Introductory lectures on psycho-analysis

It pleases me greatly to see you here again to continue our discussions after a year has passed. Last year the subject of my lectures was the application of psycho-analysis to errors and to dreams; I hope this year to lead you to some comprehension of neurotic phenomena which, as you will soon discover, have much in common with both our former subjects. I must tell you before I begin, however, that I cannot concede you the same attitude towards me now as I did last year. Then I endeavoured to make no step without being in agreement with your judgement; I debated a great deal with you, submitted to your objections, in fact, recognized you and your “healthy common-sense” as the deciding factor. That is no longer possible and for a very simple reason. Errors and dreams are phenomena which were familiar to you; one might say you had as much experience of them as I, or could easily have obtained it. The manifestations of neurosis, however, are an unknown region to you; those of you who are not yourselves medical men have no access there except through the accounts I give you; and of what use is the most excellent judgement where there is no knowledge of the subject under debate?

However, do not receive this announcement as though I were going to give these lectures ex cathedra or to demand unconditional acceptance from you. Any such misconception would do me a gross injustice. I do not aim at producing conviction,—my aim is to stimulate enquiry and to destroy prejudices. If owing to ignorance of the subject you are not in a position to adjudicate, then you should neither believe nor reject. You should only listen and allow what I tell you to make its own effect upon you. Convictions are not so easily acquired, or, when they are achieved without much trouble, they soon prove worthless and unstable. No one has a right to conviction on these matters who has not worked at this subject for many years, as I have, and has not himself experienced the same new and astonishing discoveries. Then why these sudden convictions in intellectual matters, lightning conversions, and instantaneous repudiations? Do you not see that the coup de foudre, “love at first sight,” proceeds from a very different mental sphere, from the affective one? We do not require even our patients to bring with them any conviction in favour of psycho-analysis or any devotion to it. It would make us suspicious of them. Benevolent scepticism is the attitude in them which we like best. Therefore will you also try to let psycho-analytical conceptions develop quietly in your minds alongside the popular or the psychiatric view, until opportunities arise for them to influence each other and be united into a decisive opinion.

On the other hand, you are not for a moment to suppose that the psycho-analytic point of view which I shall lay before you is a speculative system of ideas. On the contrary, it is the result of experience, being founded either on direct observations or on conclusions drawn from observation. Whether these have been drawn in an adequate or a justifiable manner future advances in science will show; after nearly two and a half decades and now that I am fairly well advanced in years I may say, without boasting, that it was particularly difficult, intense, and all-absorbing work that yielded these observations. I have often had the impression that our opponents were unwilling to consider this source of our statements, as if they looked upon them as ideas derived subjectively which anyone could dispute at his own sweet will. This attitude on the part of my opponents is not quite comprehensible to me. Perhaps it comes from the circumstance that physicians pay so little attention to neurotics and listen so carelessly to what they say that it has become impossible for them to perceive anything in the patients’ communications or to make detailed observations from them. I will take this opportunity of assuring you that in these lectures I shall make few controversial references, least of all to individuals. I have never been able to convince myself of the truth of the saying that “strife is the father of all things.” I think the source of it was the philosophy of the Greek sophists and that it errs, as does the latter, through the over estimation of dialectics. It seems to me, on the contrary, that scientific controversy, so-called, is on the whole quite unfruitful, apart from the fact that it is almost always conducted in a highly personal manner. Until a few years ago I could boast that I had only once been engaged in a regular scientific dispute, and that with one single investigator, Löwenfeld of Munich. The end of it was that we became friends and have remained so to this day. But I did not repeat the experiment for a very long time because I was not certain that the outcome would be the same.

Now you will surely judge that a refusal of this kind to discuss matters publicly points to a high degree of inaccessibility to criticism, to obstinacy, or, in the polite colloquialism of the scientific world, to “pig-headedness.”^[43] My reply to you would be that, should you have arrived at a conviction by means of such hard work, you would also thereby derive a certain right to maintain it with some tenacity. Further, on my own behalf, I can say that in the course of my work I have modified my views on important points, changed them or replaced them by others, and have of course in each case published the fact. What has been the result of this frankness? Some people have ignored my corrections of myself altogether and still to-day criticize me in respect of views which no longer mean the same to me. Others positively reproach me for these changes and declare me to be unreliable on that account. No one who changes his views once or twice deserves to be believed, for it is only too likely that he will be mistaken again in his latest assertions; but anyone who sticks to anything he has once said, or refuses to give way upon it easily enough, is obstinate or pig-headed; is it not so? What is to be done in the face of these self-contradictory criticisms except to remain as one is and behave as seems best to one? This is what I decided to do; and I am not deterred from remodelling and improving my theories in accordance with later experience. I have so far found nothing to alter in my fundamental standpoint and I hope this will never be necessary.

So now I have to lay before you the psycho-analytic theory of neurotic manifestations. For this purpose it will be simplest, on account of both the analogy and the contrast, to take an example which links up with the phenomena we have already considered. I will take a ‘symptomatic act’ which I see many people commit in my own consulting-room. The analyst has little to offer to the people who come to a physician’s consulting-room for half-an-hour to recount the lifelong misery of their fate. His deeper comprehension makes it difficult for him to give, as another might, the opinion that there is nothing wrong with them and that they had better take a light course of hydrotherapy. One of our colleagues once replied, with a shrug, when asked how he dealt with consultation patients, that he “fined them so many crowns for ‘wasting the time of the court.’” You will therefore not be surprised to hear that even the busiest psycho-analysts are not much sought after for consultations. I have had the ordinary door between the waiting-room and my consulting-room supplemented by another door and covered with felt. The reason for this is obvious. Now it constantly happens when I admit people from the waiting-room that they omit to close these doors, leaving even both doors open behind them. When I see this happen, I at once, with some stiffness, request him or her to go back and make good the omission, no matter how fine a gentleman he may be nor how many hours she had spent on her toilet. My action gives the impression of being uncalled-for and pedantic; occasionally too I have found myself in the wrong, when the person turned out to be one of those who cannot themselves grasp a door-handle and are glad when those with them avoid it. But in the majority of cases I was right, for anyone who behaves in this way and leaves the door of a physician’s consulting-room open into the waiting-room belongs to the rabble and deserves to be received with coldness. Now don’t allow yourselves to be biassed before you have heard the rest. This omission on the part of a patient occurs only when he has been waiting alone in the outer room and thus leaves an empty room behind him, never when others, strangers to him, have also been waiting there. In the latter case he knows very well that it is to his own interest not to be overheard while he talks to the physician and he never neglects to close both doors carefully.

