The problem of lay-analyses

Several of the contributors to this series of “Autobiographical Studies”^[2] have begun by expressing their misgivings at the unusual difficulties of the task they have undertaken. The difficulties in my case are, I think, even greater; for I have already more than once published papers upon the same lines as the present one, papers which, from the nature of the subject, have dealt more with personal considerations than is usual or than would otherwise have been necessary.

I gave my first account of the development and subject-matter of psychoanalysis in five lectures which I delivered in 1909 before Clark University at Worcester, Mass., where I had been invited to attend the celebration of the twentieth anniversary of the foundation of that body.^[3] Only recently I gave way to the temptation of making a contribution of a similar kind to an American collective publication dealing with the opening years of the twentieth century, since its editors had shown their recognition of the importance of psychoanalysis by allotting a special chapter to it.^[4] Between these two dates appeared a paper, “On the History of the Psycho-Analytic Movement,”^[5] which, in fact, contains the essence of all that I can say on the present occasion. Since I must not contradict myself and since I have no wish to repeat myself exactly, I must endeavor to construct a narrative in which subjective and objective attitudes, biographical and historical interests, are combined in a new proportion.

I was born on May 6th, 1856, at Freiberg in Moravia, a small town in what is now Czecho-Slovakia. My parents were Jews, and I have remained a Jew myself. I have reason to believe that my father’s family were settled for a long time on the Rhine (at Cologne), that, as a result of a persecution of the Jews during the fourteenth or fifteenth century, they fled eastwards, and that, in the course of the nineteenth century, they migrated back from Lithuania through Galicia into German Austria. When I was a child of four I came to Vienna, and I went through the whole of my education there. At the Gymnasium I was at the top of my class for seven years; I enjoyed special privileges there, and was scarcely obliged to pass any examinations. Although we lived in very limited circumstances, my father insisted that, in my choice of a profession, I should follow my own inclinations. Neither at that time, nor indeed in my later life, did I feel any particular predilection for the career of a physician. I was moved, rather, by a sort of curiosity, which was, however, directed more towards human concerns than towards natural objects; nor had I recognized the importance of observation as one of the best means of gratifying it. At the same time, the theories of Darwin, which were then of topical interest, strongly attracted me, for they held out hopes of an extraordinary advance in our understanding of the world; and it was hearing Goethe’s beautiful essay on Nature read aloud at a popular lecture just before I left school that decided me to become a medical student.

When, in 1873, I first joined the University, I was met by some appreciable disappointments. Above all, I found that I was expected to feel myself inferior and an alien, because I was a Jew. I refused absolutely to do the first of these things. I have never been able to see why I should feel ashamed of my descent or, as people were beginning to say, of my race. I put up, without much regret, with my nonadmission to the community; for it seemed to me that in spite of this exclusion an active fellow-worker could not fail to find some nook or cranny in the frame-work of humanity. These first impressions at the University, however, had one consequence which was afterwards to prove important; for at an early age I was made familiar with the fate of being in the Opposition and of being put under the ban of the “compact majority.” The foundations were thus laid for a certain degree of independence of judgment.

I was compelled, moreover, during my first years at the University, to make the discovery that the peculiarities and limitations of my gifts denied me all success in many of the departments of science into which my youthful eagerness had plunged me. Thus I learned the truth of Mephistopheles’ warning:

At length, in Ernst Brücke’s physiological laboratory, I found rest and satisfaction—and men, too, whom I could respect and take as my models. Brücke gave me a problem to work out in the histology of the nervous system; I succeeded in solving it to his satisfaction and in carrying the work further on my own account. I worked at this Institute, with short interruptions, from 1876 to 1882, and it was generally thought that I was marked out to fill the next post of Assistant that might fall vacant there. The various branches of medicine proper, apart from psychiatry, had no attraction for me. I was decidedly negligent in pursuing my medical studies, and it was not until 1881 that I took my somewhat belated degree as a Doctor of Medicine.

The turning point came in 1882, when my teacher, for whom I felt the highest possible esteem, corrected my father’s generous improvidence by strongly advising me, in view of my bad financial position, to abandon my theoretical career. I followed his advice, left the physiological laboratory and entered the General Hospital^[7] as an “Aspirant.” I was soon afterwards promoted to being a junior physician, and worked in various departments of the hospital, amongst others for more than six months under Meynert, by whose work and personality I had been greatly struck while I was still a student.

In a certain sense I nevertheless remained faithful to the line of work upon which I had originally started. The subject which Brücke had proposed for my investigations had been the spinal cord of one of the lowest of the fishes (Ammocoetes Petromyzon); and I now passed on to the human central nervous system. Just at this time Flechsig’s discoveries of the non-simultaneity of the formation of the medullary sheaths were throwing a revealing light upon the intricate course of its tracts. The fact that I began by choosing the medulla oblongata as the one and only subject of my work was another sign of the continuity of my development. In complete contrast to the diffuse character of my studies during my earlier years at the University, I was now developing an inclination to concentrate my work exclusively upon a single subject or problem. This inclination has persisted and has since led to my being accused of one-sidedness.

I now became as active a worker in the Institute of Cerebral Anatomy as I had previously been in the physiological one. Some short papers upon the course of the tracts and the nuclear origins in the medulla oblongata date from these hospital years, and my results were regularly noted down by Edinger. One day Meynert, who had given me access to the laboratory even during the times when I was not actually working under him, proposed that I should definitely devote myself to the anatomy of the brain, and promised to hand over his lecturing work to me, as he felt he was too old to manage the newer methods. This I declined, in alarm at the magnitude of the task; it is possible, too, that I had guessed already that this great man was by no means kindly disposed towards me.

From the practical point of view, brain anatomy was certainly no better than physiology, and, with an eye to material considerations, I began to study nervous diseases. There were, at that time, few specialists in that branch of medicine in Vienna, the material for its study was distributed over a number of different departments of the hospital, there was no satisfactory opportunity of learning the subject, and one was forced to be one’s own teacher. Even Nothnagel, who had been appointed a short time before, on account of his book upon cerebral localization, did not single out neuropathology from among the other subdivisions of medicine. In the distance glimmered the great name of Charcot; so I formed a plan of first obtaining an appointment as Lecturer on Nervous Diseases in Vienna and of then going to Paris to continue my studies.

