Selected papers on hysteria and other psychoneuroses

by Sigmund Freud

One, thereby, becomes astonishingly convinced, that it is not possible to press upon the patient things which he apparently does not know, or to influence the results of the analysis by exciting his expectations. I have not succeeded a single time in altering or falsifying the reproductions of memory or the connections of events by my predictions; had I succeeded it surely would have been revealed in the end by a contradiction in the construction. If anything occurred as I predicted, the correctness of my conjecture was always attested by numerous trustworthy reminiscences. Hence, one must not fear to express his opinion to the patient concerning the connections which are to follow; it does no harm.

Another manifestation which can be repeatedly observed refers to the patient’s independent reproductions. It can be asserted that not a single reminiscence comes to the surface during such an analysis which has no significance. An interposition of irrelevant memory pictures having no connection with the important associations does not really occur. An exception not contrary to the rule may be postulated for those reminiscences which, though in themselves unimportant, are indispensable as intercalations, since the associations between two related reminiscences passed through them only.—As mentioned above, the period during which a reminiscence abides in the pass of the patient’s consciousness is directly proportionate to its significance. A picture which does not disappear requires further consideration; a thought which cannot be abolished must be followed further. A reminiscence never recurs if it has been adjusted, a picture spoken away cannot be seen again. However, if that does happen it can be definitely expected that the second time the picture will be joined by a new content of thought, that the idea will contain a new inference which will show that no perfect adjustment has taken place. On the other hand, a recurrence of different intensities, at first vaguely then quite plainly, often occurs, but it does not, however, contradict the assertion just advanced.

If the object of the analysis is to remove a symptom (pains, symptoms like vomiting, sensations and contractures) which is capable of aggravation or recurrence, the symptom shows during the work the interesting and not undesirable phenomenon of “joining in the discussion.” The symptom in question reappears, or appears with greater intensity, as soon as one penetrates into the region of the pathogenic organization containing the etiology of this symptom, and it continues to accompany the work with characteristic and instructive fluctuations. The intensity of the same (let us say of a nausea) increases the deeper one penetrates into its pathogenic reminiscence; it reaches its height shortly before the latter has been expressed, and suddenly subsides or disappears completely for a while after it has been fully expressed. If through resistance the patient delays the expression, the tension of the sensation of nausea becomes unbearable, and, if the expression cannot be forced, vomiting actually sets in. One thus gains a plastic impression of the fact that the vomiting takes the place of a psychic action (here that of speaking) just as was asserted in the conversion theory of hysteria.

The fluctuation of intensity on the part of the hysterical symptom recurs as often as one of its new and pathogenic reminiscences is attacked; the symptom remains, as it were, all the time the order of the day. If it is necessary to drop for awhile the thread upon which this symptom hangs, the symptom, too, merges into obscurity in order to emerge again at a later period of the analysis. This play continues until, through the completion of the pathogenic material, there occurs a definite adjustment of this symptom.

Strictly speaking the hysterical symptom does not behave here differently than a memory picture or a reproduced thought which is evoked by the pressure of the hand. Here, as there, the adjustment necessitates the same obsessing obstinacy of recurrence in the memory of the patient. The difference lies only in the apparent spontaneous appearance of the hysterical symptom, whereas one readily recalls having himself provoked the scenes and ideas. But in reality the memory symbols run in an uninterrupted series from the unchanged memory remnants of affectful experiences and thinking-acts to the hysterical symptoms.

The phenomenon of “joining in the discussion” of the hysterical symptom during the analysis carries with it a practical inconvenience to which the patient should be reconciled. It is quite impossible to undertake the analysis of a symptom in one stretch or to divide the pauses in the work in such a manner as to precisely coincide with the resting point in the adjustment. Furthermore, the interruption which is categorically dictated by the accessory circumstances of the treatment, like the late hour, etc., often occurs in the most awkward locations, just when some critical point could be approached or when a new theme comes to light. These are the same inconveniences which every newspaper reader experiences in reading the daily fragments of his newspaper romance, when, immediately after the decisive speech of the heroine, or after the report of a shot, etc., he reads, “To be continued.” In our case the raked-up but unabolished theme, the at first strengthened but not yet explained symptom, remains in the patient’s psyche, and troubles him perhaps more than before.

