In the case of the second patient, the young girl, it is an erotic attachment for her father that had established itself in the years prior to puberty, which plays the same role in her life. She also has arrived at the conclusion that she may not marry so long as she is sick. We may suspect she became ill in order that she need not marry, and that she might stay with her father.
It is impossible to evade the question of how, in what manner, and driven by what motives, an individual may come by such a remarkable and unprofitable attitude toward life. Granted of course that this bearing is a general characteristic of neurosis, and not a special peculiarity of these two cases, it is nevertheless a general trait in every neurosis of very great importance in practice. Breuer's first hysterical patient was fixated in the same manner upon the time when she nursed her very sick father. In spite of her recuperation she has, in certain respects, since that time, been done with life; although she remained healthy and able, she did not enter on the normal life of women. In every one of our patients we may see, by the use of analysis, that in his disease-symptoms and their results he has gone back again into a definite period of his past. In the majority of cases he even chooses a very early phase of his life, sometime a childhood phase, indeed, laughable as it may appear, a phase of his very suckling existence.
The closest analogies to these conditions of our neurotics are furnished by the types of sickness which the war has just now made so frequent—the so-called traumatic neuroses. Even before the war there were such cases after railroad collisions and other frightful occurrences which endangered life. The traumatic neuroses are, fundamentally, not the same as the spontaneous neuroses which we have been analysing and treating; moreover, we have not yet succeeded in bringing them within our hypotheses, and I hope to be able to make clear to you wherein this limitation lies. Yet on one point we may emphasize the existence of a complete agreement between the two forms. The traumatic neuroses show clear indications that they are grounded in a fixation upon the moment of the traumatic disaster. In their dreams these patients regularly live over the traumatic situation; where there are attacks of an hysterical type, which permit of an analysis, we learn that the attack approximates a complete transposition into this situation. It is as if these patients had not yet gotten through with the traumatic situation, as if it were actually before them as a task which was not yet mastered. We take this view of the matter in all seriousness; it shows the way to an economic view of psychic occurrences. For the expression "traumatic" has no other than an economic meaning, and the disturbance permanently attacks the management of available energy. The traumatic experience is one which, in a very short space of time, is able to increase the strength of a given stimulus so enormously that its assimilation, or rather its elaboration, can no longer be effected by normal means.
This analogy tempts us to classify as traumatic those experiences as well upon which our neurotics appear to be fixated. Thus the possibility is held out to us of having found a simple determining factor for the neurosis. It would then be comparable to a traumatic disease, and would arise from the inability to meet an overpowering emotional experience. As a matter of fact this reads like the first formula, by which Breuer and I, in 1893-1895, accounted theoretically for our new observations. A case such as that of our first patient, the young woman separated from her husband, is very well explained by this conception. She was not able to get over the unfeasibility of her marriage, and has not been able to extricate herself from this trauma. But our very next, that of the girl attached to her father, shows us that the formula is not sufficiently comprehensive. On the one hand, such baby love of a little girl for her father is so usual, and so often outlived that the designation "traumatic" would carry no significance; on the other hand, the history of the patient teaches us that this first erotic fixation apparently passed by harmlessly at the time, and did not again appear until many years later in the symptoms of the compulsion neurosis. We see complications before us, the existence of a greater wealth of determining factors in the disease, but we also suspect that the traumatic viewpoint will not have to be given up as wrong; rather it will have to subordinate itself when it is fitted into a different context.
Here again we must leave the road we have been traveling. For the time being, it leads us no further and we have many other things to find out before we can go on again. But before we leave this subject let us note that the fixation on some particular phase of the past has bearings which extend far beyond the neurosis. Every neurosis contains such a fixation, but every fixation does not lead to a neurosis, nor fall into the same class with neuroses, nor even set the conditions for the development of a neurosis. Mourning is a type of emotional fixation on a theory of the past, which also brings with it the most complete alienation from the present and the future. But mourning is sharply distinguished from neuroses that may be designated as pathological forms of mourning.
It also happens that men are brought to complete deadlock by a traumatic experience that has so completely shaken the foundations on which they have built their lives that they give up all interest in the present and future, and become completely absorbed in their retrospections; but these unhappy persons are not necessarily neurotic. We must not overestimate this one feature as a diagnostic for a neurosis, no matter how invariable and potent it may be.