In the course of the following years, while I continued to work as a junior physician, I published a number of clinical observations upon organic diseases of the nervous system. I gradually became familiar with the ground; I was able to localize the site of a lesion in the medulla oblongata so accurately that the pathological anatomist had no further information to add; I was the first person in Vienna to send a case for autopsy with a diagnosis of polyneuritis acuta. The fame of my diagnoses and their post mortem confirmation brought me an influx of American physicians, to whom I lectured upon the patients in my department in a sort of pidgin-English. I understood nothing about the neuroses. On one occasion I introduced to my audience a neurotic suffering from a persistent headache as a case of chronic localized meningitis; they quite rightly rose in revolt against me, and my premature activities as a teacher came to an end. By way of excuse I may add that this happened at a time when greater authorities than myself in Vienna were in the habit of diagnosing neurasthenia as cerebral tumor.

In the spring of 1885 I was appointed Lecturer on Neuropathology on the ground of my histological and clinical publications. Soon afterwards, as the result of a warm testimonial from Brücke, I was awarded a Traveling Fellowship of considerable value. In the autumn of the same year I made the journey to Paris.

I became a student at the Salpêtrière, but as one of the crowd of foreign visitors, I had little attention paid me to begin with. One day in my hearing Charcot expressed his regret that since the war he had heard nothing from the German translator of his lectures; he went on to say that he would be glad if someone would undertake to translate the new volume of his lectures into German. I wrote to him and offered to do so; I can still remember a phrase in the letter, to the effect that I suffered only from l’aphasie motrice and not from l’aphasie sensorielle du français. Charcot accepted the offer, I was admitted to the circle of his personal acquaintances, and from that time forward I took a full part in all that went on at the Clinic.

As I write these lines, a number of papers and newspaper-articles have reached me from France, which gave evidence of a violent objection to the acceptance of psychoanalysis, and which often make the most inaccurate assertions in regard to my relations with the French school. I read, for instance, that I made use of my visit to Paris to familiarize myself with the theories of Pierre Janet and then made off with my booty. I should therefore like to say explicitly that during the whole of my visit to the Salpêtrière, Janet’s name was never so much as mentioned.

What impressed me most of all while I was with Charcot were his latest investigations upon hysteria, some of which were carried out under my own eyes. He had proved, for instance, the genuineness of hysterical phenomena and their conformity to laws (“introite et hic dii sunt”), the frequent occurrence of hysteria in men, the production of hysterical paralyses and contractures by hypnotic suggestion and the fact that such artificial products showed, down to their smallest details, the same features as spontaneous attacks, which were often brought on traumatically. Many of Charcot’s demonstrations began by provoking in me and in other visitors a sense of astonishment and an inclination to scepticism, which we tried to justify by an appeal to one of the theories of the day. He was always friendly and patient in dealing with such doubts, but he was also most decided; it was in one of these discussions that (speaking of theory) he remarked, “Ça n’empêche pas d’exister,” a mot which left an indelible mark upon my mind.

No doubt the whole of what Charcot taught us at that time does not hold good today: some of it has become doubtful, some has definitely failed to withstand the test of time. But enough is left over, and has found a permanent place in the storehouse of science. Before leaving Paris I discussed with the great man a plan for a comparative study of hysterical and organic paralyses. I wished to establish the thesis that in hysteria paralyses and anæsthesias of the various parts of the body are demarcated according to the popular idea of their limits and not according to anatomical facts. He agreed with this view, but it was easy to see that in reality he took no special interest in penetrating more deeply into the psychology of the neuroses. When all is said and done, it was from pathological anatomy that his work had started.

Before I returned to Vienna I stopped for a few weeks in Berlin, in order to gain a little knowledge of the general disorders of childhood. Kassowitz, who was at the head of a public institute in Vienna for the treatment of children’s diseases, had promised to put me in charge of a department for the nervous diseases of children. In Berlin I was given assistance and a friendly reception by Baginsky. In the course of the next few years I published, from the Kassowitz Institute, several monographs of considerable size on unilateral and bilateral cerebral palsies in children. And for that reason, at a later date (in 1897), Nothnagel made me responsible for dealing with the same subject in his great Handbuch der allgemeinen und speziellen Therapie.

In the autumn of 1886 I settled down in Vienna as a physician, and married the girl who had been waiting for me in a distant city for more than four years. I may here go back a little and explain how it was the fault of my fiancée that I was not already famous at that early age. A side interest, though it was a deep one, had led me in 1884 to obtain from Merck some of what was then the little-known alkaloid cocaine and to study its physiological action. While I was in the middle of this work, an opportunity arose for making a journey to visit my fiancée, from whom I had been parted for two years. I hastily wound up my investigation of cocaine and contented myself in my book on the subject with prophesying that further uses for it would soon be found. I suggested, however, to my friend, L. Königstein, the ophthalmologist, that he should investigate the question of how far the anæsthetizing properties of cocaine were applicable in diseases of the eye. When I returned from my holiday I found that not he, but another of my friends, Carl Koller (now in New York), to whom I had also spoken about cocaine, had made the decisive experiments upon animals’ eyes and had demonstrated them at the Ophthalmological Congress at Heidelberg. Koller is therefore rightly regarded as the discoverer of local anæsthesia by cocaine, which has become so important in minor surgery; but I bore my fiancée no grudge for my neglected opportunity.