Occurring in this way, the patient’s omission is neither accidental nor meaningless, and not even unimportant, for it betrays the visitor’s attitude to the physician. He belongs to that large class who seek those in high places, and wish to be dazzled and intimidated. Perhaps he had made enquiries by telephone at what time he would be most likely to gain admittance and had been expecting to find a crowd of applicants in a queue, as if at the grocer’s in war-time. Then he is shown into an empty room which, moreover, is most modestly furnished, and he is dumbfounded. He must somehow make the physician atone for the superfluous respect he had been prepared to show him; and so he omits to close the doors between the waiting- and the consulting-rooms. He intends this to mean: “Pooh! there is no one here and I daresay there won’t be, however long I stay!” He would behave during the interview in an uncivil and supercilious manner, too, if his presumption were not curbed at the outset by a sharp reminder.

In the analysis of this little symptomatic act you find nothing that is not already known to you; namely, the conclusion that it is no accident but has in it motive, meaning, and intention; that it belongs to a mental context which can be specified; and that it provides a small indication of a more important mental process. But above all it implies that the process thus indicated is not known to the consciousness of the person who carries it out; for not one of the patients who left the two doors open would have admitted that he wished to show any depreciation of me by his neglect. Many of them could probably recall a sense of disappointment on entering the empty waiting-room, but the connection between this impression and the succeeding symptomatic act certainly remained outside their consciousness.

Now let us place this little analysis of a symptomatic act by the side of an observation made on a patient. I will choose one which is fresh in my memory, and also because it can be described in comparatively few words. A certain amount of detail is indispensable for any such account.

A young officer, home on short leave of absence, asked me to treat his mother-in-law, who was living in the happiest surroundings and yet was embittering her own and her family’s lives by a nonsensical idea. I found her a well-preserved lady, fifty-three years of age, of a friendly, simple disposition, who gave without hesitation the following account of herself. She is most happily married, and lives in the country with her husband who manages a large factory. She cannot say enough of her husband’s kindness and consideration; theirs had been a love-marriage thirty years ago, since when they had never had a cloud, a quarrel, or a moment’s jealousy. Her two children have both married well, but her husband’s sense of duty keeps him still at work. A year before, an incredible and, to her, incomprehensible thing happened. She received an anonymous letter telling her that her excellent husband was carrying on an intrigue with a young girl, and believed it on the spot—since then her happiness has been destroyed. The details were more or less as follows: she had a housemaid with whom she discussed confidential matters, perhaps rather too freely. This young woman cherished a positively venomous hatred for another girl who had succeeded better in life than herself, although of no better origin. Instead of going into service, the other young woman had had a commercial training, been taken into the factory and, owing to vacancies caused by the absence of staff on service in the field, had been promoted to a good position. She lived in the factory, knew all the gentlemen, and was even addressed as “Miss.” The other one who had been left behind in life was only too ready to accuse her former schoolmate of all possible evil. One day our patient and her housemaid were discussing an elderly gentleman who had visited the house and of whom it was said that he did not live with his wife but kept a mistress. Why, she did not know, but she suddenly said: “I cannot imagine anything more awful than to hear that my husband had a mistress.” The next day she received by post an anonymous letter in disguised handwriting which informed her of the very thing she had just imagined. She concluded—probably correctly—that the letter was the handiwork of her malicious housemaid, for the woman who was named as the mistress of her husband was the very girl who was the object of this housemaid’s hatred. Although she at once saw through the plot and had seen enough of such cowardly accusations in her own surroundings to place little credence in them, our patient was nevertheless prostrated by this letter. She became terribly excited and at once sent for her husband to overwhelm him with reproaches. The husband laughingly denied the accusation and did the best thing he could. He sent for the family physician (who also attended the factory), and he did his best to calm the unhappy lady. The next thing they did was also most reasonable. The housemaid was dismissed, but not the supposed mistress. From that time on the patient claims to have repeatedly brought herself to a calm view of the matter, so that she no longer believes the contents of the letter; but it has never gone very deep nor lasted very long. It was enough to hear the young woman’s name mentioned, or to meet her in the street, for a new attack of suspicion, agony, and reproaches to break out.

This is the clinical picture of this excellent woman’s case. It did not require much experience of psychiatry to perceive that, in contrast to other neurotics, she described her symptoms too mildly—as we say, dissimulated them—and that she had never really overcome her belief in the anonymous letter.

