwig von
Zinzendorf," Schr. z. angew. Seelenkunde, No. 8, 1910.

"' Jung, " Zur Psychologie und Pathologie sog. okkulter Phanomene."
Leipzic, O. Mutze, 1902. Hitschmann, "Zur Kritik des Hellsehens," Wr.
klin. Rundschau, 1910.

""Ferenczi, "Introjektion und t)bertragung," Jahrh., I, 2, 1909.

"» " Der Kunstler." Vienna, H. Heller, 1907.

"*"Dichtung und Neurose." Bergmann, Wiesbaden, 1909.

II

146 freud's theory of the neuroses

Sadger have undertaken special investigations in this direction.
The latter in particular has sought to interpret the lives of the
individual poets, as C. F. Meyer/^^ Lenau,"** Kleist"'' and others
psycho-analytically. The first incitement to the application of
information regarding the mind gained by psycho-analysis to a
deeper penetration into the mind of the poet was put forward by
Freud in connection with the solution of the dream problem in his
interpretation of Shakespeare's drama of Hamlet"^ in which he
could reveal, in connection with the CEdipus of Sophocles, a
masked form of the universal incest complex."®

A penetrating glimpse of the secret strata of the poetic work
is afforded by the analysis undertaken by Freud of the delusions
and dreams in W. Jensen's Gradiva.^®" It is shown there that the
poet, without knowledge of dream and neurosis psychology, can
still create his bit of phantasy so that the physician can analyze it
like a real clinical history. From this follows the necessity for the
conclusion that the psycho-analyst and the poet must have worked
from the same sources, that they elaborated the same subject but
each with a different method; the agreement in results seems,
therefore, to warrant the conclusion that both have worked cor-
rectly. The method of the analyst consists in the conscious obser-
vation of the abnormal mental processes in others in order to
guess the rules and be able to formulate them. The poet goes at
it differently: he directs his attention to the unconscious in his
own soul, listens to the possibilities of development of the same
and allows it artistic expression instead of suppressing it by con-
scious criticism. Thus, he experiences out of himself what the
analyst learns from others : namely, what rules the activity of this
unconscious must follow; but he need not formulate these rules,
not once clearly recognize them, they are as a result of his intelli-
gence incorporated in his creations. The analyst develops these

"'"Eine pathographische Studie." Bergmann, Wiesbaden, 1908.

"•"Aus dem Liebesleben Nik. Lenaus," Schr. s. angew. Seelenk., No.
6, 1909.

^" Bergmann, Wiesbaden, 1910.

"' Traumdeutung, 2d ed., page 187.

^"The detailed proof for this, E. Jones has brought forward in
" The CEdipus-Complex as an Explanation of Hamlet's Mystery " (Amer.
Journal of Psychology, Jan., 1910).

^ Schriften zur angewandten Seelenkunde, Part I.

APPLICATION OF PSYCHO-ANALYSIS 14/

rules by analysis of the poems as he has detected them in cases of
real illness; the conclusion seems inevitable: either both the poet
and the physician have misunderstood the unconscious in similar
manner or both have understood it correctly.

The sources of the poetic phantasy arise not far from those of
the dream and day-dream of people and Freud has shown in his
lecture " Der Dichter und das Phantasieren "^^^ (Poet and
Phantasy) that the material of the narrating poet (romance), as
far as it arises from free invention, betrays its genesis by its
analogous structure to the day-dream. These phantasies are
indeed, by the poetic technique which in individual cases is not
demanded, divested of their purely individual interest and trans-
formed to general sources of pleasure.

Recently, Freud has published a psycho-analytic study on the
peculiar mental physiognomy of one of the greatest artists, " Eine
Kindheitserinnerung des Leonardo da Vinci ""^ (A Childhood
Memory of Leonardo da Vinci), and therewith given an example
of the influence of psycho-analysis on biography. The investiga-
tion gives, proceeding from the interpretation of a childhood
phantasy, an original and surprising insight into the conditions
of the artistic work of this universal genius. Here the attempt is
made anew to derive from the exceptional case of one of the
greatest geniuses of mankind one of the most important propor-
sitions of psycho-analytic science, namely, the fundamental and
definite importance for the whole course of mental development
of all the first impressions of childhood, the later force of which
can be essentially weakened by no later experience, no matter how
intense. The subsequent effect is explained by the fact that these
first impressions have given sensuous pleasure. Infantilism and
sexuality, which are disclosed by the Freudian investigations as
the chief components of the neuroses, show themselves further to
be the directing streams in the development of every character,
both of the exceptional (genius) and of the normal. Thereby is
the way prepared for a kind of characterology which will perhaps
be in a position to set up certain types and to bring the develop-
ment of these into close connection with quite definite expressions
of certain instinctive activities. For such a formation of final

*"Lit. No. 31-

^Schr. s. angew. Seelenkunde, No. 7, 1910.