I will now return to the year of 1886, the time of my settling down in Vienna as a specialist in nervous diseases. The duty devolved upon me of giving a report before the “Gesellschaft der Aerzte” [Society of Medicine] upon what I had seen and learnt with Charcot. But I met with a bad reception. Persons of authority, such as the chairman (Bamberger, the physician), declared that what I said was incredible. Meynert urged me to find some cases in Vienna similar to those which I had described and to present them before the Society. I tried to do so; but the senior physicians in whose departments I found any such cases, refused to allow me to observe them or to work at them. One of them, an old surgeon, actually broke out with the exclamation: “But, my dear sir, how can you talk such nonsense? Hysteron (sic) means the uterus. So how can a man be hysterical?” I objected in vain that what I wanted was, not to have my diagnosis approved, but to have the case put at my disposal. At length, outside the hospital, I came upon a case of classical hysterical hemi-anæsthesia in a man, and demonstrated it before the “Gesellschaft der Aerzte.” This time I was applauded, but no further interest was taken in me. The impression that the great authorities had rejected my innovations remained unshaken; and, with my hysteria in men and my production of hysterical paralyses by suggestion, I found myself forced into the Opposition. As I was soon afterwards excluded from the laboratory of cerebral anatomy and for a whole term had nowhere to deliver my lectures, I withdrew from academic life and ceased to attend the learned societies. It is a whole generation since I have visited the “Gesellschaft der Aerzte.”

Anyone who wanted to make a living from the treatment of nerve-patients must clearly be able to do something to help them. My therapeutic arsenal contained only two weapons, electrotherapy and hypnosis, for prescribing a visit to a hydropathic establishment after a single consultation was an inadequate source of income. My knowledge of electrotherapy was derived from W. Erb’s text-book, which provided detailed instructions for the treatment of all the symptoms of nervous diseases. Unluckily I was soon driven to see that following these instructions was of no help whatever and that what I had taken for an epitome of exact observations was merely the construction of phantasy. The realization that the work of the greatest name in German neuropathology had no more relation to reality than some “Egyptian” dream-book, such as are sold in cheap book-shops, was painful, but it helped to rid me of yet another piece of the innocent faith in authority by which I was still obsessed. So I put my electrical apparatus aside, even before Möbius had solved the problem by explaining that the successes of electric treatment in nervous disorders (in so far as there were any) were the effect of suggestion on the part of the physician.

With hypnosis the case was better. While I was still a student I had attended a public exhibition given by the “magnetist” Hansen and had noticed that one of the persons experimented upon had became deathly pale at the onset of cataleptic rigidity and had remained so as long as that condition lasted. This firmly convinced me of the genuineness of the phenomena of hypnosis. Scientific support was soon afterwards given to this view by Heidenhain; but that did not restrain the professors of psychiatry from declaring for a long time to come that hypnosis was not only fraudulent but dangerous and from regarding hypnotists with contempt. In Paris I had seen hypnosis used freely as a method for producing symptoms in patients and then removing them again. And now the news reached us that a school had arisen at Nancy which made an extensive and remarkably successful use of suggestion, with or without hypnosis, for therapeutic purposes. It thus came about, as a matter of course, that in the first years of my activity as a physician my principal instrument of work, apart from haphazard and unsystematic psycho-therapeutic methods, was hypnotic suggestion.

This implied, of course, that I abandoned the treatment of organic nervous diseases; but that was of little importance. For on the one hand the prospects in the treatment of such disorders were in any case never promising, while on the other hand, in the private practice of a physician working in a large town, the quality of such patients was nothing compared to the crowds of neurotics, whose number seemed further multiplied by the manner in which they hurried, with their troubles unsolved, from one physician to another. And apart from this, there was something positively seductive in working with hypnosis. For the first time there was a sense of having overcome one’s impotence; and it was highly flattering to enjoy the reputation of being a miracle-worker. It was not until later that I was to discover the drawbacks of the procedure. At the moment there were only two points to complain of: first, that I could not succeed in hypnotizing every patient, and secondly, that I was unable to put individual patients into as deep a state of hypnosis as I should have wished. With the idea of perfecting my hypnotic technique, I made a journey to Nancy in the summer of 1889 and spent several weeks there. I witnessed the moving spectacle of old Liébault working among the poor women and children of the laboring classes, I was a spectator of Bernheim’s astonishing experiments upon his hospital patients, and I received the profoundest impression of the possibility that there could be powerful mental processes which nevertheless remained hidden from the consciousness of men. Thinking it would be instructive, I had persuaded one of my patients to follow me to Nancy. She was a very highly gifted hysteric, a woman of good birth, who had been handed over to me because no one knew what to do with her. By hypnotic influence I had made it possible for her to lead a tolerable existence and I was always able to take her out of the misery of her condition. But she always relapsed again after a short time, and in my ignorance I attributed this to the fact that her hypnosis had never reached the stage of somnambulism with amnesia. Bernheim now attempted several times to bring this about, but he too failed. He frankly admitted to me that his great therapeutic successes by means of suggestion were only achieved in his hospital practice and not with his private patients. I had many stimulating conversations with him, and undertook to translate into German his two works upon suggestion and its therapeutic effects.

During the period from 1886 to 1891 I did little scientific work, and published scarcely anything. I was occupied with establishing myself in my new profession and with assuring my own material existence as well as that of a rapidly increasing family. In 1891 there appeared the first of my studies upon the cerebral palsies of children, which was written in collaboration with my friend and assistant, Dr. Oskar Rie. An invitation which I received in the same year to contribute to an encyclopædia of medicine led me to investigate the theory of aphasia, which was at that time dominated by the views of Wernicke and Lichtheim, which laid stress exclusively upon localization. The fruit of this inquiry was a small critical and speculative book, Zur Auffassung der Aphasie. But I must now show how it happened that scientific research once more became the chief interest of my life.

I must supplement what I have just said by explaining that from the very first I made use of hypnosis in another manner, apart from hypnotic suggestion. I used it for questioning the patient upon the origin of his symptom, which in his waking state he could often describe only very imperfectly or not at all. Not only did this method seem more effective than bald suggestive commands or prohibitions, but it also satisfied the curiosity of the physician, who, after all, had a right to learn something of the origin of the phenomenon which he strove to remove by the monotonous procedure of suggestion.

The manner in which I arrived at this other procedure was as follows: While I was still working in Brücke’s laboratory I had made the acquaintance of Dr. Josef Breuer, who was one of the most respected family physicians in Vienna, but who also had a scientific past, since he had produced several works of permanent value upon the physiology of breathing and upon the organ of equilibrium. He was a man of striking intelligence and fourteen years older than myself. Our relations soon became more intimate and he became my friend and helper in my difficult circumstances. We grew accustomed to share all our scientific interests with each other. In this relationship the gain was naturally mine. The development of psychoanalysis afterwards cost me his friendship. It was not easy for me to pay such a price, but I could not escape it.