Now what attitude does a psychiatrist take up to such a case? We know already what he would say to the symptomatic act of a patient who does not close the waiting-room doors. He explains it as an accident, without interest psychologically, and no concern of his. But he cannot continue to take up this attitude in regard to the case of the jealous lady. The symptomatic action appears to be unimportant; the symptom calls for notice as a grave matter. Subjectively it involves intense suffering, and objectively it threatens to break up a family; its claim to psychiatric interest is therefore indisputable. First the psychiatrist tries to characterize the symptom by some essential attribute. The idea with which this lady torments herself cannot be called nonsensical in itself; it does happen that elderly husbands contract relationships with young women. But there is something else about it that is nonsensical and incomprehensible. The patient has absolutely no grounds, except the anonymous letter, for supposing that her loving and faithful husband belongs to this category of men, otherwise not so uncommon. She knows that this communication carries no proof, she can explain its origin satisfactorily; she ought therefore to be able to say to herself that she has no grounds for her jealousy and she does even say so, but she suffers just as much as if she regarded her jealousy as well-founded. Ideas of this kind that are inaccessible to logic and the arguments of reality are unanimously described as delusions. The good lady suffers therefore, from a delusion of jealousy. That is evidently the essential characteristic of the case.

Having established this first point, our psychiatric interest increases. When a delusion cannot be dissipated by the facts of reality, it probably does not spring from reality. Where else then does it spring from? Delusions can have the most various contents; why is the content of it in this case jealousy? What kind of people have delusions, and particularly delusions of jealousy? Now we should like to listen to the psychiatrist, but he leaves us in the lurch here. He considers only one of our questions. He will examine the family history of this woman and will perhaps bring us the answer that the kind of people who suffer from delusions are those in whose families similar or different disorders have occurred repeatedly. In other words, this lady has developed a delusion because she had an hereditary predisposition to do so. That is certainly something; but is it all that we want to know? Is it the sole cause of her disease? Does it satisfy us to assume that it is unimportant, arbitrary, or inexplicable that one kind of delusion should have been developed instead of another? And are we to understand the proposition—that the hereditary predisposition is decisive—also in a negative sense; that is, that no matter what experiences and emotions life had brought her she was destined some time or other to produce a delusion? You will want to know why scientific psychiatry gives no further explanation. And I reply: “Only a rogue gives more than he has.” The psychiatrist knows of no path leading to any further explanation in such a case. He has to content himself with a diagnosis and, in spite of wide experience, with a very uncertain prognosis of its future course.

Now can psycho-analysis do better than this? Yes, certainly I hope to show you that even in such an obscure case as this it is possible to discover something which makes closer comprehension possible. First, I shall ask you to notice this incomprehensible detail; that the anonymous letter on which her delusion is founded was positively provoked by the patient herself, by her saying to the scheming housemaid the day before that nothing could be more awful than to hear that her husband had an intrigue with a young woman. She first put the idea of sending the letter into the servant’s mind by this. So the delusion acquires a certain independence of the letter; it existed beforehand as a fear—or, as a wish?—in her mind. Besides this, the further small indications revealed in the bare two hours of analysis are noteworthy. The patient responded very coldly, it is true, to the request to tell me her further thoughts, ideas, and recollections, after she had finished her story. She declared that nothing came to her mind, she had told me everything; and after two hours the attempt had to be given up, because she announced that she felt quite well already and was certain that the morbid idea would not return. Her saying this was naturally due to resistance and to the fear of further analysis, In these two hours she had let fall some remarks, nevertheless, which made a certain interpretation not only possible but inevitable, and this interpretation threw a sharp light on the origin of the delusion of jealousy. There actually existed in her an infatuation for a young man, for the very son-in-law who had urged her to seek my assistance. Of this infatuation she herself knew nothing or only perhaps very little; in the circumstances of their relationship it was easily possible for it to disguise itself as harmless tenderness on her part. After what we have already learnt it is not difficult to see into the mind of this good woman and excellent mother. Such an infatuation, such a monstrous, impossible thing, could not come into her conscious mind; it persisted, nevertheless, and unconsciously exerted a heavy pressure. Something had to happen, some sort of relief had to be found; and the simplest alleviation lay in that mechanism of displacement which so regularly plays its part in the formation of delusional jealousy. If not merely she, old woman that she was, were in love with a young man, but if only her old husband too were in love with a young mistress, then her torturing conscience would be absolved from the infidelity. The phantasy of her husband’s infidelity was thus a cooling balm on her burning wound. Of her own love she never became conscious; but its reflection in the delusion, which brought such advantages, thus became compulsive, delusional and conscious. All arguments against it could naturally avail nothing; for they were directed only against the reflection, and not against the original to which its strength was due and which lay buried out of reach in the Unconscious.

Let us now piece together the results of this short, obstructed psycho-analytic attempt to understand this case. It is assumed of course that the information acquired was correct, a point which I cannot submit to your judgement here. First of all, the delusion is no longer senseless and incomprehensible; it is sensible, logically motivated, and has its place in connection with an affective experience of the patient’s. Secondly, it has arisen as a necessary reaction to another mental process which has itself been revealed by other indications; and it owes its delusional character, its quality of resisting real and logical objections, to this relation with this other mental process. It is something desired in itself, a kind of consolation. Thirdly, the fact that the delusion is one of jealousy and no other is unmistakably determined by the experience underlying the disease. You will also recognize the two important analogies with the symptomatic act we analysed; namely, the discovery of the sense or intention behind the symptom and the relation of it to something in the given situation which is unconscious.

This does not, of course, answer all the questions arising out of this case. On the contrary, it bristles with further problems, some of which have not yet proved soluble at all, while others cannot be solved owing to the unfavourable circumstances met with in this case. For instance, why does this happily-married lady fall in love with her son-in-law, and why does relief come to her in the form of this kind of reflection, this projection of her own state of mind on to her husband, when other forms of relief were also possible? Do not think that it is idle and uncalled-for to propound these questions. We have already a good deal of material at hand to provide possible answers. The patient had come to that critical time of life which brings a sudden and unwelcome increase of sexual desire to a woman; that may have been sufficient in itself. Or there may have been an additional reason, in that the sexual capacity of her excellent and faithful husband may have been for some years insufficient for the still vigorous woman’s needs. Observation has taught us that it is just such men, whose fidelity is thus a matter of course, who treat their wives with particular tenderness and are unusually considerate of their nervous ailments. Neither is it unimportant, moreover, that the object of this abnormal infatuation should be her daughter’s young husband. A strong erotic attachment to the daughter, with its roots in the individual sexual constitution of the mother, often manages to maintain itself in such a transformation. I may perhaps remind you in this connection that the relation between mother-in-law and son-in-law has from time immemorial been regarded by mankind as a particularly sensitive one, which among primitive races has given rise to very powerful taboos and precautions.^[44] On the positive as well as on the negative side it frequently exceeds the limits regarded as desirable in civilized society. Of these three possible factors, whether one of them has been at work in the case before us, or two of them, or whether all three together have taken part, I cannot tell you; though only because the analysis of the case could not be continued beyond the second hour.