But the patient must understand this as it cannot be differently arranged. Indeed, there are patients who during such an analysis are unable to get rid of the theme once touched; they are obsessed by it even during the interval between the two treatments, and as they are unable to advance alone with the adjustment, they suffer more than before. Such patients, too, finally learn to wait for the doctor, postponing all interest which they have in the adjustment of the pathogenic material for the hours of the treatment, and they then begin to feel freer during the intervals.

The general condition of the patient during such an analysis seems also worthy of consideration. For a while it remains uninfluenced by the treatment expressing the former effective factors. But then a moment comes in which the patient is seized, and his interest chained and from that time his general condition becomes more and more dependent on the condition of the work. Whenever a new explanation is gained and an important contribution in the chain of the analysis is reached, the patient feels relieved and experiences a presentiment of the approaching deliverance; but at each standstill of the work, at each threatening entanglement, the psychic burden which oppresses him grows, and the unhappy sensation of his incapacity increases. To be sure, both conditions are only temporary, for the analysis continues disdaining to boast of a moment of wellbeing, and continues regardlessly over the period of gloominess. One is generally pleased if it is possible to substitute the spontaneous fluctuations in the condition of the patient by such as one himself provokes and understands, just as one prefers to see in place of the spontaneous discharge of the symptoms that order of the day which corresponds to the condition of the analysis.

Usually the deeper one penetrates into the above described layers of the psychic structure the more obscure and difficult the work will at first become. But once the nucleus is reached light ensues, and there is no more fear that a marked gloom will be cast over the condition of the patient. However, the reward of the labor, the cessation of the symptoms of the disease can only be expected when the full analysis of every individual symptom has been accomplished; indeed where the individual symptoms are connected through many junctures one is not even encouraged by partial successes during the work. By virtue of the great number of existing causal connections every unadjusted pathogenic idea acts as a motive for the complete creation of the neurosis, and only with the last word of the analysis does the whole picture of the disease disappear, just as happens in the behavior of the individual reproduced reminiscence.

If a pathogenic reminiscence or a pathogenic connection which was previously withdrawn from the ego consciousness is revealed by the work of the analysis and inserted into the ego, one can observe in the psychic personality which was thus enriched the many ways in which it gives utterance to its gain. Especially does it frequently happen that after the patients have been painstakingly forced to a certain knowledge, they say: “Why I have known that all the time, I could have told you that before.” Those who have more insight recognize this afterwards as a self deception and accuse themselves of ungratefulness. In general the position that the ego takes towards the new acquisition depends upon the strata of the analysis from which the latter originates. Whatever belongs to the outermost layers is recognized without any difficulty, for it always remained in the possession of the ego, and the only thing that was new to the ego was its connection with the deeper layers of the pathogenic material. Whatever is brought to light from these deeper layers also finds appreciation and recognition, but frequently only after long hesitation and reflection. Of course, visual memory pictures are here more difficult to deny than reminiscences of mere streams of thought. Not very seldom the patient will at first say, “It is possible that I thought of that, but I cannot recall it,” and only after a longer familiarity with this supposition recognition will appear. He then recalls and even verifies by sight associations that he once really had this thought. During the analysis I make it a point of holding the value of an emerging reminiscence independent of the patient’s recognition. I am not tired of repeating that we are obliged to accept everything that we bring to light with our means. Should there be anything unreal or incorrect in the material thus revealed, the connection will later teach us to separate it. I may add that I rarely ever have occasion to subsequently withdraw the recognition from a reminiscence which I had preliminarily admitted. In spite of the deceptive appearance of an urgent contradiction, whatever came to the surface finally proved itself correct.