Even before I went to Paris, Breuer had told me about a case of hysteria which, between 1880 and 1882, he had treated in a peculiar manner which had allowed him to penetrate deeply into the causation and significance of hysterical symptoms. This was at a time, therefore, when Janet’s works still belonged to the future. He repeatedly read me pieces of the case history, and I had an impression that it accomplished more towards an understanding of neuroses than any previous observation. I determined to inform Charcot of these discoveries when I reached Paris, and I actually did so. But the great man showed no interest in my first outline of the subject, so that I never recurred to it and allowed it to pass from my mind.

When I was back in Vienna I turned once more to Breuer’s observation and made him tell me more about it. The patient had been a young girl of unusual education and gifts, who had fallen ill while she was nursing her father, of whom she was devotedly fond. When Breuer took over her case it presented a variegated picture of paralyses and contractures, inhibitions and states of mental confusion. A chance observation showed her physician that she could be relieved of these clouded states of consciousness if she was induced to express in words the affective phantasy by which she was at the moment dominated. From this discovery, Breuer arrived at a new method of treatment. He put her into deep hypnosis and made her tell him each time what it was that was oppressing her mind. After the attacks of depressive confusion had been overcome in this way, he employed the same procedure for removing her inhibitions and physical disorders. In her waking state the girl could no more describe than other patients how her symptoms had arisen, and she could discover no link between them and any experiences of her life. In hypnosis she immediately revealed the missing connection. It turned out that all of her symptoms went back to moving events which she had experienced while nursing her father; that is to say, her symptoms had a meaning and were residues or reminiscences of those emotional situations. It turned out in most instances that there had been some thought or impulse which she had had to suppress while she was by her father’s sick-bed, and that, in place of it, as a substitute for it, the symptom had afterwards appeared. But as a rule the symptom was not the precipitate of a single such “traumatic” scene, but the result of a summation of a number of similar situations. When the patient recalled a situation of this kind in a hallucinatory way under hypnosis and carried through to its conclusion, with a free expression of emotion, the mental act which she had originally suppressed, the symptom was wiped away and did not return. By this procedure Breuer succeeded, after long and painful efforts, in relieving his patient of all her symptoms.

The patient had recovered and had remained well and, in fact, had become capable of doing serious work. But over the final stage of this hypnotic treatment there rested a veil of obscurity, which Breuer never raised for me; and I could not understand why he had so long kept secret what seemed to me an invaluable discovery instead of making science the richer by it. The immediate question, however, was whether it was possible to generalize from what he had found in a single case. The state of things which he had discovered seemed to me to be of so fundamental a nature that I could not believe it could fail to be present in any case of hysteria if it had been proved to occur in a single one. But the question could only be decided by experience. I therefore began to repeat Breuer’s investigations with my own patients and eventually, especially after my visit to Bernheim in 1889 had taught me the limitations of hypnotic suggestion, I worked at nothing else. After observing for several years that his findings were invariably confirmed in every case of hysteria that was accessible to such treatment, and after having accumulated a considerable amount of material in the shape of observations analogous to his, I proposed to him that we should issue a joint publication. At first he objected vehemently, but in the end he gave way, especially since, in the meantime, Janet’s works had anticipated some of his results, such as the tracing back of hysterical symptoms to events in the patient’s life, and their removal by means of hypnotic reproduction in statu nascendi. In 1893 we issued a preliminary paper, “On the Psychical Mechanism of Hysterical Phenomena,”^[8] and in 1895 there followed our book, Studien über Hysterie.

If the account I have so far given has led the reader to expect that the Studien über Hysterie must, in all essentials of their material content, be the product of Breuer’s mind, that is precisely what I myself have always maintained and what it has been my aim to repeat here. As regards the theory put forward in the book, I was partly responsible, but to an extent which it is today no longer possible to determine. That theory was in any case unpretentious and hardly went beyond the direct description of the observations. It did not seek to establish the nature of hysteria but merely to throw light upon the origin of its symptoms. Thus it laid stress upon the significance of the life of the emotions and upon the importance of distinguishing between mental acts which are unconscious and those which are conscious (or rather capable of being conscious); it introduced a dynamic factor, by supposing that a symptom arises through the damming-up of an effect, and an economic factor, by regarding that same symptom as the product or equivalent of a quantity of energy which would otherwise have been employed in some other way. (This latter process was described as conversion.) Breuer spoke of our method as cathartic; its therapeutic aim was explained as being to provide that the accumulated affect used for maintaining the symptom, which had got onto the wrong lines and had, as it were, become stuck there, should be directed onto the normal path along which it could obtain discharge (or abreaction). The practical results of the cathartic procedure were excellent. Its defects, which became evident later, were those of all forms of hypnotic treatment. There are still a number of psychotherapists who have not gone beyond catharsis as Breuer understood it and who still speak in its favor. Its value as an abridged method of treatment was shown afresh in the hands of E. Simmel in the treatment of war neuroses in the German army during the Great War. The theory of catharsis had not much to say on the subject of sexuality. In the case histories which I contributed to the Studien, sexual factors played a certain part, but scarcely more attention was paid to them than to other emotional excitations. Breuer wrote of the girl, who has since become famous as his first patient, that her sexual side was extraordinarily undeveloped. It would have been difficult to guess from the Studien über Hysterie what an importance sexuality has in the ætiology of the neuroses.