I perceive now that I have been speaking entirely of things which you were not yet prepared to understand. I did so in order to carry out the comparison between psychiatry and psycho-analysis. But I may ask you one thing at this point: Have you observed anything in the nature of a contradiction between the two? Psychiatry does not employ the technical methods of psycho-analysis, neglects any consideration of the content of the delusion, and in pointing to heredity gives us but a general and remote ætiology instead of first disclosing the more specific and immediate one. But is any contradiction or opposition contained in this? Is not the one rather a supplement to the other? Is the hereditary factor inconsistent with the importance of experience and would they not both work together most effectively? You will admit that there is nothing essential in the work of psychiatry which could oppose psycho-analytic researches. It is therefore the psychiatrists who oppose it, and not psychiatry itself. Psycho-Analysis stands to psychiatry more or less as histology does to anatomy; in one, the outer forms of organs are studied, in the other, the construction of these out of the tissues and constituent elements. It is not easy to conceive of any contradiction between these two fields of study, in which the work of the one is continued in the other. You know that nowadays anatomy is the basis of the scientific study of medicine; but time was when dissecting human corpses in order to discover the internal structure of the body was as much a matter for severe prohibition as practising psycho-analysis in order to discover the internal workings of the human mind seems to-day to be a matter for condemnation. And, presumably at a not too distant date, we shall have perceived that there can be no psychiatry which is scientifically radical without a thorough knowledge of the deep-seated unconscious processes in mental life.

There may be some of you who perhaps are friendly enough towards psycho-analysis, often attacked as it is, to wish that it would justify itself in another direction also, that is, therapeutically. You know that psychiatric therapy has hitherto been unable to influence delusions. Can psycho-analysis do so perhaps, by reason of its insight into the mechanism of these symptoms? No, I have to tell you that it cannot; for the present, at any rate, it is just as powerless as any other therapy to heal these sufferers. It is true that we can understand what has happened to the patient; but we have no means by which we can make him understand it himself. You have heard that I could not continue the analysis of this delusion beyond the first preliminaries. Would you then maintain that analysis of such cases is undesirable because it remains fruitless? I do not think so. It is our right, yes, and our duty, to pursue our researches without respect to the immediate gain effected. The day will come, where and when we know not, when every little piece of knowledge will be converted into power, and into therapeutic power. Even if psycho-analysis showed itself as unsuccessful with all other forms of nervous and mental diseases as with delusions, it would still remain justified as an irreplaceable instrument of scientific research. It is true that we should not be in a position to practise it; the human material on which we learn lives, and has its own will, and must have its own motives in order to participate in the work; and it would then refuse to do so. I will therefore close my lecture for to-day by telling you that there are large groups of nervous disturbances for which this conversion of our own advance in knowledge into therapeutic power has actually been carried out; and that with these diseases, otherwise so refractory, our measures yield, under certain conditions, results which give place to none in the domain of medical therapy.

In the last lecture I explained to you that clinical psychiatry troubles itself little about the actual form of the individual symptom or the content of it; but that psycho-analysis has made this its starting-point, and has ascertained that the symptom itself has a meaning and is connected with experiences in the life of the patient. The meaning of neurotic symptoms was first discovered by J. Breuer in the study and successful cure of a case of hysteria (1880–82), which has since then become famous. It is true that P. Janet independently reached the same result; in fact, priority in publication must be granted to the French investigator, for Breuer did not publish his observations until more than a decade later (1893–95), during the period of our work together. Incidentally, it is of no great importance to us who made the discovery, for you know that every discovery is made more than once, and none is made all at once, nor is success meted out according to deserts. America is not called after Columbus. Before Breuer and Janet, the great psychiatrist Leuret expressed the opinion that even the delusions of the insane would prove to have some meaning, if only we knew how to translate them. I confess that for a long time I was willing to accord Janet very high recognition for his explanation of neurotic symptoms, because he regarded them as expressions of “idées inconscientes” possessing the patient’s mind. Since then, however, Janet has taken up an attitude of undue reserve, as if he meant to imply that the Unconscious had been nothing more to him than a manner of speaking, a makeshift, une façon de parler, and that he had nothing “real” in mind. Since then I have not understood Janet’s views, but I believe that he has gratuitously deprived himself of great credit.

Neurotic symptoms then, just like errors and dreams, have their meaning and, like these, are related to the life of the person in whom they appear. This is an important matter which I should like to demonstrate to you by some examples. I can merely assert, I cannot prove, that it is so in every case; anyone observing for himself will be convinced of it. For certain reasons though, I shall not take these examples from cases of hysteria, but from another very remarkable form of neurosis, closely allied in origin to the latter, about which I must say a few preliminary words. This, which we call the obsessional neurosis, is not so popular as the widely-known hysteria; it is, if I may so express myself, not so noisily ostentatious, behaves more as if it were a private affair of the patient’s, dispenses almost entirely with bodily manifestations and creates all its symptoms in the mental sphere. The obsessional neurosis and hysteria are the two forms of neurotic disease upon the study of which psycho-analysis was first built up, and in the treatment of which also our therapy celebrates its triumphs. In the obsessional neurosis, however, that mysterious leap from the mental to the physical is absent, and it has really become more intimately comprehensible and transparent to us through psycho-analytic research than hysteria; we have come to understand that it displays far more markedly certain extreme features of the neurotic constitution.

