(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "Freud's theories of the neuroses"

THE LIBRARY 

OF 

THE UNIVERSITY 

OF CALIFORNIA 

LOS ANGELES 

GIFT OF 
DR. ROY VAN WART 



Digitized by tine Internet Arciiive 

in 2007 witii funding from 

IVIicrosoft Corporation 



littp://www.arcliive.org/details/freudstlieoriesofOOIiitsiala 



Nervous and Mental Disease Monograph Series No. 17 



Freud's Theories of the 
Neuroses 



By 

DR. EDUARDJHJTSCHMANN 

of Vienna 



New York 
1913 



ANNOUNCEMENT 



Nd. 1. 

No. 2. 
No. 3. 
No. 4. 

No. 5. 



THE Nervous and Mental Disease 
Monograph Series will consist of 
short monographs, translations 
and minor text-books, on subjects 
related to these specialvles It is 
purposed to issue them from time to time 
as the material becomes available. The 
editors will be pleased to consider the avail- 
ability of manuscripts for the series. 

Nervous and Mental Disease Monograph Series 

Editors 

SMITH ELY JELLIFFE, M.D. 

WM. A. WHITE, M.D. 

Outlines of Psychiatry. (Fourth Edition, 1913. ) Pricci $3.00 
By WM. A. WHIT^, M.D. 

Studies in Paranoia. (Out of Print.) 
Psychology of Dementia Praecox. (Out of Print.) 
Selected Papers on Hysteria and Other Psycho- 
neuroses. (Second Edition, 1912.) Price, $2.50 

By PROF. SI&MUND FREUD, M.D. 

The Wassermann Serum Reaction in Psychiatry. Price, $2.00 
By FELIX PLAUX, M.D. 

Epidemic Poliomyelitis. (Out of Print.) 

Three Contributions t: Sexual Theory Price, $2.00 

By PROF. SIGMUriD FREUD 

Mental Mechanisms Price, $2.00 

By WM. A. WHITE, M.D. 

Studies in Psychiatry Price, $2.0C 

By Members o^ the New York Psychiatrical Society 

Methods of Mental Examination Price, $2.00 

By SHEPHI;RD IVORY FRANZ, Ph.D. 

The Theory of Schizophrenic Negativism Price, $ .60 

By PROFESSOR R. BLEULER 

Cerebellar Functions . Price, $3.00 

By DR. ARDRE-THOMAS 

History of the Prison Psychoses... • . . • Price. $1.25 

By DRS. P. KITSCHE and K.'wiLMANWS 

General Paresis . Price, ^3.00 

By PROF. E. KRAEPELIK 

Dreams and Myths Price, $1.00 

By DR. KARL ABRAHAM 

Poliomyelitis Price, $3.00 

DR. I. WICKMANN 

Frued's Theories of the Neuroses . . • Price, $2.00 

DR. E. EITSCHMANN 



No. 


6. 


No. 


7. 


No. 


8. 


No. 


9. 


No. 


10. 


No. 


11. 


No. 


12. 


No. 


13. 


No< 


14. 


No. 


15. 


No. 


16. 


No. 


17. 



AddresB all communications to JOURNAL OF NERVOUS AND MENTAL DISEASE 
DISEASE, 64 West Fifty-Sixth Street, New York. 



Nervous and Mental Disease Monograph 
Series, No. 17 



FREUD'S theories OF THE 
NEUROSES 



BY 

DR. EDUARD HITSCHMANN 

of Vienna 



Authorized Translation by 

DR. C. R. PAYNE 

Westport, N. Y. 



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

of London 



NEW YORK 

THE JOURNAL OF NERVOUS AND MENTAL DISEASE 
PUBLISHING COMPANY 

1913 



NERVOUS AND MENTAL DISEASE 
MONOGRAPH SERIES 

Edited by 

Dra. SMITH ELY JELLIFFE and WM. A. WHITE 

Nambeis Issued 

X. Ootlines of Psychiatry. (4th Edition.) $3.00. 

By Di. William A. White. 
a. Stadies in Paranoia. 

By Drs. N. Gierllch and M. Friedman. 

3 . The Psychology of Dementia Praecox. ( Out of Print. ) 

By Dr. C.G.Jang. 

4. Selected Papers on Hysteria and other Psychonearoses. 

(3d Edition.) $2.50. By Prof . Sigmand Fread. 

5. TheWassermannSeramDiagnosis inPsychiatry. $2.00. 

By Dr. Felix Plaut. 

6. Epidemic Poliomyelitis. New York, 1907. (Outof Print.) 

7. Three Contributions to Sexual Theory. 92.00. 

By Prof. Sigmund Freud. 

8. Mental Mechanisms, f 2.00. By Dr. Wm. A. White. 

9. Studies in Psychiatry. $2.00. 

New York Psychiatrical Society. 

10. Handbook of Mental Examination Methods. S2.00. 

By Shepherd Ivory Franz. 

XI. The Theory of Schizophrenic Negativism. $0.60. 

By Professor E. Bleuler- 

X2. Cerebellar Functions. 93.00. 

