The Traumatic Theory Criticized
Although, as a matter of fact, the discovery of Breuer and Freud is certainly true, as can easily be proved by every case of hysteria, several objections can be raised to the theory. It must be acknowledged that their method shows with wonderful clearness the connection between the actual symptoms and the shock, as well as the psychological consequences which necessarily follow from the traumatic event, but nevertheless, a doubt arises as to the etiological significance of the so-called trauma or shock.
It is extremely difficult for any critical observer of hysteria to admit that a neurosis, with all its complications, can be based on events in the past, as it were on one emotional experience long past. It is more or less fashionable at present to consider all abnormal psychic conditions, in so far as they are of exogenic growth, as the consequences of hereditary degeneration, and not as essentially influenced by the psychology of the patient and the environment. This conception is too narrow, and not justified by the facts. To use an analogy, we know perfectly well how to find the right middle course in dealing with the etiology of tuberculosis. There are, of course, cases of tuberculosis where in earliest childhood the germ of the disease falls upon a soil predisposed by heredity, so that even in the most favorable conditions the patient cannot escape his fate. None the less, there are also cases where, under favorable conditions, illness can be prevented, despite a predisposition to the disease. Nor must we forget that there are still other cases without hereditary disposition or individual inclination, and, in spite of this, fatal infection occurs. All this holds equally true of the neuroses, where matters are not essentially different in their method of procedure than they are in general pathology. Neither a theory in which the predisposition is all-important, nor one in which the influence of the environment is all-important, will ever suffice. It is true the shock-theory can be said to give predominance to the predisposition, even insisting that some past trauma is the condition sine qua non of the neurosis. Yet Freud’s ingenious empiricism presented even in the “Studies in Hysteria” some views, insufficiently exploited at the time, which contained the elements of a theory that perhaps more accentuates the value of environment than inherited or traumatic predisposition.
The Conception of “Repression”
Freud synthesized these observations in a form that was to extend far beyond the limits of the shock-theory. This conception is the hypothesis of repression (“Verdrängung”). As you know, by the word “repression” is understood the psychic mechanism of the re-transportation of a conscious thought into the unconscious sphere. We call this sphere the “unconscious” and define it as the psyche of which we are not conscious. The conception of repression was derived from the numerous observations made upon neurotic patients who seemed to have the capacity of forgetting important events or thoughts, and this to such an extent that one might easily believe nothing had ever happened. These observations can be constantly made by anyone who comes into close psychological relations with his patients. As a result of the Breuer and Freud studies, it was found that a very special method was needed to call again into consciousness those traumatic events long since forgotten. I wish to call attention to this fact, since it is decidedly astonishing for a priori we are not inclined to believe that valuable things can ever be forgotten. For this reason several critics object that the reminiscences which have been called into consciousness by certain hypnotic processes are only suggested ones, and do not correspond with reality. Even granting this, it would certainly not be justifiable to regard this in itself as a condemnation of “repression,” since there are and have been not a few cases where the fact of repressed reminiscences can be proved by objective demonstration. Even if we exclude this kind of proof, it is possible to test the phenomena by experiment. The association-tests provide us with the necessary experiences. Here we find the extraordinary fact that associations pertaining to complexes saturated with emotion emerge with much greater difficulty into consciousness, and are much more easily forgotten.
As my experiments on this subject were never reëxamined, the conclusions were never adopted, until just lately, when Wilhelm Peters, a disciple of Kraepelin, proved in general my previous observation, namely, that painful events are very rarely correctly reproduced (“die unlustbetonten Erlebnisse werden am seltensten richtig reproduciert”).
As you see, the conception rests upon a firm empirical basis. There is still another side of the question worth looking at. We might ask if the repression has its root in a conscious determination of the individual, or do the reminiscences disappear rather passively without conscious knowledge on the part of the patient? In Freud’s works you will find a series of excellent proofs of the existence of a conscious tendency to repress what is painful. Every psychoanalyst will know more than a dozen cases showing clearly in their history one particular moment at least in which the patient knows more or less clearly that he will not allow himself to think of the repressed reminiscences. A patient once gave this significant answer: “Je l’ai mis de côté” (I have put it aside).
But, on the other hand, we must not forget that there are a number of cases where it is impossible for us to show, even with the most careful examination, the slightest trace of conscious repression; in these cases it seems as if the mechanism of repression were much more in the nature of a passive disappearance, or even as if the impressions were dragged beneath the surface by some force operating from below. From the first class of cases we get the impression of complete mental development, accompanied by a kind of cowardice in regard to their own feelings; but among the second class of cases you may find patients showing a more serious retardation of development. The mechanism of repression seems here to be much more an automatic one.
This difference is closely connected with the question I mentioned before—that is, the question of the relative importance of predisposition and environment. The first class of cases appears to be mainly influenced by environment and education; in the other, predisposition seems to play the chief part. It is pretty clear where treatment will have more effect. (As I have already said, the conception of repression contains an element which is in intrinsic contradiction with the shock-theory.) We find, for instance, in the case of Miss Lucy R.,[[2]] described by Freud, that the essential etiological moment is not to be found in the traumatic scenes, but in the insufficient readiness of the patient to set store upon the convictions passing through her mind. But if we think of the later views we find in the “Selected Papers on Hysteria,”[[3]] where Freud, forced through further experience, supposes certain traumatic sexual events in early childhood to be the source of the neurosis, then we get the impression of an incongruity between the conception of repression and that of shock. The conception of “repression” contains the elements of an etiological theory of environment, while the conception of “shock” is a theory of predisposition.
But at first the theory of neurosis developed along the lines of the trauma conception. Pursuing Freud’s later investigations, we see him coming to the conclusion that no such positive value can be ascribed to the traumatic events of later life, as their effects could only be conceivable if the particular predisposition of the patient were taken into account. Evidently the enigma was to be resolved just at this point. As the analytical work progressed, the roots of hysterical symptoms were found in childhood; they reached back from the present far into the past. The further end of the chain threatened to get lost in the mists of early childhood. But it was just there that reminiscences appeared of certain scenes where sexual activities had been manifested in an active or passive way, and these were unmistakably connected with the events which provoked the neurosis. (For further details of these events you must consult the works of Freud, as well as the numerous analyses which have already been published.)