The stage of development which now followed, the transition from catharsis to psychoanalysis proper, has been described by me several times already in such detail that I shall find it difficult to bring forward any new facts. The event which formed the opening of this period was Breuer’s retirement from our common work, so that I became sole administrator of his legacy. There had been differences of opinion between us at quite an early stage, but they had not been a ground for our separating. In answering the question of when it is that a mental process becomes pathogenic, that is, when it is that it becomes impossible for it to find a normal discharge, Breuer preferred what might be called a physiological theory: he thought that the processes which could not find normal outcome were such as had originated during unusual, hypnoid, mental states. This opened the further question of the origin of these hypnoid states. I, on the other hand, was inclined to suspect the existence of an interplay of forces and the operation of intentions and purposes such as are to be observed in normal life. Thus it was a case of “Hypnoid Hysteria” versus “Defence Neurosis.” But such differences as this would scarcely have alienated him from the subject if there had not been other factors at work. One of these was undoubtedly that his work as a physician and family doctor took up much of his time and that he could not, like me, devote his whole strength to the work of catharsis. Again, he was affected by the reception which our book had received both in Vienna and in Germany. His self-confidence and powers of resistance were not developed so fully as the rest of his mental organization. When, for instance, the Studien met with a severe rebuff from Strümpell, I was able to laugh at the lack of comprehension which his criticism showed, but Breuer felt hurt and grew discouraged. But what contributed chiefly to his decision was that my own further work led in a direction with which he found it impossible to reconcile himself.

The theory which we had attempted to construct in the Studien remained, as I have said, very incomplete; and in particular we had scarcely touched upon the problem of ætiology, upon the question of the ground in which the pathogenic process takes root. I now learned from my rapidly increasing experience that it was not any kind of emotional excitation that was in action behind the phenomena of the neurosis but regularly one of a sexual nature, whether it was a current sexual conflict or the effect of earlier sexual experiences. I was not prepared for this conclusion and my expectations played no part in it, for I had begun my investigation of neurotics quite unsuspectingly. While I was writing my “History of the Psycho-Analytic Movement” in 1914, there recurred to my mind some remarks that had been made to me by Breuer, Charcot and Chrobak, which might have led me to this discovery earlier. But at the time I heard them I did not understand what these authorities meant; indeed they had told me more than they knew themselves or were prepared to defend. What I heard from them lay dormant and passive within me, until the chance of my cathartic experiments brought it out as an apparently original discovery. Nor was I then aware that in deriving hysteria from sexuality, I was going back to the very beginnings of medicine and following up a thought of Plato’s. It was not until later that I learnt this from an essay by Havelock Ellis.

Under the influence of my surprising discovery, I now took a momentous step. I went beyond the domain of hysteria and began to investigate the sexual life of the so-called neurasthenics who used to visit me in numbers during my consultation hours. This experiment cost me, it is true, my popularity as a doctor, but it brought me convictions which today, almost thirty years later, have lost none of their force. There was a great deal of equivocation and mystery-making to be overcome, but once that had been done, it turned out that in all of these patients grave abuses of the sexual function were present. Considering how extremely widespread are these abuses on the one hand and neurasthenia on the other, a frequent coincidence between the two would not have proved much; but there was more in it than that one bald fact. Closer observation suggested to me that it was possible to pick out from the confused jumble of clinical pictures covered by the name of neurasthenia two fundamentally different types, which might appear in any degree of mixture but which were nevertheless to be observed in their pure forms. In the one type the central phenomenon was the anxiety attack with its equivalents, rudimentary forms and chronic surrogate symptoms; I consequently gave it the name of anxiety neurosis, and limited the term neurasthenia to the other type. Now it was easy to establish the fact that each of these types have a different abnormality of sexual life as its corresponding ætiological factor: in the former case coitus interruptus, undischarged excitement and sexual abstinence, and in the latter, excessive masturbation and too numerous nocturnal emissions. In a few specially instructive cases, which had shown a surprising alternation in the clinical picture from one type to the other, it was possible to prove that there had been a corresponding change in the underlying sexual régime. If it was possible to put an end to the abuse and allow its place to be taken by normal sexual activity, a striking improvement in the condition was the reward.

I was thus led into regarding the neuroses as being without exception disturbances of the sexual function, the so-called “actual” neuroses being the direct toxic expression of such disturbances and the psycho-neuroses their mental expression. My conscience as a physician felt pleased at my having arrived at this conclusion. I hoped that I had filled up a gap in medical science, which, in dealing with a function of such great biological importance, had failed to take into account any injuries beyond those caused by infection or by gross anatomical lesions. The standpoint of medicine was, moreover, favored by the view that sexuality was not something purely mental. It had a somatic side as well, and it was possible to assign special chemical processes to it and to attribute sexual excitement to the presence of some particular, though at present unknown, substance. There must also have been some good reason why the true spontaneous neuroses resembled no group of diseases more closely than the phenomena of intoxication and abstinence, which are produced by the administration or privation of certain toxic substances, or than Basedow’s disease, which is known to depend upon the product of the thyroid gland.

Since that time I have had no opportunity of returning to the investigation of the actual neuroses; nor has this part of my work been continued by anyone else. If I look back today at my early findings, they strike me as being the first rough outlines of what is probably a far more complicated subject. But on the whole they seem to me still to hold good. I should have been very glad if I had been able, later on, to make a psychoanalytical examination of some more cases of simple juvenile neurasthenia, but unluckily the occasion did not arise. To avoid misconceptions, I should like to make it clear that I am far from denying the existence of mental conflicts and of neurotic complexes in neurasthenia. All that I am asserting is that the symptoms of these patients are not mentally determined or removable by analysis, but that they must be regarded as direct toxic consequences of disturbed sexual chemical processes.

During the years that followed the publication of the Studien, having reached these conclusions upon the part played by sexuality in the ætiology of the neuroses, I read some papers on the subject before various medical societies, but was only met with incredulity and contradiction. Breuer did what he could for some time longer to throw the great weight of his personal influence into the scales in my favor, but he effected nothing and it was easy to see that he too shrank from recognizing the sexual ætiology of the neuroses. He might have crushed me or at least disconcerted me by pointing to his own first patient, in whose case sexual factors had ostensibly played no part whatever. But he never did so, and I could not understand why this was until I came to interpret the case correctly and to reconstruct, from some remarks which he had made, the conclusion of his treatment of it. After the work of catharsis had seemed to be completed, the girl had suddenly developed a condition of “transference love”; he had not connected this with her illness, and had therefore retired in dismay. It was obviously painful to him to be reminded of this apparent contretemps. His attitude towards me oscillated for some time between appreciation and bitter criticism; then accidental difficulties arose, as they never fail to do in a strained situation, and we parted.