The obsessional neurosis^[45] takes this form: the patient’s mind is occupied with thoughts that do not really interest him, he feels impulses which seem alien to him, and he is impelled to perform actions which not only afford him no pleasure but from which he is powerless to desist. The thoughts (obsessions) may be meaningless in themselves or only of no interest to the patient; they are often absolutely silly; in every case they are the starting-point of a strained concentration of thought which exhausts the patient and to which he yields most unwillingly. Against his will he has to worry and speculate as if it were a matter of life or death to him. The impulses which he perceives within him may seem to be of an equally childish and meaningless character; mostly, however, they consist of something terrifying, such as temptations to commit serious crimes, so that the patient not only repudiates them as alien, but flees from them in horror, and guards himself by prohibitions, precautions, and restrictions against the possibility of carrying them out. As a matter of fact he never, literally not even once, carries these impulses into effect; flight and precautions invariably win. What he does really commit are very harmless, certainly trivial acts—what are termed the obsessive actions—which are mostly repetitions and ceremonial elaborations of ordinary everyday performances, making these common necessary actions—going to bed, washing, dressing, going for walks, etc.—into highly laborious tasks of almost insuperable difficulty. The morbid ideas, impulses, and actions are not by any means combined in the same proportions in individual types and cases of the obsessional neurosis; on the contrary, the rule is that one or another of these manifestations dominates the picture and gives the disease its name; but what is common to all forms of it is unmistakable enough.

This is a mad disease, surely. I don’t think the wildest psychiatric phantasy could have invented anything like it, and if we did not see it every day with our own eyes we could hardly bring ourselves to believe in it. Now do not imagine that you can do anything for such a patient by advising him to distract himself, to pay no attention to these silly ideas, and to do something sensible instead of his nonsensical practices. This is what he would like himself; for he is perfectly aware of his condition, he shares your opinion about his obsessional symptoms, he even volunteers it quite readily. Only he simply cannot help himself; the actions performed in an obsessional condition are supported by a kind of energy which probably has no counterpart in normal mental life. Only one thing is open to him—he can displace and he can exchange; instead of one silly idea he can adopt another of a slightly milder character, from one precaution or prohibition he can proceed to another, instead of one ceremonial rite he can perform another. He can displace his sense of compulsion, but he cannot dispel it. This capacity for displacing all the symptoms, involving radical alteration of their original forms, is a main characteristic of the disease; it is, moreover, striking that in this condition the ‘opposite-values’ (polarities) pervading mental life appear to be exceptionally sharply differentiated. In addition to compulsions of both positive and negative character, doubt appears in the intellectual sphere, gradually spreading until it gnaws even at what is usually held to be certain. All these things combine to bring about an ever-increasing indecisiveness, loss of energy, and curtailment of freedom; and that although the obsessional neurotic is originally always a person of a very energetic disposition, often highly opinionated, and as a rule intellectually gifted above the average. He has usually attained to an agreeably high standard of ethical development, is over-conscientious, and more than usually correct. You may imagine that it is a sufficiently arduous task to find one’s bearings in this maze of contradictory character-traits and morbid manifestations. At the moment our aim is merely to interpret some symptoms of this disease.

Perhaps in view of our previous discussions you would like to know what present-day psychiatry has to offer concerning the obsessional neurosis; it is but a miserable contribution, however. Psychiatry has given names to the various compulsions; and has nothing more to say about them. It asserts instead that persons exhibiting these symptoms are “degenerate.” That is not much satisfaction to us; it is no more than an estimate of their value, a condemnation instead of an explanation. We are intended, I suppose, to conclude that deterioration from type would naturally produce all kinds of oddities in people. Now, we do believe that people who develop such symptoms must be somewhat different in type from other human beings; but we should like to know whether they are more “degenerate” than other nervous patients, than hysterical or insane people. The characterization is clearly again much too general. One may even doubt whether it is justified at all when one learns that such symptoms occur in men and women of exceptional ability who have left their mark on their generation. Thanks to their own discretion and the untruthfulness of biographers we usually learn very little of an intimate nature about our exemplary great men; but it does happen occasionally that one of them is a fanatic about truth like Émile Zola,^[46] and then we hear of the many extraordinary obsessive habits from which he suffered throughout life.

Psychiatry has got out of this difficulty by dubbing these people “dégénerés superieurs.” Very well; but psycho-analysis has shown that these extraordinary obsessional symptoms can be removed permanently, like the symptoms of other diseases, and as in other people who are not degenerate. I myself have frequently succeeded in doing so.

I shall only give you two examples of analysis of obsessional symptoms; one is an old one, but I have never found a better; and one is a recent one. I shall limit myself to these two because an account of this kind must be very explicit and go into great detail.

