I think it worth emphasizing that with all changes my ideas on the etiology of the psychoneuroses still never disavowed or abandoned two points of view, to wit, the estimation of sexuality and infantilism. In other respects we have in place of the accidental influences the constitutional moments, and instead of the pure psychologically intended defense we have the organic “sexual repression.” Should anybody ask where a cogent proof can be found for the asserted etiological significance of sexual factors in the psychoneuroses, and argue that since an outburst of these diseases can result from the most banal emotions, and even from somatic causes, a specific etiology in the form of special experiences of childhood must therefore be disavowed; I mention as an answer for all these arguments the psychoanalytic investigation of neurotics as the source from which the disputed conviction emanates. If one only makes use of this method of investigation he will discover that the symptoms represent the whole or a partial sexual manifestation of the patient from the sources of the normal or perverse partial impulses of sexuality. Not only does a good part of the hysterical symptomatology originate directly from the manifestations of the sexual excitement, not only are a series of erogenous zones in strengthening infantile attributes raised in the neurosis to the importance of genitals, but even the most complicated symptoms become revealed as the converted representations of fancies having a sexual situation as a content. He who can interpret the language of hysteria can understand that the neurosis only deals with the repressed sexuality. One should, however, understand the sexual function in its proper sphere as circumscribed by the infantile predisposition. Where a banal emotion has to be added to the causation of the disease, the analysis regularly shows that the sexual components of the traumatic experience, which are never missing, have exercised the pathogenic effect.
We have unexpectedly advanced from the question of the causation of the psychoneuroses to the problem of its essence. If we wish to take cognizance of what we discovered by psychoanalysis we can only say that the essence of these maladies lies in disturbances of the sexual processes, in those processes in the organism which determine the formation and utilization of the sexual libido. We can hardly avoid perceiving these processes in the last place as chemical, so that we can recognize in the so called actual neuroses the somatic effects of disturbances in the sexual metabolism, while in the psychoneuroses we recognize besides the psychic effects of the same disturbances. The resemblance of the neuroses to the manifestations of intoxication and abstinence following certain alkaloids, and to Basedow’s and Addison’s diseases, obtrudes itself clinically without any further ado, and just as these two diseases should no more be described as “nervous diseases,” so will the genuine “neuroses” soon have to be removed from this class despite their nomenclature.
Everything that can exert harmful influences in the processes serving the sexual function therefore belongs to the etiology of the neurosis. In the first place we have the noxas directly affecting the sexual functions insofar as they are accepted as injuries by the sexual constitution which is changeable through culture and breeding. In the second place, we have all the different noxas and traumas which may also injure the sexual processes by injuring the organism as a whole. But we must not forget that the etiological problem in the neuroses is at least as complicated as in the causation of any other disease. One single pathogenic influence almost never suffices, it mostly requires a multiplicity of etiological moments reinforcing one another, and which can not be brought in contrast to one another. It is for that reason that the state of neurotic illness is not sharply separated from the normal. The disease is the result of a summation, and the measure of the etiological determinations can be completed from any one part. To seek the etiology of the neurosis exclusively in heredity or in the constitution would be no less one sided than to attempt to raise to the etiology the accidental influences of sexuality alone, even though the explanations show that the essence of this malady lies only in a disturbance of the sexual processes of the organism.
CHAPTER X.
Hysterical Fancies and their Relations to Bisexuality.[[57]]
The delusional formations of paranoiacs containing the greatness and sufferings of their own ego, which manifest themselves quite typically in almost monotonous forms are universally familiar. Furthermore, through numerous communications we became acquainted with the peculiar organizations by means of which certain perverts put into operation their sexual gratifications, be it in fancy or reality. On the other hand it may sound rather novel to some to hear that quite analogous psychic formations regularly appear in all psychoneuroses, especially in hysteria, and that these so called hysterical fancies show important relations to the causation of the neurotic symptoms.
Of the same source and of the normal prototype are all these fantastic creations, so called reveries of youth, which have already gained a certain consideration in the literature, though not a sufficient one.[[58]] They are perhaps equally frequent in both sexes; in girls and women they seem to be wholly of an erotic nature, while in men they are of an erotic or ambitious nature. Yet even in men the significance of the erotic moment is not to be put in the second place, for on examining more closely the reveries of men we generally learn that all these heroic acts are accomplished, that all these successes are acquired in order to please a woman and to be preferred to other men.[[59]] These fancies are wish gratifications which emanate from privation and longing. They are justly named “day dreams” for they give the key for the understanding of night dreams in which the nucleus of the dream formation is produced by just such complicated, disfigured day fancies which are misunderstood by the conscious psychic judgment.[[60]]
These day dreams are garnished with great interest, are cautiously nurtured, and coyly guarded, as if they were numbered among the most intimate estates of personality. On the street, however, the day dreamer can be readily recognized by a sudden, as if absent minded smile, by talking to himself, or by a running-like acceleration of his gait wherein he designates the acme of the imaginary situation.
All hysterical attacks which I have been thus far able to examine proved to be such involuntary incursions of day dreams. Observation leaves no doubt that such fancies may exist as unconscious or conscious and whenever they become unconscious they may also become pathogenic, that is, they may express themselves in symptoms and attacks. Under favorable conditions it is possible for consciousness to seize such unconscious fancies. One of my patients whose attention I have called to her fancies narrated that once while in the street she suddenly found herself in tears, and rapidly reflecting over the cause of her weeping the fancy became clear to her. She fancied herself in delicate relationship with a piano virtuoso familiar in the city, but whom she did not know personally. In her fancy she bore him a child (she was childless), and he then deserted her, leaving her and her child in misery. At this passage of the romance she burst into tears.
The unconscious fancies are either from the first unconscious, having been formed in the unconscious, or what is more frequently the case they were once conscious fancies, day dreams, and were then intentionally forgotten, merging into the unconscious by “repression.” Their content then either remained the same or underwent a transformation, so that the present unconscious fancy represents a descendant of the once conscious one. The unconscious fancy stands in a very important relation to the sexual life of the person, it is really identical with that fancy which helped it towards sexual gratification during a period of masturbation. The masturbating act (in the broader sense the onanistic) then consisted of two parts, the evocation of the fancy, and the active performance of self gratification at the height of the same. This combination is familiarly in itself a soldering.[[61]] Originally this action was a purely auto-erotic undertaking for the pleasure obtained from a certain so called erogenous part of the body. Later this action blended with a wish presentation from the sphere of the object loved, and served for a partial realization of the situation in which this fancy culminated. If, then, the person forgoes in this manner the masturbo-fantastic gratification, the action remains undone, the fancy, however, changes from a conscious to an unconscious one. If no other manner of sexual gratification occurs, if the person remains abstinent and does not succeed in sublimating his libido, that is, in diverting the sexual excitement to a higher aim, we then have the conditions for the refreshment of the unconscious fancy; it grows exuberantly and with all the force of the desire for love at least a fragment of its content becomes a morbid symptom.
The unconscious fancies are then the nearest psychical first steps of a whole series of hysterical symptoms. The hysterical symptoms are nothing other than unconscious fancies brought to light by “conversion,” and insofar as they are somatic symptoms they are frequently enough taken from the spheres of the sexual feelings and motor innervations which originally accompanied the former still conscious fancies. In this way the disuse of onanism is really made retrograde, and the final aim of the whole pathological process, the restoration of the primary sexual gratification, though it never becomes perfect, in a manner always achieves a certain approximation.