148 freud's theory of the neuroses

character from definite constitutional instinctive impulses and the
later fate of these, Freud has laid down a formula according to
which the character traits which remain are either unchanged
continuations of original instincts, sublimations of the same or
reactions against them."^

It is conceivable that such important results for the compre-
hension of mental life may not remain limited to the psychology
of isolated individuals and it is an indirect proof of the correctness
of the Freudian theory that these have proved so very fruitful in
the field of folk-psychology. In the " Schriften zur angewandten
Seelenkunde" (Papers on Applied Psychology), edited by Freud,
are some works along this line. Riklin could show in " Wunscher-
fiillung und Symbolik" that the wish-fulfilling and symbolism
which Freud had discovered in the dream and neurosis was also
active in legends (part 2, 1907). Abraham has shown in a study
on folk-psychology, " Traum und Mythus" (Dream and Myth)
(part 4, 1908), that the fundamental meaning of the CEdipus tales
as given by Freud also gives expression to the same psychological
facts in folk-myths ; Rank in a limited group of myths, " Mythus
von der Geburt des Helden" (Myths of the Birth of Heroes)
(part 5, 1909), demonstrated the value of the detailed knowledge
gained by psycho-analysis for the deeper understanding of myth
formation and myth interpretation.

Further, Freud has endeavored to illuminate^®* from the
psycho-analytic standpoint the most important performance of the
folk-mind in addition to the myth and legend creation, namely
religion, on the basis of certain apparent similarities between defi-
nite obsessional acts of those with obsessional neurosis and the
forms of religious customs, and has come to the conclusion on
the ground of certain agreements and analogies that the obses-
sional neurosis is a pathological counterpart of the religious struc-
ture ; we may call the neurosis an individual religious practice, the
religion, an universal obsessional neurosis. Here the complexes
in the sense of Jung lose as you might say their pathogenic activ-
ity ** since they become universal."

The individual root of the belief in God Freud has disclosed
in the intimate connection with the father-complex; the personal

'*Lit. No. 29.

"* " Zwangshandlungen und Religionsiibung," Lit. No. 25.

APPLICATION OF PSYCHO-ANALYSIS 149

God is psychologically no other than an enlarged father and
psycho-analysis brings daily before our eyes how youthful persons
lose their religious faith as soon as the authority of the father is
broken in them. Biologically, religion goes back to the helpless-
ness of the little human child, which when it has later recognized
its weakness against the great powers of life seeks to deny its
position just as in childhood it feels and seeks to deny its dis-
consolateness by regressive renewing of infantile protective meas-
ures.^^^ In ultimate analysis, religion seems like the delusion,
dream and neurosis to be an attempt on the part of us human
beings to make up for the deficiency of reality which we find quite
generally unsatisfying by the production of wish- fulfillment.

The brief resume given in this chapter of the fruitful activity
of psycho-analysis applied to other fields of mental science shows
that we have here more than a purely rnedical instrument and
since in all these fields as yet only the first beginnings in life have
been touched upon, so with the constantly growing number of
co-workers from other fields of science, further elaboration is to
be expected.

"«Lit. No. 39.

4

CHRONOLOGICAL REVIEW OF FREUD'S WRITINGS^*'
FROM 1893 TO 1910

1. tJber den psychischen Mechanismus hysterischer Phanomene. By Dr.

Josef Breuer and Dr. Sigmund Freud in Vienna. Neurologisches
Zentralblatt, 1893, Nr. i and 2, also reprinted as introduction to the
" Studien iiber Hysterie," 1895, and in the " Sammlung kleiner
Schriften zur Neurosenlehre aus den Jahren 1893-1906" (Kl. Schr.
I). F. Deuticke. Vienna and Leipzic, 1906.

2. Quelques considerations pour une etude comparative des paralysies

motrices organiques et hysteriques. Archives de Neurologic, 1893,
Nr. -JT. (Also Kl. Schr. I.)

