Selected papers on hysteria and other psychoneuroses

by Sigmund Freud

II

In a predisposed person if there is no adaptation for conversion, and still for the purpose of defense a separation of the unbearable idea from its affect is undertaken, the affect must then remain in the psychic sphere. The weakened idea remains apart from all association in consciousness, but its freed affect attaches itself to other not in themselves unbearable ideas, which on account of this “false” connection become obsessions. This is in brief the psychological theory of the obsessions and phobias concerning which I have spoken above.

I will now state what parts demanded in this theory can be directly demonstrated and what parts I have supplemented. Besides the end product of the process, the obsession, we can in the first place directly demonstrate the source from which the affect in the false connection originates. In all cases that I have analyzed it was the sexual life that has furnished a painful affect of precisely the same character as the one attached to the obsession. It is not theoretically excluded that this affect could not occasionally originate in other spheres, but I must say that thus far I have found no other origin. Moreover, one can readily understand that it is precisely the sexual life which furnishes the most manifold occasions for the appearance of unbearable ideas.

Moreover, the exertion of the will, the attempt at defence, upon which this theory lays stress is demonstrated by the most unequivocal utterances of the patients. At least in a number of cases the patients themselves inform us that the phobia or obsession appeared only after the exertion of the will manifestly gained its point. “Something very disagreeable happened to me once and I have exerted all my power to push it away, not to think of it. When I have finally succeeded I have gotten the other thing instead, which I have not lost since.” With these words a patient verified the main points of the theory here developed.

Not all who suffer from obsessions are so clear concerning the origin of the same. As a rule when we call the patient’s attention to the original idea of a sexual nature we receive the following answer: “It could not have come from that. Why I have not thought much about it. For a moment I was frightened, then I distracted myself and since then it has not bothered me.” In this, so frequent objection, we have the proof that the obsession represents a compensation or substitute for the unbearable sexual idea, and that it has taken its place in consciousness.

Between the patient’s exertion of the will which succeeds in repressing the unacceptable sexual idea and the appearance of the obsession, which though in itself of little intensity, is here furnished with inconceivably strong affect, there is a yawning gap which the theory here developed will fill. The separation of the sexual idea from its affect and the connection of the latter with another suitable but not unbearable idea—these are processes which take place unconsciously which we can only presume but not prove by any clinico-psychological analysis. Perhaps it would be more correct to say that these are not really processes of a psychic nature but physical processes of which the psychic result so presents itself that the expressions “separation of the idea from its affect and false connection of the latter,” seem actual occurrences.

Besides the cases evincing in turn the sexual unbearable idea and the obsession we find a series of others in which there are simultaneously obsessions and painfully accentuated sexual ideas. It will not do very well to call the latter “sexual obsessions”; they lack the essential character of obsessions in proving themselves fully justified, whereas the painfulness of the ordinary obsession is a problem for the doctor as well as the patient. From the amount of insight that could be obtained in such cases, it seems that we deal here with a continued defense against sexual ideas which are constantly renewed, a work heretofore not accomplished.

As long as the patients are aware of the sexual origin of their obsessions they often conceal them. If they complain they generally express surprise that this affect underlies the symptoms, at being afraid, and at having certain impulses, etc. To the experienced physician, however, the affect appears justified and intelligible; he finds the striking part only in the connection of such an affect with an idea unworthy of it. In other words the affect of the obsession appears to him as one dislocated or transposed, and if he has accepted the observations here laid down he can in a great many cases of obsessions attempt a retranslation into the sexual.

Any idea which either through its character may be combinable with an affect of such quality or which bears a certain relation to the unbearable by virtue of which it seems fit as a substitute for the same, may be used for the secondary connection of the freed affect. Thus, for example, freed anxiety, the sexual origin of which can not be recalled, attaches itself to the common primary phobias of man for animals, thunderstorms, darkness, etc., or to things which are unmistakably in some way associated with the sexual, such as urination, defecation, pollutions and infections.