A lady of nearly thirty years of age suffered from very severe obsessional symptoms. I might perhaps have been able to help her if my work had not been destroyed by the caprice of fate—perhaps I shall tell you about it later. In the course of a day she would perform the following peculiar obsessive act, among others, several times over. She would run out of her room into the adjoining one, there take up a certain position at the table in the centre of the room, ring for her maid, give her a trivial order or send her away without, and then run back again. There was certainly nothing very dreadful about this, but it might well arouse curiosity. The explanation presented itself in the simplest and most unexceptionable manner, without any assistance on the part of the analyst. I cannot imagine how I could even have suspected the meaning of this obsession or could possibly have suggested an interpretation for it. Every time I had asked the patient, “Why do you do this? What is the meaning of it?” she had answered, “I don’t know.” But one day, after I had succeeded in overcoming a great hesitation on her part, involving a matter of principle, she suddenly did know, for she related the history of the obsessive act. More than ten years previously she had married a man very much older than herself, who had proved impotent on the wedding-night. Innumerable times on that night he had run out of his room into hers in order to make the attempt, but had failed every time. In the morning he had said angrily: “It’s enough to disgrace one in the eyes of the maid who does the beds,” and seizing a bottle of red ink which happened to be at hand he poured it on the sheet, but not exactly in the place where such a mark might have been. At first I did not understand what this recollection could have to do with the obsessive act in question; for I could see no similarity between the two situations, except in the running from one room into the other, and perhaps also in the appearance of the servant on the scene. The patient then led me to the table in the adjoining room, where I found a great mark on the table-cover. She explained further that she stood by the table in such a way that when the maid came in she could not miss seeing this mark. After this, there could no longer be any doubt about the connection between the current obsessive act and the scene of the wedding-night, though there was still a great deal to learn about it.

It was clear, first of all, that the patient identified herself with her husband; in imitating his running from one room into another she acted his part. To keep up the similarity we must assume that she has substituted the table and table-cover for the bed and sheet. This might seem too arbitrary; but then we have not studied dream-symbolism in vain. In dreams a table is very often found to represent a bed. “Bed and board” together mean marriage, so that the one easily stands for the other.

All this would be proof enough that the obsessive act is full of meaning; it seems to be a representation, a repetition of that all-important scene. But we are not bound to stop at this semblance; if we investigate more closely the relation between the two situations we shall probably find out something more, the purpose of the obsessive act. The kernel of it evidently lies in the calling of the maid, to whom she displays the mark, in contrast to her husband’s words: “It’s enough to disgrace one before the servant.” In this way he, whose part she is playing, is not ashamed before the servant, the stain is where it ought to be. We see therefore that she has not simply repeated the scene, she has continued it and corrected it, transformed it into what it ought to have been. This implies something else, too, a correction of the circumstance which made that night so distressing, and which made the red ink necessary: namely, the husband’s impotence. The obsessive act thus says: “No, it is not true, he was not disgraced before the servant, he was not impotent.” As in a dream she represents this wish as fulfilled, in a current obsessive act, which serves the purpose of restoring her husband’s credit after that unfortunate incident.

Everything else which I could tell you about this lady fits in with this, or, more correctly stated, everything else that we know about her points to this interpretation of the obsessive act, in itself so incomprehensible. She had been separated from her husband for years and was trying to make up her mind to divorce him legally. But there would have been no prospect of being free from him in her mind; she forced herself to be true to him. She withdrew from the world and from everyone so that she might not be tempted, and in her phantasies she excused and idealized him. The deepest secret of her illness was that it enabled her to shield him from malicious gossip, to justify her separation from him, and to make a comfortable existence apart from her possible for him. The analysis of a harmless obsessive act thus leads straight to the inmost core of the patient’s disease, and at the same time betrays a great deal of the secret of the obsessional neurosis in general. I am quite willing that you should spend some time over this example, for it unites conditions which cannot reasonably be expected in all cases. The interpretation of the symptom was discovered by the patient herself in a flash, without guidance or interference from the analyst, and it had arisen in connection with an event which did not belong, as it commonly does, to a forgotten period in childhood, but which had occurred in the patient’s adult life and was clear in her memory. All those objections which critics habitually raise against our interpretations of symptoms are quite out of place here. To be sure, we cannot always be so fortunate.

And one thing more! Has it not struck you that this innocent obsessive act leads directly to this lady’s most private affairs? A woman can hardly have anything more intimate to relate than the story of her wedding-night; and is it by chance and without special significance that we are led straight to the innermost secrets of her sexual life? It might certainly be due to the choice I made of this example. Let us not decide this point too quickly; but let us turn to the second example, which is of a totally different nature, and belongs to a very common type, that of rituals preparatory to sleep.

A well-grown clever girl of 19, the only child of her parents, superior to them in education and intellectual activity, was a wild, high-spirited child, but of late years had become very nervous without any apparent cause. She was very irritable, particularly with her mother, was discontented and depressed, inclined to indecision and doubt, finally confessing that she could no longer walk alone through squares and wide streets. We will not go very closely into her complicated condition, which requires at least two diagnoses: agoraphobia and obsessional neurosis; but will turn our attention to the ritual elaborated by this young girl preparatory to going to bed, as a result of which she caused her parents great distress. In a certain sense, every normal person may be said to carry out a ritual before going to sleep, or at least, he requires certain conditions without which he is hindered in going to sleep; the transition from waking life to sleep has been made into a regular formula which is repeated every night in the same manner. But everything that a healthy person requires as a condition of sleep can be rationally explained, and if the external circumstances make any alteration necessary he adapts himself easily to it without waste of time. The morbid ritual on the other hand is inexorable, it will be maintained at the greatest sacrifices; it is disguised, too, under rational motives and appears superficially to differ from the normal only in a certain exaggerated carefulness of execution. On a closer examination, however, it is clear that the disguise is insufficient, that the ritual includes observances which go far beyond what reason can justify and even some which directly contravene this. As the motive of her nightly precautions, our patient declares that she must have silence at night and must exclude all possibility of noise. She does two things for this purpose; she stops the large clock in her room and removes all other clocks out of the room, including even the tiny wrist-watch on her bed-table. Flower-pots and vases are placed carefully together on the writing-table, so that they cannot fall down in the night and break, and so disturb her sleep. She knows that these precautions have only an illusory justification in the demand for quiet; the ticking of the little watch could not be heard, even if it lay on the table by the bed; and we all know that the regular ticking of a pendulum-clock never disturbs sleep, but is more likely to induce it. She also admits that her fear that the flower-pots and vases, if left in their places at night, might fall down of themselves and break is utterly improbable. For some other practices in her ritual this insistence upon silence as a motive is dropped; indeed, by ordaining that the door between her bedroom and that of her parents shall remain half-open (a condition which she ensures by placing various objects in the doorway) she seems, on the contrary, to open the way to sources of noise. The most important observances are concerned with the bed itself, however. The bolster at the head of the bed must not touch the back of the wooden bedstead. The pillow must lie across the bolster exactly in a diagonal position and in no other; she then places her head exactly in the middle of this diamond, lengthways. The eiderdown must be shaken before she puts it over her, so that all the feathers sink to the foot-end; she never fails, however, to press this out and redistribute them all over it again.