Another result of my taking up the study of nervous disorders in general was that I altered the technique of catharsis. I abandoned hypnosis and sought to replace it by some other method, because I was anxious not to be restricted to treating hysteriform conditions. Increasing experience had also given rise to two grave doubts in my mind as to the use of hypnosis even as a means to catharsis. The first was that even the most brilliant results were liable to be suddenly wiped away if my personal relation with the patient became disturbed. It was true that they became reestablished if a reconciliation could be effected; but such an occurrence showed that the personal emotional relation between doctor and patient was after all stronger than the whole cathartic process, and it was precisely that factor which escaped every effort at control. And one day I had an experience which showed me in the crudest light what I had long suspected. One of my most acquiescent patients, with whom hypnosis had enabled me to bring about the most marvellous results, and whom I was engaged in relieving of her suffering by tracing back her attacks of pain to their origins, as she woke up on one occasion, threw her arms round my neck. The unexpected entrance of a servant relieved us from a painful discussion, but from that time onwards there was a tacit understanding between us that hypnotic treatment should be discontinued. I was modest enough not to attribute the event to my own irresistible personal attraction, and I felt that I had now grasped the nature of the element of mystery that was at work behind hypnosis. In order to exclude it, or at all events to isolate it, it was necessary to abandon hypnosis.

But hypnosis had been of immense help in the cathartic treatment, by widening the field of the patient’s consciousness and putting within his reach knowledge which he did not possess in his waking life. It seemed no easy task to find a substitute for it. While I was in this perplexity, a recollection came to my help of an experiment which I had often witnessed while I was with Bernheim. When the subject awoke from the state of somnambulism, he seemed to have lost all memory of what had happened while he was in that state. But Bernheim maintained that the memory was present all the same; and if he insisted on the subject remembering, if he asseverated that he knew it all and had only to say it, and if at the same time he laid his hand on the subject’s forehead, then the forgotten memories used in fact to return, hesitatingly at first, but eventually in a flood and with complete clarity. I determined that I would act in the same way. My patients, I reflected, must in fact “know” all the things which had hitherto only been made accessible to them by hypnosis; and assurances and encouragement on my part, assisted perhaps by the touch of my hand, would, I thought, have the power of forcing the forgotten facts and connections into consciousness. No doubt this seemed a more laborious process than putting them under hypnosis, but it might prove highly instructive. So I abandoned hypnosis, only retaining my practice of requiring the patient to lie upon a sofa while I sat behind him, seeing him, but not seen myself.

My expectations were fulfilled; I was set free from hypnosis. But along with the change in technique, the process of catharsis took on a new complexion. Hypnosis had screened from view an interplay of forces which now came in sight, and the understanding of which gave a solid foundation to my theory.

How had it come about that the patients had forgotten so many of the facts of their external and internal lives, but could nevertheless recollect them if a particular technique was applied? Observation supplied an exhaustive answer to these questions. Everything that had been forgotten had in some way or other been painful; it had been either alarming or disagreeable or shameful, by the standards of the subject’s personality. The thought arose spontaneously: it was precisely on that account that it had been forgotten, i. e. that it had not remained conscious. In order to make it conscious again, in spite of this, it was necessary to overcome something that fought against one in the patient; it was necessary to make an expenditure of effort on one’s own part in order to compel and subdue it. The amount of effort required of the physician varied in different cases; it increased in direct proportion to the difficulty of what had to be remembered. The expenditure of force on the part of the physician was evidently the measure of a resistance on the part of the patient. It was only necessary to translate into words what I myself had observed, and I was in possession of the theory of repression.

It was now easy to reconstruct the pathogenic process. Let us keep to a simple example, in which a particular impulsion had arisen in the subject’s mind, but was opposed by other powerful tendencies. We should have expected the mental conflict which now arose to take the following course. The two dynamic quantities—for our present purposes let us call them “the instinct” and “the resistance”—would struggle with each other for some time in the fullest light of consciousness, until the instinct was repudiated and the charge^[9] of energy withdrawn from it. This would have been the normal solution. In a neurosis, however, (for reasons which were still unknown) the conflict found a different outcome. The ego drew back, as it were, after the first shock of its conflict with the objectionable impulse; it debarred the impulse from access to consciousness and to direct motor discharge, but at the same time the impulse retained its full charge of energy. I named this process repression; it was a novelty, and nothing like it had ever before been recognized in mental life. It was obviously a primary mechanism of defence, comparable to an attempt at flight, and was only a fore-runner of the later developed normal condemning judgment. The first act of repression involved further consequences. In the first place, the ego was obliged to protect itself against the constant threat of a renewed advance on the part of the repressed impulse by making a permanent expenditure of energy, a counter-charge, and it thus impoverished itself. On the other hand, the repressed impulse, which was now unconscious, was able to find means of discharge and of substitutive gratification by circuitous routes and thus to bring the whole purpose of the repression to nothing. In the case of conversion-hysteria, the circuitous route led to the nerve supply of the body; the repressed impulse broke through at some point or other and produced symptoms. The symptoms were thus results of a compromise, for although they were substitutive gratifications, they were nevertheless distorted and deflected from their aim, owing to the resistance of the ego.

The theory of repression became the foundation-stone of our understanding of the neuroses. A different view had now to be taken of the task of therapy. Its aim was no longer to “abreact” an effect which had got onto the wrong lines, but to uncover repressions and replace them by acts of judgment which might result either in the acceptance or in the rejection of what had formerly been repudiated. I showed my recognition of the new situation by no longer calling my method of investigation and treatment catharsis but psychoanalysis.

It is possible to take repression as a centre and to bring all the elements of psychoanalytic theory into relation with it. But before doing so, I have a further remark of a polemical nature to make. According to Janet’s view, a hysteric was a wretched person who, on account of a constitutional weakness, was unable to hold her mental acts together, and it was for that reason that she fell a victim to mental dissociation and to a restriction of the field of her consciousness. The results of psychoanalytical investigations, on the other hand, showed that these phenomena were the result of dynamic factors—of mental conflict and of repression. This distinction seems to me to be far-reaching enough to put an end to the glib repetition of the view that whatever is of value in psychoanalysis is merely borrowed from the ideas of Janet. The reader will have learned from my account that historically psychoanalysis is completely independent of Janet’s discoveries, just as, in its content, it diverges from them and goes far beyond them. Janet’s works would never have had the implications which have made psychoanalysis of such importance to the mental sciences and have made it attract such universal interest. I always treated Janet himself with respect, since his discoveries coincided, to a considerable extent, with those of Breuer, which had been made earlier, but were published later than his. But when, in the course of time, psychoanalysis became a subject of discussion in France, Janet behaved ill, showed ignorance of the facts and used ugly arguments. And finally he revealed himself to my eyes and destroyed the value of his own work by declaring that when he had spoken of ‘unconscious’ mental acts, he had meant nothing by the phrase—it had been no more than a façon de parler.