By Dr. Andre-Thomas. 

13. History of Prison Psychoses. $1.25. 

By Drs. P. Nitsche and K. Wilmanns. 
X4. General Paresis. $3.00. By Prof. E. ELraepelin. 

X5. Dreams and Myths. $1.00. By Dr. Karl Abraham. 
x6. Poliomyelitis. $3.00. Dr. I. Wickmann 

17. Prued's Theories of the Neuroses. S2.00. 

Dr. E. Hitschmann. 



Copyright, 1913, by 
The Journal of Nervous and Mental Disease 
PxjBLisHiNG Company, New York 



Press of 

The new Era printins coHPANr 

Lancaster. Pa. 



m 

170 

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 alrea dy 
a ccepted the conception of the dissociation of mind and of t he 
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 
tHe ir correct mutual relationship by mt roducmg a dynamic con- 
c eption: tne mental life is represented as a play 01 iih|^enniU'*Jind 
i nhibitin g f^frpg anrl if in rtnp ff\' 3e. a group of ideas remain i n 

tVip nnrnr[«;riQn<; an artivp rnvLfliri- Y{'^ih r^tViPr p-rnyp's of Meas lla S 
c aused t |]f icr>loti'r.n or>A fViP ii|^prf psr.iniisnpss of the first group . 
Thus, the peculiarity, o f tl \s Fre mJiRji 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 antago ni«^m hptw<^f>n tht^ i'ngfi'npf<^ w!l'^^ 
erve sexuality and the gaining of sexual pleasure and those oth er 
instincts which have as a goal the constitution of the personalil v. 
the.egQiiiigtinct s. The ego feels itself th rpatpnpH hv tVip ^j^rn^nHg 
oj the overpowering sexua l instinct and seeks .lo ,£ rptect it self 
by repressip n. 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. T he;; hvst pnVal r epression finds its 
analo gue resp prtingr i't<; p|-p^pq.i; "i li i i p ■■ i i ny L^^yr- 

p ^nted o ut under sexuality of children, in the p^rmally appea ring 
" organic repression of the c fijld'*; ingti'nffi'vp and sexual~!r!e. 
This repression is the prel iminary ^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 th e in dividual already possesses a store of memories 
w hich are withdraw n from consci ous dis position '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 s uch emotionally toned / 
eroti c complexes . r^^*' ^^r fflf"^^^ pictufe^of '"Hysteflcalta. jThis I 
chief content of 'C^ p- vnt^r\\^^^\^c\\\r^j^^^\^^'ex\c.'?\9, is rea'ilv often i 
hidden from superficial, observation o r 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 TOTinterim pulses 
agamst"~Tti eir abnoi null y ~5trong TiisHnctive impulses. O nly Tig^' 
who knows the romance of the hysterical can also bring the com- 
prehension of the striking character ch agges 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^ ^^ ^ cert ain 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 

h ysterical notoriousl y ill. Later inyy,sti c ratinn^ how£ver, pho^« 
tnese recent experie nrps \q hp rpgnla rly <^9pflirts of |he erotici sm 
(a disappointment in love, a compulsory or renounced gn^ag e- 
ment, a sexual assault, a sudden sexual enlightenment), ^ yd when 
t o. superficial ob servation , there seem to be other motives (n ursing 
the sick, deaih ot a relative, etc.). a .more penetrating investiga - 
tion regularly reveals unconscious att firTimpni-g hptwp^ p these bana l 
''^Tntf '^"'^ '^'^^y'^] or>A ^'i^f^ntilp I'mpj-^^t^t^jong Thus, the hysteric'aT 
patients Suffe r from remj ^ r |]''i^<='"^pf T l^p f]x^ti(;)n of certain me ntar 

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 ch arar^^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^y oi '-"-"^ 

te xia 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^ 
el aborate fll^Y FrpnH The sexual traumatic experiences, sinc^e tl^i^ * 
ideas which accompanied these had powerful affecti (sum oj 
excitation^ which had not been ab reacted 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 whp n th^s ac.car 
panying affect, separated f rom the unbearable idea^ w as 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 abl e to make important contributions concerning th e "''' \^ 
d ireciiort 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 co ugh or vomiting, etc.'*' I f his discoveries in the 
psychological ItJlUl'lU iiij aiid^ determinations to be discussed "later is 
1 to nbe dAflSiaSf^d as 1^'reud's greatest work, still, he has never 
' / fa iled to'^phasize distinctly tliat ey frv'TiycifprTrat cyrnprnm hfi'^ 
^ not only a psychic oripn but also a somatic hasisan d (;?^n on]vcQiTie 
t o expression wlie ji 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 
i ust as in children the erogenous peculiarity can be moved to a ny 
favo rite body zone so an analop^ous movability returns in t he 
iptomatology of hysteria ."^ I n this neurosis, the repr ession 
concerns t he 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 ea ting, hys- 
t erical p^lobus. j f^ftPrr ^'" ^^^ tll^^^^ ^If* yomitinp^ Ti^H h^^^n-pnpr- 
jetic suckers in ch ildhood. I n this fashion, a ll hysterical abulias 
c ome about, since tne organs or systems of orp ^aiVH wlii i li>.4»erv<^ 
these two instincts when they deny the erogenous function also 
r efuse 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. Th e psychic determin a- ' 
tions afp Tin<" gimpl/^ Knf mcf^^ f-nmpl jcated. Determination plays 
animportant role through a comprehensive and widespread sym- 