3. Die Abwehrneuropsychosen. Attempt at a psychological theory of

acquired hysteria, many phobias and obsessions and certain halluci-
natory psychoses. Neurologisches Zentralblatt, 1894, Nr. 10 and 11.
(Also Kl. Schr. I.)

4. t)ber die Berechtigung, von der Neurasthenic einen bestimmten Symp-

tomenkomplex als " Angstneurose " abzutrennen. Neurologisches
Zentralblatt, 189S, Nr. 2. (Also Kl. Schr. I.)

5. Studien Uber Hysterie. By Dr. Josef Breuer and Dr. Sigmund Freud.

Leipzic and Vienna, F. Deuticke, 1895; 2, unchanged edition, 1909.
Parts of Freud's share in this book enlarged by some later papers
on hysteria have been translated into English by Dr. A. A. Brill:
" Selected Papers on Hysteria and other Psychoneuroses " by S.
Freud, Nr. 4 of the " Nervous and Mental Disease Monograph
Series," New York, 1910.

6. Obsessions et Phobies. Leur Mecanisme psychiquc et leur etiologie.

Revue neurologique, HI, 1895. (Also Kl. Schr. I.) (German trans-
lation: Wiener kl. Rundschau, 1895.)

7. Zur Kritik der "Angstneurose." Wiener kl. Rundschau, 1895. (Also

Kl. Schr. I.)

8. Weiterc Bemerkungen uber die Abwehrneuropsychosen. Neurologi-

sches Zentralblatt, 1896, Nr. 10. (Kl. Schr. I.)

9. L'heredite et I'etiologie des Nevroses. Revue neurol., IV, 1896. (KL

Schr. I.)

10. Zur Atiologie der Hysterie. Wiener kl. Rundschau, 1896, Nr. 22-26.

(Kl. Schr. I.)

11. Die Sexualitat in der Atiologie der Neurosen. Wiener kl. Rundschau,

1898, Nr. 2, 4. 5, 7. (Kl. Schr. I.)

"•Compare also Abraham's bibliography of Freud's writings in the
Jahrbuch fiir psychoanalytische und psychopathologische Forschungen,
Vol. I, 1909.

150

REVIEW OF FREUD S WRITINGS I5I

12. Zum psychischen Mechanismus der Vergesslichkeit. Monatsschrift f.

Psychiatric u. Neurologic, Vol. 4, 1898. Reprinted in " Zur Psycho-
pathologic des Alltagslebens."

13. t)ber Dcckerinnerungen. Ebenda, Vol. 6, 1899. (Also "AUtag.")

14. Die Traumdeutung. F. Deuticke, Leipzic and Vienna, 1900; 2d en-

larged edition, 1909.

15. Ubcr den Traum. Wiesbaden, J. F. Bergmann, 1901. (Grenzfragen

des Ncrven- und Seclcnlebens, edited by Lowenfeld and Kurella.)

16. Zur Psychopathologie des Alltagslebens. t)ber Vergcssen, Ver-

sprechen, Vergreifen, Aberglaube und Irrtum. Monatsschrift f.
Psychiatric und Neurologic, Vol. 10, 1901. In book form: Berlin,
S. Karger, 1904 ; 2d enlarged edition, 1907 ; 3d enlarged edition, 1910.
Translated into Russian by Dr. B. Medem, 1910.

17. Die Frcudschc psychoanalytische Mcthode. In: Lowenfeld, " Psychi-

sche Zwangserscheinungen," 1904. (Kl. Schr. I.)

18. Uber Psychotherapie. Wiener med. Pressc, 1905, Nr. I. (Kl. Schr. I.)

19. Der Witz und seine Beziehung zum Unbewussten. F, Deuticke, Vienna

and Leipzic, 1905.

20. Drei Abhandlungen zur Sexualtheorie. F. Deuticke, Vienna and

Leipzic, 1905. 2d essentially unchanged edition, 1910.
21.- Bruchstiick ciner Hysterieanalyse. Monatsschr. f. Psychiatric u. Neu-
rologic, Vol. 18, Parts 4 and 5 1905. (Kl. Schr. II.)

22. Meine Ansichten iibcr die RoUe der Sexualitat in der Atiologie der

Neurose. In Lowenfeld : " Sexuallebcn u. Ncrvenleiden," 4th ed.,
1906. (Kl. Schr. I.)

23. Sammlung kleiner Schriften zur Neuroscnlchre aus den Jahren 1893

to 1906. Vienna and Leipzic, F. Deuticke, 1906, (Kl. Schr. I.)

