Selected papers on hysteria and other psychoneuroses

by Sigmund Freud

In still other cases the pressure of the hand awakens a reminiscence well known to the patient, which appearance, however, causes him surprise because he had forgotten its relation to the starting idea. In the further course of the analysis this relation becomes clear. From all these results of the pressure one receives a delusive impression of a superior intelligence external to the patient’s consciousness, which systematically holds a large psychic material for definite purposes, and has provided an ingenious arrangement for its return into consciousness. I presume, however, that this unconscious second intelligence is really only apparent.

In every complicated analysis one works repeatedly, nay continuously, with the help of this procedure (pressure on the forehead), which leads us from the place where the patient’s conscious reconductions become interrupted, showing us the way over reminiscences which remained known, and calling our attention to connections which have merged into forgetfulness. It also evokes and connects memories which have for years been withdrawn from the association, but can still be recognized as memories; and finally, as the highest performance of reproduction, it causes the appearance of thoughts which the patient never wishes to recognize as his own, which he does not remember, although he admits that they are inexorably demanded by the connection, and is convinced that just these ideas cause the termination of the analysis and the cessation of the symptoms.

I will now attempt to give a series of examples showing the excellent achievements of this procedure. I treated a young lady who suffered for six years from an intolerable and protracted nervous cough, which apparently was nurtured by every common catarrh, but must have had its strong psychic motives. Every other remedy had long since shown itself to be powerless, and I therefore attempted to remove the symptom by psychoanalysis. All that she could remember was that the nervous cough began at the age of fourteen while she boarded with her aunt. She remembered absolutely no psychic excitement during that time, and did not believe that there was a motive for her suffering. Under the pressure of my hand, she at first recalled a large dog. She then recognized the memory picture; it was her aunt’s dog which was attached to her, and used to accompany her everywhere, and without any further aid it occurred to her that this dog died and that the children buried it solemnly; and on the return from this funeral her cough appeared. I asked her why she began to cough, and after helping her with the pressure, the following thought occurred to her: “Now I am all alone in this world; no one loves me here; this animal was my only friend, and now I have lost it.” She then continued her story. “The cough disappeared when I left my aunt, but reappeared a year and a half later.”—“What was the reason for it?”—“I do not know.”—I again exerted some pressure on the forehead, and she recalled the news of her uncle’s death during which the cough again manifested itself, and also recalled a train of thought similar to the former. The uncle was apparently the only one in the family who sympathized with and loved her. That was, therefore, the pathogenic idea: “People do not love her; everybody else is preferred; she really does not deserve to be loved,” etc. To the idea of love there clung something which caused a marked resistance to the communication. The analysis was interrupted before this explanation.

Some time ago I attempted to relieve an elderly lady of her anxiety attacks, which considering their characteristic qualities, were hardly adapted to such influence. Since her menopause she had become extremely religious, and always received me as if I were the Devil. She was always armed with a small ivory crucifix which she hid in her hand. Her attacks of anxiety, which bore the hysterical character, could be traced to her early girlhood, and were supposed to have originated from the application of an iodine preparation used to reduce a moderate swelling of the thyroid. I naturally repudiated this origin, and sought to substitute it by another which was in better harmony with my views concerning the etiology of neurotic symptoms. To the first question for an impression of her youth which would stand in causal connection to the attacks of anxiety, there appeared under the pressure of my hand the reminiscence of reading a so called devotional book wherein piously enough there was some mention of the sexual processes. The passage in question made an impression on this girl, which was contrary to the intention of the author. She burst into tears and flung the book away. That was before the first attack of anxiety. A second pressure on the forehead of the patient evoked the next reminiscence, it referred to her brother’s teacher who showed her great respect, and for whom she entertained a warmer feeling. This reminiscence culminated in the reproduction of an evening in her parents’ home, during which they all sat around the table with the young man, and delightfully enjoyed themselves in a lively conversation. During the night following this evening she was awakened by the first attack of anxiety which surely had more to do with some resistance against a sensual feeling than perhaps with the coincidently used iodine. In what other way could I have succeeded in revealing in this obstinate patient, prejudiced against me and every worldly remedy, such a connection contrary to her own opinion and assertion?