But the study of pathogenic repressions and of other phenomena which have still to be mentioned compelled psychoanalysis to take the concept of the “unconscious” seriously. Psychoanalysis regarded everything mental as being in the first instance unconscious; the further quality of “consciousness” might also be present, or again it might be absent. This, of course, provoked a denial from the philosophers, for whom “conscious” and “mental” were identical, and who protested that they could not conceive of such a monstrosity as the “unconscious mental.” There was no help for it, however, and this idiosyncrasy of the philosophers could only be disregarded with a shrug. Experience (gained from pathological material, of which the philosophers were ignorant) of the frequency and power of impulses of which one knew nothing directly, and whose existence had to be inferred like some fact in the external world, left no alternative open. It could be pointed out, incidentally, that this was only treating one’s own mental life as one had always treated other people’s. One did not hesitate to ascribe mental processes to other people, although one had no immediate consciousness of them and could only infer them from their words and actions. But what held good for other people must be applicable to oneself. Anyone who tried to push the argument further and to conclude from it that one’s own hidden processes belonged actually to a second consciousness would be faced with the concept of a consciousness of which one knew nothing, of an “unconscious consciousness”—and this would scarcely be preferable to the assumption of an “unconscious mental.” If, on the other hand, one declared, like some other philosophers, that one was prepared to take pathological phenomena into account, but that the processes underlying them ought not to be described as mental but as “psychoid,” the difference of opinion would degenerate into an unfruitful dispute about words, though, even so, expediency would decide in favour of keeping the expression “unconscious mental.” The further question as to the ultimate nature of this unconscious is no wiser or more profitable than the older one as to the nature of the conscious.

It would be more difficult to explain concisely how it came about that psychoanalysis made a further distinction in the unconscious, and separated it into a preconscious and an unconscious proper. It will be sufficient to say that it appeared a legitimate course to supplement the theories which were a direct expression of experience by hypotheses which were designed to facilitate the handling of the material and related to matters which could not be a subject of immediate observation. The very same procedure is adopted by the older sciences. The sub-division of the unconscious is part of an attempt to picture the apparatus of the mind as being built up of a number of instances or systems, whose inter-relations may be expressed in spatial terms, without reference, of course, to the actual anatomy of the brain. (I have described this as the topographical method of approach.) Such ideas as these are part of a speculative superstructure of psychoanalysis, any portion of which can be abandoned or changed without loss or regret the moment its inadequacy has been proved. But there is still plenty to be described that lies closer to actual experience.

I have already mentioned that my investigation of the precipitating and underlying causes of the neuroses led me more and more frequently to conflicts between the subject’s sexual impulses and his resistances to sexuality. In my search for the pathogenic situations in which the repressions of sexuality had set in and in which the symptoms, as substitutes for what was repressed, had their origin, I was carried further and further back into the patient’s life and ended by reaching the first years of his childhood. What poets and students of human nature had always asserted turned out to be true: the impressions of that remote period of life, though they were for the most part buried in amnesia, left ineradicable traces upon the individual’s growth and in particular laid the foundations of any nervous disorder that was to follow. But since these experiences of childhood were always concerned with sexual excitations and the reaction against them, I found myself faced by the fact of infantile sexuality—once again a novelty and a contradiction of one of the strongest of human prejudices. Childhood was looked upon as “innocent” and free from the lusts of sex, and the fight with the demon of “sensuality” was not thought to begin until the troubled age of puberty. Such occasional sexual activities as it had been impossible to overlook in children were put down as signs of degeneracy and premature depravity or as a curious freak of nature. Few of the findings of psychoanalysis have met with such universal contradiction or have aroused such an outburst of indignation as the assertion that the sexual function starts at the beginning of life and reveals its presence by important signs even in childhood. And yet no other finding of analysis can be demonstrated so easily and so completely.

Before going further into the question of infantile sexuality, I must mention an error into which I fell for a while and which might well have had fatal consequences for the whole of my work. Under the pressure of the technical procedure which I used at that time, the majority of my patients reproduced from their childhood, scenes in which they were sexually seduced by some grown-up person. With female patients the part of seducer was almost always assigned to their father. I believed these stories, and consequently supposed that I had discovered the roots of the subsequent neurosis in these experiences of sexual seduction in childhood. My confidence was strengthened by a few cases in which relations of this kind with a father, uncle or elder brother had continued up to an age at which memory was quite to be trusted. If the reader feels inclined to shake his head at my credulity, I cannot altogether blame him; though I may plead that this was at a time when I was intentionally keeping my critical faculty in abeyance so as to preserve an unprejudiced and receptive attitude towards the many novelties which were coming to my notice every day. When, however, I was at last obliged to recognize that these scenes of seduction had never taken place, and that they were only phantasies which my patients had made up or which I myself had perhaps forced upon them, I was for some time completely at a loss. My confidence alike in my technique and in its results suffered a severe blow, it could not be disputed that I had arrived at these scenes by a technical method which I considered correct, and their subject-matter was unquestionably related to the symptoms from which my investigation had started. When I had pulled myself together, I was able to draw the right conclusions from my discovery: namely, that the neurotic symptoms were not related directly to actual events but to phantasies embodying wishes, and that, as far as the neurosis was concerned, psychical reality was of more importance than material reality. I do not believe even now that I forced the seduction-phantasies upon my patients, that I “suggested” them. I had, in fact, stumbled for the first time upon the Œdipus complex, which was later to assume such an overwhelming importance, but which I did not recognize as yet in its disguise of phantasy. Moreover, seduction during childhood retained a certain share, though a humbler one, in the ætiology of neuroses. But the seducers turned out as a rule to have been older children.

