CHAPTER V.
The Defense Neuro-psychoses.
A Tentative Psychological Theory of Acquired Hysteria, many Phobias and Obsessions, and Certain Hallucinatory Psychoses.
After an exhaustive study of many nervous patients afflicted with phobias and obsessions a tentative explanation of these symptoms urged itself upon me. This helped me afterwards happily to divine the origin of such morbid ideas in new and other cases, and I therefore believe it worthy of reporting and further examination. Simultaneously with this “psychological theory of phobias and obsessions,” the examination of these patients resulted in a contribution to the theory of hysteria, or rather in an alteration of the same, which seems to imply an important and common character to hysteria as well as the mentioned neuroses. Furthermore, I had the opportunity to look into the psychological mechanism of a form of indubitable psychic disease and found that my attempted observation shows an intelligible connection between these psychoses and the two neuroses mentioned. At the conclusion of this theme I will describe the supporting hypothesis which I have used in all three cases.
I.
I am beginning with that alteration which seems to be necessary for the theory of the hysterical neuroses.
That the symptom-complex of hysteria as far as it can be understood, justifies the assumption of a splitting of consciousness with the formation of separate psychic groups, has attained general recognition since P. Janet, J. Breuer, and others have given out their interesting work. Less understood are the opinions concerning the origin of this splitting of consciousness and concerning the rôle played by this character in the structure of the hysterical neuroses.
According to Janet’s[[36]] theory, the splitting of consciousness is a primary feature of the hysterical alteration. It is due to a congenital weakness of the capacity for psychic synthesis, and to a narrowing of the “field of consciousness” (champ du conscience) which as a psychic stigma proves the degeneration of hysterical individuals.
In contradistinction to Janet’s views, which in my opinion admit the most manifold objections, are those advocated by J. Breuer in our joint communication. According to Breuer, the “basis and determination” of hysteria is the occurrence of peculiar dream-like conscious states with a narrowed association capacity, for which he proposes the name “hypnoid states.” The splitting of consciousness is secondary and acquired, and originates because the ideas emerging in the hypnoid states are isolated from associative communication with the rest of consciousness.
I can now demonstrate two other extreme forms of hysteria in which it is impossible to show that the splitting of consciousness is primary in the sense of Janet. In the first of these forms I could repeatedly show that the splitting of the content of consciousness was an arbitrary act of the patient, that is, it was initiated through an exertion of the will which motive can be stated. I naturally do not maintain that the patient intended to produce a splitting of his consciousness; the patient’s intention was different, but instead of attaining its aim it provoked a splitting of consciousness.
In the third form of hysteria, as we have demonstrated by psychic-analysis of intelligent patients, the splitting of consciousness plays only an insignificant and perhaps really no rôle. This includes those cases in which there had been no reaction to the traumatic stimulus and which were then adjusted and cured by ab-reaction. They are the pure retention hysterias.
In connection with the phobias and obsessions I have only to deal here with the second form of hysteria which for reasons to be presently explained I will designate as defense hysteria and thus distinguish it from the hypnoid and retention hysterias. Preliminarily I am able to call my cases of defense hysteria “acquired” hysterias for they show neither marked hereditary taints nor any degenerative disfigurements.