24. Tatbestandsdiagnostik und Psychoanalyse. Archiv f. Kriminalanthro-

pologic und Kriminalistik by Gross, Vol. 26, 1906. (Kl. Schr. II.)

25. Zwangshandlungen und Religionsiibung. Zeitschrift f. Religions-

psychologic, Vol. I, Part I, 1907. (Kl. Schr. II.)

26. Zur scxuellen Aufklarung der Kinder. " Soziale Medizin und Hy-

giene," Vol. II, 1907. (Kl. Schr. II).

27. Der Wahn und die Traume in W. Jensens " Gradiva." Schriften zur

angewandten Seelenkunde, edited by Prof. Dr. Sigm. Freud, Part I,
Leipzic and Vienna, F, Deuticke, 1908.

28. Hysterische Phantasicn und ihrc Beziehung zur Bisexualitat. Zeitschr.

f, Sexualwissenschaft, Nr. I, Part i, 1908. (Kl. Schr. II.)

29. Charakter und Analerotik. Psychiatr.-neurol. Wochenschr., 9th Year,

Nr. 52, 1908. (Kl. Schr. II.)

30. Die " kulturclle " Sexualmoral und die modcrne Nervositat. " Sexual-

probleme," der Zeitschrift " Mutterschutz " neue Folge. 4th Year,
1908. (Kl. Schr. II.)

31. Der Dichter und das Phantasieren. Neue Revue, 1st Year, 2d part of

March, 1908. (Kl. Schr. II.)

32. Uber infantile Sexualtheorien. " Scxualprobleme," 4th Year, 1908.

(Kl. Schr. II.)

152 FREUD S THEORY OF THE NEUROSES

33. Allgemeines fiber den hysteri'schen Anfall. Zeitschrift f. Psycho-

therapie und med. Psychologic, ist year, 1909. (Kl. Schr. II.)

34. Sammlung kleiner Schriften zur Neurosenlehre. 2d ed., 1909. Vienna

and Leipzic, F. Deuticke. (Kl. Schr. II.)

35. Analyse der Phobic eines fiinfjahrigen Knaben. Jahrbuch f. psycho-

analytischc und psychopathologische Forschungen. Edited by Prof.
Dr. E. Bleulcr and Prof. Dr. S. Freud. Special editor, Dozent Dr.
C. G. Jung, Vol. I, 1909. F. Deuticke.

36. Bemerkungen uber einen Fall von Zwangsneurose. Ebenda.

37. Uber Psychoanalyse. Five lectures delivered at the 20 year anni-

versary of Clark Univ., Worcester, Mass., Sep., 1909. Leipzic and
Vienna, F. Deuticke, 1910.

38. Die psychogene Sehstorung in psychoanalytischer Auffassung. Arzt-

Hche Standeszeitung, 1910, Nr. 9.

39. Eine Kindheitserinnerung des Leonardo da Vinci. 7th Part of the

Schr. zur angew. Seelenkunde. Vienna and Leipzic, 1910.

40. Uber den Gegensinn der Urworte. Review of the book of same name

by Dr. phil. Karl Abel, (1884) Jahrb., Vol. II, Part i, 1910.

41. Die zukunftigen Chancen der Psychoanalyse. Zentralblatt f. Psycho-

analyse, 1910, Part I. Edited by Prof. Dr. S. Freud. Spec, editors,
Dr. A. Adler and Dr. W. Stekel. Pub. J. F. Bergmann, Wiesbaden.

REVIEW OF FREUD S WRITINGS 153

FREUDIAN LITERATURE IN ENGLISH

A. A. Brill: Psychological Factors in Dementia Praecox, Journal of
Abnormal Psychology, 1908. A Case of Schizophrenia (Dementia Prae-
cox), Amer. Journal of Insanity, July, 1909. Freud's Conceptions of the
Psychoneuroses, Med. Record, Dec, 1909. A Contribution to the Psycho-
pathology of Everyday Life, Psychotherapy, 1909. Dreams and their
Relation to the Neurosis, N. Y. Med. Journal, Apr., 1910. The Anxiety
Neuroses, Journal of Abnormal Psychology, 1910. Freud's Theory of
Wit, Journal of Abnormal Psychology, 191 1. Psychological Mechanisms
of Paranoia, N. Y. Med. Journal, Dec, 191 1. Freud's Theory of the
Compulsion Neurosis, Amer. Medicine, Dec, 191 1. Hysterical Dreamy
States; their Psychological Mechanism, N. Y. Med. Journal, May, 1912.
A Few Remarks on the Technique of Psychoanalysis, Med. Review of
Reviews, Apr., 1912. The Only or Favorite Child in Adult Life, N. Y.
State Med. Journal, Aug., 1912. Anal Eroticism and Character, Journal
of Abnormal Psychology, Aug.-Sep., 1912. The CEdipus Complex; its
Relation to the Psychoneuroses, Neuroses and Psychosexual Impotence,
N. Y. Med. Journal, Oct., 1912. Psycho-analysis; its Theories and Prac-
tical Application (Book), Saunders Pub. Co., Phila., 1912.