Now let us turn to the second conclusion of our analysis, which however we will hardly need to limit subsequently. We have spoken of the senseless compulsive activities of our first patient, and what intimate memories she disclosed as belonging to them; later we also investigated the connection between experience and symptom and thus discovered the purpose hidden behind the compulsive activity. But we have entirely omitted one factor that deserves our whole attention. As long as the patient kept repeating the compulsive activity she did not know that it was in any way related with the experience in question. The connection between the two was hidden from her, she truthfully answered that she did not know what compelled her to do this. Once, suddenly, under the influence of the cure, she hit upon the connection and was able to tell it to us. But still she did not know of the end in the service of which she performed the compulsive activities, the purpose to correct a painful part of the past and to place the husband, still loved by her, upon a higher level. It took quite a long time and a great deal of trouble for her to grasp and admit to me that such a motive alone could have been the motive force of the compulsive activity.
The relation between the scene after the unhappy bridal night and the tender motive of the patient yield what we have called the meaning of the compulsive activity. But both the "whence" and the "why" remained hidden from her as long as she continued to carry out the compulsive act. Psychological processes had been going on within her for which the compulsive act found an expression. She could, in a normal frame of mind, observe their effect, but none of the psychological antecedents of her action had come to the knowledge of her consciousness. She had acted in just the same manner as a hypnotized person to whom Bernheim had given the injunction that five minutes after his awakening in the ward he was to open an umbrella, and he had carried out this order on awakening, but could give no motive for his so doing. We have exactly such facts in mind when we speak of the existence of unconscious psychological processes. Let anyone in the world account for these facts in a more correct scientific manner, and we will gladly withdraw completely our assumption of unconscious psychological processes. Until then, however, we shall continue to use this assumption, and when anyone wants to bring forward the objection that the unconscious can have no reality for science and is a mere makeshift, (une façon de parler), we must simply shrug our shoulders and reject his incomprehensible statement resignedly. A strange unreality which can call out such real and palpable effects as a compulsion symptom!
In our second patient we meet with fundamentally the same thing. She had created a decree which she must follow: the pillow must not touch the head of the bed; yet she does not know how it originated, what its meaning is, nor to what motive it owes the source of its power. It is immaterial whether she looks upon it with indifference or struggles against it, storms against it, determines to overcome it. She must nevertheless follow it and carry out its ordinance, though she asks herself, in vain, why. One must admit that these symptoms of compulsion neurosis offer the clearest evidence for a special sphere of psychological activity, cut off from the rest. What else could be back of these images and impulses, which appear from one knows not where, which have such great resistance to all the influences of an otherwise normal psychic life; which give the patient himself the impression that here are super-powerful guests from another world, immortals mixing in the affairs of mortals. Neurotic symptoms lead unmistakably to a conviction of the existence of an unconscious psychology, and for that very reason clinical psychiatry, which recognizes only a conscious psychology, has no explanation other than that they are present as indications of a particular kind of degeneration. To be sure, the compulsive images and impulses are not themselves unconscious—no more so than the carrying out of the compulsive-acts escapes conscious observation. They would not have been symptoms had they not penetrated through into consciousness. But their psychological antecedents as disclosed by the analysis, the associations into which we place them by our interpretations, are unconscious, at least until we have made them known to the patient during the course of the analysis.
Consider now, in addition, that the facts established in our two cases are confirmed in all the symptoms of all neurotic diseases, that always and everywhere the meaning of the symptoms is unknown to the sufferer, that analysis shows without fail that these symptoms are derivatives of unconscious experiences which can, under various favorable conditions, become conscious. You will understand then that in psychoanalysis we cannot do without this unconscious psyche, and are accustomed to deal with it as with something tangible. Perhaps you will also be able to understand how those who know the unconscious only as an idea, who have never analyzed, never interpreted dreams, or never translated neurotic symptoms into meaning and purpose, are most ill-suited to pass an opinion on this subject. Let us express our point of view once more. Our ability to give meaning to neurotic symptoms by means of analytic interpretation is an irrefutable indication of the existence of unconscious psychological processes—or, if you prefer, an irrefutable proof of the necessity for their assumption.