bolism ana lo£[ous to that of dream life. Thu s, for example, m a 
f emale~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 wa s the punishment tor an in tended 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 sy mptom is difficult and 
j oined to a series of favoring somatic conditions, it is evident that 
an hysterical symptom, once formed, is retained to give alternate 
exp ression_tQ-dUi fiCS£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 t hem 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_l l i l iiiii iiil ii 1 I 11 nnmil''- ^rllffi 9la9e; th e distinctio n lies 
.in the f act that the excitation, in the displacement ot wliich 
the jieurosis iinds HpiLSSiuii, ij, in Uit uuAiLl| iiLUiumiu pa purely 



92 FREUD S THEORY OF THE NEUROSES 

somatic one (the snmptir covimi ovp;fo»v.or,fy i n the hysteria, a 
psychic one (through the c onflicts 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. 



Cbe jjotirnal 



OF 



Dmoits ana Itlemdl Disease 

AN AMERICAN MONTHLY JOURNAL OF NEUROLOGY 

AND PSYCHIATRY 

Established 1874 



OFFICIAL ORGAN OF 

The American Neurological Association 
The New York Neurological Society 
Boston Society of Psychiatry and Keuroloj^y 
The Philadelphia Neurological Society, and 
The Chicago Neurological Society, Etc. 



EDITOR 
Dr. WILLIAM G. SPILLER 

A3SOCIATJB MDITOSS 
Dr. E. W. TAYLOR Dr. E. E. SOUTHARD 

MANAGING JE^DITOS AND PUBI^ISHER 

Dr. SMITH ELY JELLIFFE 

64 West 56th Street, New York City 

FOREIGN AND DOMESTIC AGENTS 

Z.KlTgcT, Karlstra«se 15, Berlin, Germany; H K. Lewis, i:,6 Go^wei■ Street, London 

W. C, Stetger & Co . 45 Park Place, New York ; Gustave E. ^tecbert, issV/est 

i-cth Street, M.w York ; Paul B. Hoeher, 6g East sgth Street, New York. 

Printed by Tbs New Era Printing Company, Lancaster, Pa. 

ISSUJ^D MONTHI,Y-50 Cents Per Copy~$5'00 PMR YEAR 
Foreign Subscriptioa, $5.60 per Year. 



NERVOUS AND MENTAL DISEASE 
MONOGRAPH SERIES 

Edited by 
Dra. SMITH ELY TELLIFFE and WII. A. WHITE 

i:f umbeis Issued 

1. Outlines of P8ychlat:7;. (4tta Edition ) $3.00. 

By Dr. William A, Whitfr. 

2. Studies in PaxaQoia.' 

By Drs. N. Gierlich and M. Fiiddmao. 

3 . The Psychology of Dementia Piaecox. (Out 0* P^nt. ) 

By Dr. C. G.Jung 

4. Selected Papers on Hyrteria and other Psychondurnses . 

(ic" -idition.) ^2.50. ByPrrf.Sigmund Freud. 

5. TheWasaermannSerumDiagnosisinPsychiatry. $3.00. 

By Dr, Fellz Plaut. 

6. Epidemic Poliomyelitis. New York, 1907. (Outof Print) 

7. Three Contributions to Cezual Theory. $2.00. 

By Prof. Sigmond Freed. 
f>. Mental Mec;;anism8. f s.ox By Di. Wm. A. White. 

9. Studies in Psycbiatrv. ^2.00. 

New York Psychiatrical Society. 

10. Handbook of Mental Examination Methods. $2.00. 

By Shepherd Ivory Fra ex 

11. The Theory of Schizophrenic Negativism. $0.60. 

By Professor E. Bleuler. 

12. Cei;!bellaz Functions. $3.00. 

By i)r. Andre-Thomas. 

13. EUstory of Prison Psychoses. $1.25. 

By Drs. P. Wltsche and K. Wilmanns. 

14. Oeneral Paresis. $3.00. By Prof. £. Kraepelin. - 

15. Dreams and Mjrths. ;f 1.00. By Dr. Karl Abraham. 

16. Poliomyelitis. $3.00. Dr. I. Wickmann 

17. Frued's Theories of the Neuroses. $2.00. 

Dr. S. Hitschmaaxu 



UNIVERSITY OF CALIFORNIA LIBRARY 

Los Angeles 
''^ISfdlWJfBJ^^ °" ^^ last date stamped below. 



OCT 23 1985 
REC-D 



3 1158 00347 0852 




! 

i 
) 


j ^ 

1 i 

1 ^ ;|