Ferenczi : The Psycho-analysis of Dreams, Amer. Journal of Psy-
chology, Apr., 1910.

Freud : Selected Papers on Hysteria and other Psychoneuroses, Trans-
lation by Dr. A. A. Brill (Journal of Nervous and Mental Disease Mono-
graph Series), 2d ed., 1912. The Origin and Development of Psycho-
analysis, Amer. Journal of Psychology, Apr., 1910. Three Contributions
to the Sexual Theory. Translation by Dr. A. A. Brill (Journal of Ner-
vous and Mental Disease Monograph Series), 1910. Freud's Interpreta-
tion of Dreams, Translation by Dr. Brill, MacMillan Co., N. Y., and Geo.
Allen, London, 1912.

Trigant Burrow: Freud's Psychology in its Relation to the Neuroses,
American Journal of the Medical Sciences, June, 191 1. Some Psycho-
logical Phases of Medicine, Journal of Abnormal Psychology, August-
September, 191 1. Conscious and Unconscious Mentation from the Psycho-
analytic Viewpoint, Psychological Bulletin, Vol. IX, No. 4, Apr. 15, 1912.
Psychology and Society, Journal of Abnormal Psychology, Jan.-Feb.,

1913-

Ernest Jones: Rationalization in Everyday Life, Journal of Abnormal
Psychology, Aug.-Sep., 1908. Psycho-analysis in Psychotherapy, Journal
of Abnormal Psychology, June-July, 1909. Remarks on a Case of Com-
plete Auto-Psychic Amnesia, Journal of Abnormal Psychology, Aug.-Sep.,

1909. Psycho-analytic Notes on a Case of Hypomania, Amer. Journal of
Insanity, Oct., 1909. On the Nightmare, Amer. Journal of Insanity, Jan.,

1910. The CEdipus Complex as an Explanation of Hamlet's Mystery,
Amer. Journal of Psychology, Jan., 1910. Freud's Psychology, Psycho-
logical Bulletin, Apr., 1910. Freud's Theory of Dreams, Amer. Journal
of Psychology, Apr., 1910. The Psycho-analytic Method of Treatment,

154 freud's theory of the neuroses

Journal of Nervous and Mental Disease, May, 1910. The Mental Char-
acteristics of Chronic Epilepsy, Maryland Med. Journal, June, 1910. The
Therapeutic Effect of Suggestion, Canadian Med. and Surg. Journal,
Feb., 191 1. Papers on Psycho-analysis, Baillere, Tindall & Cox, London,
1912.

Jung : The Psychology of Dementia Prsecox. Translation by Drs.
Peterson and Brill (Journal of Nervous and Mental Disease Monograph
Series, No. 3, 1909). The Association Method, Amer. Journal of Psy-
chology, Apr., 1910. Psycho-physical Investigations with the Galvanom-
eter and Pneumograph on Normal and Insane Individuals (with Peter-
son), Brain, July, 1907.

J. J. Putnam : Personal Experiences of Sigmund Freud and His Work,
Journal of Abnormal Psychology, Dec, 1909, and Jan.-Mar., 1910. On the
Etiology and Treatment of the Psychoneuroses, Boston Med. and Surg.
Journal, July 21, 1910. A Plea for the Study of Philosophic Methods in
Preparation for Psycho-analytic Work. Journal of Abnormal Psychology,
Oct.-Nov., 191 1. On Freud's Psycho-anal3i:ic Method and its Evolution
(Harvey Lecture), Boston Med. and Surg. Journal, Jan. 25, 1912, and
Volume of Harvey Lectures for 1911-1912. Comments on Sex Issues
from the Freudian Standpoint, New York Medical Journal, June 22, 1912.

William A. White : Mental Mechanisms, Monograph Series, Journal of
Nervous and Mental Disease.

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