In those patients whom I have analyzed there existed psychic health until the moment in which a case of incompatibility occurred in their ideation, that is, until there appeared an experience, idea, or feeling which evoked such a painful affect that the person decided to forget it because he did not trust his own ability to remove the resistance between the unbearable ideas and his ego.
Such incompatible ideas originate in the feminine sex on the basis of sexual experiences and feelings. With all desired precision the patients recall their efforts of defense, their intention “to push it away,” not to think of it, to repress it. As appropriate examples I can easily cite the following cases from my own experience: A young lady reproached herself because, while nursing her sick father, she thought of a young man who made a slight erotic impression on her; a governess fell in love with her employer and decided to crowd it out of her mind because it was incompatible with her pride, etc.
I am unable to maintain that the exertion of the will, in crowding such thoughts out of one’s mind, is a pathological act, nor am I able to state whether and how, the intentional forgetting succeeds in those persons who remain well under the same psychic influences. I only know that in the patients whom I analyzed such “forgetting” was unsuccessful and led to either a hysteria, obsession, or a hallucinatory psychosis. The ability to produce, by the exertion of the will one of these states all of which are connected with the splitting of consciousness, is to be considered as the expression of a pathological disposition, but it need not necessarily be identified with personal or hereditary “degeneration.”
Over the road leading from the patient’s exertion of the will to the origin of a neurotic symptom I formed a conception which in the current psychological abstractions may be thus expressed: The task assumed by the defensive ego to treat the incompatible idea as “non arrivée” can not be directly accomplished. The memory trace as well as the affect adhering to the idea are here and can not be exterminated. The task can however, be brought to an approximate solution if it is possible to change the strong idea into a weak one and to take away the affect or sum of excitement which adheres to it. The weak idea will then exert almost no claims on the association work; but the separated sum of excitement must be utilized in another direction.
Thus far the processes are the same in hysteria, in phobias and obsessions, but from now on their ways part. The unbearable idea in hysteria is rendered harmless because the sum of excitement is transformed into physical manifestations, a process for which I would like to propose the term conversion.
The conversion may be total or partial, and follows that motor or sensory innervation which is either ultimately or more loosely connected with the traumatic experience. In this way the ego succeeds in freeing itself from opposition but instead it becomes burdened with a memory symbol which remains in consciousness as an unadjusted motor innervation, or as a constantly recurring hallucinatory sensation similar to a parasite. It thus remains fixed until a conversion takes place in the opposite direction. The memory symbol of the repressed idea does not perish, but from now on forms the nucleus for a second psychic group.
I will follow up this view of the psycho-physical processes in hysteria with a few more words. If such a nucleus for an hysterical splitting is once formed in a “traumatic moment” it then increases in other moments which might be designated as “auxiliary traumatic” as soon as a newly formed similar impression succeeds in breaking through the barrier formed by the will and in adding new affects to the weakened idea, and in forcing for a while the associative union of both psychic groups until a new conversion produces defense. The condition thus attained in hysteria in regard to the distribution of the excitement, proves to be unstable in most cases. As shown by the familiar contrast of the attacks and the persistent symptoms, the excitement which was pushed on a false path (in the bodily innervation) now and then returns to the idea from which it was discharged and forces the person to associative elaboration or to adjustment in hysterical attacks. The effect of Breuer’s cathartic method consists in the fact that it consciously reconducts the excitement from the physical into the psychic spheres and then forces an adjustment of the contradiction through intellectual work, and a discharge of the excitement through speech.
If the splitting of consciousness in acquired hysteria is due to an act of volition we can explain with surprising simplicity the remarkable fact that hypnosis regularly broadens the narrowed consciousness of hysteria, and causes the split off psychic groups to become accessible. For we know that it is peculiar to all sleep-like states to remove that distribution of excitement which depends on the “will” of the conscious personality.
We accordingly recognize that the characteristic moment of hysteria is not the splitting of consciousness but the ability of conversion, and as an important part of the hitherto unknown disposition of hysteria we can mention the psycho-physical adaptation for the transference of a great sum of excitement into bodily innervation.
The adaptation does not in itself exclude psychic health, and leads to hysteria only in event of a psychic incompatibility or accumulation of excitement. With this turn, we—Breuer and I—come near to the familiar definitions of hysteria of Oppenheim[[37]] and Strümpel,[[38]] and deviate from Janet,[[39]] who assigns to the splitting of consciousness too great a rôle in the characteristics of hysteria. The description here given can lay claim to the fact that it explains the connection between the conversion and the hysterical splitting of consciousness.