The advantage gained by the ego in the transposition of the affect for the purpose of defense is considerably less than in the hysterical conversion of psychic excitement into somatic innervation. The affect under which the ego has suffered remains now as ever unchanged and undiminished, but the unbearable idea is suppressed and excluded from memory. The repressed ideas again form the nucleus of a second psychic group which I believe can be accessible without having recourse to hypnotism. That in the phobias and obsessions there appear none of the striking symptoms which in hysteria accompany the formation of an independent psychic group, is due to the fact that in the former case the whole transformation remains in the psychic sphere and the somatic innervation experiences no change.

What I have here said concerning obsessions I will explain by some examples which are probably of a typical nature:

1. A young girl suffers from obsessive reproaches. If she reads anything in the journal about false coiners she conceives the thought that she too, made counterfeit money; if a murder was anywhere committed by an unknown assassin she anxiously asked herself whether she had not committed this crime. At the same time she is perfectly aware of the absurdity of these obsessive reproaches. For a time the consciousness of her guilt gained such a power over her that her judgment was suppressed, and she accused herself before her relatives and physician of having really committed all these crimes (Psychosis through simple aggravation—overwhelming psychosis—Uberwältigungspsychose). A thorough examination revealed the source of the origin of this guilty conscience. Accidentally incited by a sensual feeling she allowed herself to be allured by a friend to masturbate. She practiced it for years with the full consciousness of her wrong doing, and under the most violent but useless self reproaches.—The girl was cured after a few months’ treatment and strict watching.

2. Another girl suffered from the fear of getting sudden desires of micturition and of being forced to wet herself. This began after such a desire had really forced her to leave a concert hall during the performance. This phobia had gradually caused her to become quite incapable of any enjoyment and social relationship. She felt secure only when she knew that there was a toilet in the neighborhood to which she could repair unobserved. An organic suffering which might have justified this lack of confidence of the control of the bladder was excluded. At home among quiet surroundings and during the night there was no such desire to micturate. Detailed examination showed that the desire to micturate appeared for the first time under the following conditions: A gentleman to whom she was not indifferent took a seat in the concert hall not far from her. She began to think and to picture to herself how she would sit near him as his wife. In this erotic revery she experienced that physical feeling which must be compared to erection in the man, and which in her—I do not know whether it is general—ended in a slight desire to micturate. She now became extremely frightened over her otherwise accustomed sexual sensation because she had determined to overcome this as well as every desire, and in the next moment the affect transposed itself to the accompanying desire to micturate and forced her to leave the hall after a very painful struggle. In her life she was so prudish that she experienced an intensive horror for all things sexual, and could not conceive the thought of ever marrying; on the other hand she was sexually so hyperesthetic that during every erotic revery, which she gladly allowed herself, there appeared sensual feeling. The erection was always accompanied by the desire to micturate, and up to the time of the scene in the concert hall it had made no impression on her. The treatment led to an almost complete control of the phobia.

3. A young woman who had only one child after five years of married life complained of obsessive impulses to throw herself from the window or balcony, and of fears lest at the sight of a sharp knife she might kill her child. She admitted that the marriage relations were seldom practised and then only with caution against conception; but she added that she did not miss this as she was not of a sensual nature. I then ventured to tell her that at the sight of a man she conceives erotic ideas, and that she therefore lost confidence in herself and imagined herself a depraved person fit for anything. The retranslation of the obsession into the sexual was successful; weeping, she soon admitted her long concealed marital misery, and then mentioned painful ideas of an unchanged sexual character such as the often recurring sensation of something forcing itself under her skirts.

I have made use of such experiences in the therapy of phobias and obsessions, and despite the patient’s resistances I have redirected the attention to the repressed sexual ideas, and wherever feasible I have blocked the sources from which the same originated. To be sure I cannot maintain that all phobias and obsessions originate in the manner here revealed; first, my experience, in proportion to the abundance of these neuroses, embraces only a limited amount, and second, I, myself, know that these “psychasthenic” symptoms (according to Janet’s designation) are not all of the same value.[^[40]] Thus, for instance, there are pure hysterical phobias. But I believe that the mechanism of the transposition of the affect will be demonstrated in the greater part of the phobias and obsessions, and I must assert that these neuroses, which are found just as often isolated as combined with hysteria and neurasthenia, are not to be thrown together with the ordinary neurasthenia for which fundamental symptom a psychic mechanism is not all to be assumed.