On another occasion I had to deal with a young happily married woman, who as early as in the first years of her girlhood, was found every morning for some time in a state of lethargy, with rigid members, opened mouth, and protruding tongue. Similar attacks, though not so marked, recurred at the present time on awakening. A deep hypnosis could not be produced, so that I began my investigation in a state of concentration, and assured her during the first pressure that she would see something that would be directly connected with the cause of her condition during her childhood. She acted calmly and willingly, she again saw the residence in which she had passed her early girlhood, her room, the position of her bed, the grandmother who lived with them at the time, and one of her governesses whom she dearly loved. There was then a succession of small, quite indifferent scenes, in these rooms, and among these persons, the conclusion of which was the leave taking of the governess who married from the home. I did not know what to start with these reminiscences; I could not bring about any connection between them and the etiology of the attacks. To be sure the various circumstances were recognized as having occurred at the same time at which the attacks first appeared.

Before I could continue the analysis, I had occasion to talk to a colleague, who, in former years, was my patient’s family physician. From him I obtained the following explanation: At the time that he treated the mature and physically very well developed girl for these first attacks, he was struck by the excessive affection in the relations between her and her governess. He became suspicious and caused the grandmother to watch these relations. After a short while the old lady informed him that the governess was wont to pay nightly visits to the child’s bed, and that quite regularly after such visits the child was found in the morning in an attack. She did not hesitate to bring about the quiet removal of this corruptress of youth. The children, as well as the mother, were made to believe that the governess left the house in order to get married.

The treatment, which was above all successful, consisted in informing the young woman of the explanations given to me.

Occasionally the explanations, which one obtains by the pressure procedure, follow in very remarkable form, and under circumstances which make the assumption of an unconscious intelligence appear even more alluring. Thus I recall a lady who suffered for years from obsessions and phobias, and who referred the origin of her trouble to her childhood, but could mention nothing to which it could have been attributed. She was frank and intelligent, and evinced only a very slight conscious resistance. I will add here that the psychic mechanism of obsessions is very closely related to that of hysterical symptoms, and that the technique of the analysis in both is the same.

On asking the lady whether she had seen or recalled anything under the pressure of my hand, she answered, “Neither, but a word suddenly occurred to me.”—“A single word?”—“Yes, but it is too foolish.”—“Just tell it.”—“Teacher.”—“Nothing more?”—“No.” I exerted pressure a second time, and again a single word flashed through her mind: “Shirt.”—I now observed that we have dealt with a new mode of replying, and by repeated pressure I evoked the following apparently senseless series of words: Teacher—shirt—bed—city—wagon. I asked, “What does all that mean?” She reflected for a moment, and it then occurred to her that “it can only refer to this one incident which now comes to my mind. When I was ten years old my older sister of twelve had an attack of frenzy one night, and had to be bound, put in a wagon and taken to the city. I remember distinctly that it was the teacher who overpowered her and accompanied her to the asylum.”—We then continued this manner of investigation, and received from our oracle another series of words which, though we could not altogether interpret, could nevertheless be used as a continuation of this story, and as an appendix to a second. The significance of this reminiscence was soon clear. The reason why her sister’s illness made such an impression on her was because they both shared a common secret. They slept in the same room, and one night they both submitted to a sexual assault by a certain man. In discovering this sexual trauma of early youth, we revealed not only the origin of the first obsession but also the trauma which later acted pathogenically.—The peculiarity of this case lies only in the appearance of single catch words which we had to elaborate into sentences, for the irrelevance and incoherence found in these oracle like uttered words adhere to all ideas and scenes which generally occur as a result of pressure. On further investigation it is regularly found that the seemingly disconnected reminiscences are connected by close streams of thought, and that they lead quite directly to the desired pathogenic moment.

With pleasure do I therefore recall a case of analysis in which my confidence in the results of pressure was splendidly justified. A very intelligent, and apparently very happy, young woman consulted me for persistent pain in her abdomen which yielded to no treatment. I found that the pain was situated in the abdominal wall and was due to palpable muscular hardening, and I ordered local treatment.