I will pass over other trivial details of her ritual; they would teach us nothing new and lead us too far from our purpose. Do not suppose, though, that all this is carried out with perfect smoothness. Everything is accompanied by the anxiety that it has not all been done properly; it must be tested and repeated; her doubts fix first upon one, then another, of the precautions; and the result is that one or two hours elapse before the girl herself can sleep, or lets the intimidated parents sleep.

The analysis of these torments did not proceed so simply as that of the former patient’s obsessive act. I had to offer hints and suggestions of its interpretation which were invariably received by her with a positive denial or with scornful doubt. After this first reaction of rejection, however, there followed a period in which she herself took up the possibilities suggested to her, noted the associations they aroused, produced memories, and established connections until she herself had accepted all the interpretations in working them out for herself. In proportion as she did this she began to relax the performance of her obsessive precautions and before the end of the treatment she had given up the whole ritual. I must also tell you that analytic work, as we conduct it nowadays, definitely excludes any uninterrupted concentration on a single symptom until its meaning becomes fully clear. It is necessary, on the contrary, to abandon a given theme again and again, in the assurance that one will come upon it anew in another context. The interpretation of the symptom, which I am now going to tell you, is therefore a synthesis of the results which, amid the interruptions of work on other points, took weeks and months to procure.

The patient gradually learnt to understand that she banished clocks and watches from her room at night because they were symbols of the female genitals. Clocks, which we know may have other symbolic meanings besides this, acquire this significance of a genital organ by their relation to periodical processes and regular intervals. A woman may be heard to boast that menstruation occurs in her as regularly as clockwork. Now this patient’s special fear was that the ticking of the clocks would disturb her during sleep. The ticking of a clock is comparable to the throbbing of the clitoris in sexual excitation. This sensation, which was distressing to her, had actually on several occasions wakened her from sleep; and now her fear of an erection of the clitoris expressed itself by the imposition of a rule to remove all going clocks and watches far away from her during the night. Flower-pots and vases are, like all receptacles, also symbols of the female genitals. Precautions to prevent them from falling and breaking during the night are therefore not lacking in meaning. We know the very widespread custom of breaking a vessel or a plate on the occasion of a betrothal; everyone present possesses himself of a fragment in symbolic acceptance of the fact that he may no longer put forward any claims to the bride, presumably a custom which arose with monogamy. The patient also contributed a recollection and several associations to this part of her ritual. Once as a child she had fallen while carrying a glass or porcelain vessel, and had cut her finger which had bled badly. As she grew up and learnt the facts about sexual intercourse, she developed the apprehension that on her wedding-night she would not bleed and so would prove not to be a virgin. Her precautions against the vases breaking signified a rejection of the whole complex concerned with virginity and with the question of bleeding during the first act of intercourse; a rejection of the anxiety both that she would bleed and that she would not bleed. These precautions were in fact only remotely connected with the prevention of noise.

One day she divined the central idea of her ritual when she suddenly understood her rule not to let the bolster touch the back of the bed. The bolster had always seemed a woman to her, she said, and the upright back of the bedstead a man. She wished therefore, by a magic ceremony, as it were, to keep man and woman apart; that is to say, to separate the parents and prevent intercourse from occurring. Years before the institution of her ritual, she had attempted to achieve this end by a more direct method. She had simulated fear, or had exploited a tendency to fear, so that the door between her bedroom and that of her parents should not be closed. This regulation was still actually included in her present ritual; in this way she managed to make it possible to overhear her parents; a proceeding which at one time had caused her months of sleeplessness. Not content with disturbing her parents in this way, she at that time even succeeded occasionally in sleeping between the father and mother in their bed. “Bolster” and “bedstead” were then really prevented from coming together. As she finally grew too big to be comfortable in the same bed with the parents, she achieved the same thing by consciously simulating fear and getting her mother to change places with her and to give up to her her place by the father. This incident was undoubtedly the starting-point of phantasies, the effect of which was evident in the ritual.

If the bolster was a woman, then the shaking of the eiderdown till all the feathers were at the bottom, making a protuberance there, also had a meaning. It meant impregnating a woman; she did not neglect, though, to obliterate the pregnancy again, for she had for years been terrified that intercourse between her parents might result in another child and present her with a rival. On the other hand, if the large bolster meant the mother then the small pillow could only represent the daughter. Why had this pillow to be placed diamond-wise upon the bolster and her head be laid exactly in its middle lengthways? She was easily reminded that a diamond is repeatedly used in drawings on walls to signify the open female genitals. The part of the man (the father) she thus played herself and replaced the male organ by her own head. (Cf. Symbolism of beheading for castration.)

Horrible thoughts, you will say, to run in the mind of a virgin girl. I admit that; but do not forget that I have not invented these ideas, only exposed them. A ritual of this kind before sleep is also peculiar enough, and you cannot deny the correspondence, revealed by the interpretation, between the ceremonies and the phantasies. It is more important to me, however, that you should notice that the ritual was the outcome, not of one single phantasy, but of several together which of course must have had a nodal point somewhere. Note, too, that the details of the ritual reflect the sexual wishes both positively and negatively, and serve in part as expressions of them, in part as defences against them.

It would be possible to obtain much more out of the analysis of this ritual by bringing it into its place in connection with the patient’s other symptoms. But that is not our purpose at the moment. You must be content with a reference to an erotic attachment to the father, originating very early in childhood, which had enslaved this girl. It was perhaps for this reason that she was so unfriendly towards her mother. Also we cannot overlook the fact that the analysis of this symptom has again led to the patient’s sexual life. The more insight we gain into the meaning and purpose of neurotic symptoms, the less surprising will this seem.

From two selected examples I have now shown you that neurotic symptoms have meaning, like errors and like dreams, and that they are closely connected with the events of the patient’s life. Can I expect you to believe this exceptionally significant statement on the strength of two examples? No. But can you expect me to go on quoting examples to you until you declare yourselves convinced? Again, no; for in view of the explicit treatment given to each individual case I should have to devote five hours a week for a whole term to the consideration of this one point in the theory of the neuroses. I will content myself therefore with the samples given, as evidence of my statement; and will refer you for more to the literature on the subject, to the classical interpretation of symptoms in Breuer’s first case (hysteria), to the striking elucidations of very obscure symptoms in dementia præcox, so-called, made by C. G. Jung at a time when this investigator was a mere psycho-analyst and did not yet aspire to be a prophet, and to all the subsequent contributions with which our periodicals have been filled since then. Precisely this type of investigation is plentiful. Analysis, interpretation, and translation of neurotic symptoms has proved so attractive to psycho-analysts that in comparison they have temporarily neglected the other problems of the neuroses.

Anyone of you who makes the necessary effort to look up this question will certainly be strongly impressed by the wealth of evidential material. But he will also meet with a difficulty. The meaning of a symptom lies, as we have seen, in its connection with the life of the patient. The more individually the symptom has been formed, the more clearly may we expect to establish this connection. Then the task resolves itself specifically into a discovery, for every nonsensical idea and every useless action, of the past situation in which the idea was justified and the action served a useful purpose. The obsessive act of the patient who ran to the table and rang for the maid is a perfect model of this kind of symptom. But symptoms of quite a different type are very frequently seen. They are what we call typical symptoms of a disease, in each case they are practically identical, the individual differences in them vanish or at least fade away, so that it is difficult to connect them with the patient’s life or to relate them to special situations in his past. Let us consider the obsessional neurosis again. The second patient’s ceremonies preparatory to sleep are in many ways quite typical, although showing enough individual features as well to make an “historical” interpretation, so to speak, possible. But all obsessional patients are given to repetitions, to isolating certain of their actions and to rhythmic performances. Most of them wash too much. Those patients who suffer from agoraphobia (topophobia, fear of space), no longer reckoned as an obsessional neurosis but now classified as anxiety-hysteria, reproduce the same features of the pathological picture often with fatiguing monotony. They fear enclosed spaces, wide, open squares, long stretches of road, and avenues; they feel protected if accompanied, or if a vehicle drives behind them, and so on. Nevertheless, on this groundwork of similarity the various patients construct individual conditions of their own, moods, one might call them, which directly contrast with other cases. One fears narrow streets only, another wide streets only, one can walk only when few people are about, others only when surrounded with people. Similarly in hysteria, beside the wealth of individual features there are always plenty of common typical symptoms which appear to resist an easy interpretation on historical lines. Do not let us forget that it is these typical symptoms which enable us to take our bearings in forming a diagnosis. Supposing we do trace back a typical symptom in a case of hysteria to an experience or to a chain of similar experiences (for instance, an hysterical vomiting to a series of impressions of a disgusting nature), it will be confusing to discover in another case of vomiting an entirely dissimilar series of apparently causative experiences. It almost looks as though hysterical patients must vomit, for some unknown reason, and as though the historical factors revealed by analysis were but pretexts, seized upon by an inner necessity, when opportunity offered, to serve its purpose.

This brings us to the discouraging conclusion that although individual forms of neurotic symptoms can certainly be satisfactorily explained by their relation to the patient’s experiences, yet our science fails us for the far more frequent typical symptoms in the same cases. In addition to this, I have not nearly explained to you all the difficulties that arise during a resolute pursuit of the historical meaning of a symptom. Nor shall I do so; for although my intention is to conceal nothing from you and to gloss over nothing, I do not need to confuse you and stupefy you at the outset of our studies together. It is true that our understanding of symptom-interpretation has only just begun, but we will hold fast to the knowledge gained and proceed to overcome step by step the difficulties of the unknown. I will try to cheer you with the thought that it is hardly possible to presume a fundamental difference between the one kind of symptom and the other. If the individual form of symptom is so unmistakably connected with the patient’s experiences, it is possible that the typical symptom relates to an experience which is itself typical and common to all humanity. Other regularly recurring features of a neurosis, such as the repetition and doubt of the obsessional neurosis, may be universal reactions which the patient is compelled to exaggerate by the nature of the morbid change. In short, there is no reason to give up hastily in despair; let us see what more we can find out.

There is a very similar difficulty met with in the theory of dreams, one which I could not deal with in the course of our previous discussions of dreams. The manifest content of dreams is multifarious and highly differentiated individually, and we have shown exhaustively what can be obtained by analysis from this content. But there are also dreams which may in the same way be called typical and occur in everybody, dreams with an identical content, which present the same difficulties to analysis. These are the dreams of falling, flying, floating, swimming, of being hindered, of being naked, and certain other anxiety-dreams; which yield first this, then that, interpretation, according to the person concerned, without any explanation of their monotonous and typical recurrence. But we notice that in these dreams also the common groundwork is embroidered with additions of an individually varying character. Most probably they too will prove to fit in with other knowledge about the dream-life, gained from a study of other kinds of dreams—not by any forcible twist, but by a gradual widening of our comprehension of these things.