It will be seen, then, that my mistake was of the same kind as would be made by someone who believed that the legendary story of the early kings of Rome (as told by Livy) was historical truth instead of what it is in fact—a reaction against the memory of times and circumstances that were insignificant and occasionally, perhaps, inglorious. When the mistake had been cleared up, the path to the study of the sexual life of children lay open. It thus became possible to apply psychoanalysis to another field of science and to use its data as a means of discovering a new piece of biological knowledge.

The sexual function, as I found, is in existence from the very beginning of the individual’s life, though at first it is assimilated to the other vital functions and does not become independent of them until later; it has to pass through a long and complicated process of development before it becomes what we are familiar with as the normal sexual life of the adult. It begins by manifesting itself in the activity of a whole number of component instincts. These are dependent upon erotogenic zones in the body; some of them make their appearance in pairs of opposite impulses (such as sadism and masochism or the impulses to look and to be looked at); they operate independently of one another in their search for pleasure, and they find their object for the most part in the subject’s own body. Thus, to begin with, they are non-centralized and predominantly auto-erotic. Later they begin to be co-ordinated; a first stage of organization is reached under the dominance of the oral components, an anal-sadistic stage follows, and it is only after the third stage has at last been reached that the primacy of the genitals is established and that the sexual function begins to serve the ends of reproduction. In the course of this process of development a number of elements of the various component instincts turn out to be unserviceable for this last end and are therefore left on one side or turned to other uses, while others are diverted from their aims and carried over into the genital organization. I gave the name of libido to the energy of the sexual instincts and to that form of energy alone. I was next driven to suppose that the libido does not always pass through its prescribed course of development smoothly. As a result either of the excessive strength of certain of the components or of experiences involving premature gratification, fixations of the libido may occur at various points in the course of its development. If subsequently a repression takes place, the libido flows back to these points (a process described as regression), and it is from them that the energy breaks through in the form of a symptom. Later on it further became clear that the localization of the point of fixation is what determines the choice of neurosis, that is, the form in which the subsequent illness makes its appearance.

The process of arriving at an object, which plays an important part in mental life, takes place alongside of the organization of the libido. After the stage of auto-erotism, the first love-object in the case of both sexes is the mother; and it seems probable that, to begin with, the child does not distinguish its mother’s organ of nutrition from its own body. Later, but still in the first years of infancy, the relation known as the Œdipus complex, becomes established: boys concentrate their sexual wishes upon their mother and develop hostile impulses against their father as being a rival, while girls develop an analogous attitude. All of the different variations and consequences of the Œdipus complex are important; and in particular the innately bisexual constitution of human beings makes itself felt and increases the number of simultaneously active tendencies. Children do not become clear for quite a long time upon the differences between the sexes; and during this period of sexual enquiry they produce typical sexual theories which, since they are limited by the incompleteness of their authors’ own physical development, are a mixture of truth and error and fail to solve the problems of sexual life (the riddle of the Sphinx, the question of where babies come from). We see, then, that a child’s first object-choice is an incestuous one. The whole course of development that I have described is run through rapidly. For the most remarkable feature of the sexual life of man is that it comes on in two waves, with an interval between them. It reaches a first climax in the fourth or fifth year of a child’s life. But this early growth of sexuality is nipped in the bud; the sexual impulses, which have shown such liveliness, are overcome by repression, and a period of latency follows, which lasts until puberty and during which the “reaction-formations” of morality, shame and disgust are built up. Of all living creatures, man alone seems to show this double onset of sexual growth, and it may perhaps be the biological determinant of his predisposition to neuroses. At puberty the impulses and object-relations of a child’s early years become re-animated, and amongst them the emotional ties of his Œdipus complex. The sexual life of puberty is a struggle between the impulses of early years and the inhibitions of the latency period. Before this, and while the child is at the highest point of its infantile sexual development, a genital organization of a sort is established; but only the male genitals play a part in it, and the female ones remain undiscovered. (I have described this as the period of phallic primacy.) At this stage the contrast between the sexes is not stated in terms of “male” or “female” but of “possessing a penis” or “castrated.” The castration complex which arises in this connexion is of the profoundest importance in the formation alike of character and of neuroses.

In order to make this condensed account of my discoveries as to the sexual life of man more intelligible, I have brought together conclusions which I reached at different dates and incorporated by way of supplement or correction in the successive editions of my Three Contributions to the Theory of Sexuality.^[10] I hope it will have been easy to gather the nature of my extension (on which so much stress has been laid and which has excited so much opposition) of the concept of sexuality. That extension is of a twofold kind. In the first place sexuality is divorced from its too close connection with the genitals and is regarded as a more comprehensive bodily function, having pleasure as its goal and only secondarily coming to serve the ends of reproduction. In the second place, the sexual impulses are regarded as including all of those merely affectionate and friendly impulses to which usage applies the exceedingly ambiguous word ‘love.’ I do not, however, consider that these extensions are innovations, but rather restorations: they signify the removal of inexpedient limitations of the concept into which we had allowed ourselves to be led.

The detaching of sexuality from the genitals has the advantage of allowing us to bring the sexual activities of children and of perverts into the same scope as those of normal adults. The former have hitherto been entirely neglected and, though the latter have been recognized, it has been with moral indignation and without understanding. Looked at from the psychoanalytic standpoint, even the most eccentric and repellent perversions are explicable as manifestations of component instincts of sexuality which have freed themselves from the primacy of the genitals and are going in pursuit of pleasure on their own account as they did in the very early days of the libido’s development. The most important of these perversions, homosexuality, scarcely deserves the name. It can be traced back to the constitutional bisexuality of all human beings and to the after-effects of the phallic primacy. Psychoanalysis enables us to point to some trace or other of a homosexual object-choice in everyone. If I have described children as “poly-morphously perverse,” I was only using a terminology that was generally current; no moral judgment was implied by the phrase. Psychoanalysis has no concern whatever with such judgments of value.

The second of my alleged extensions of the concept of sexuality finds its justification in the fact revealed by psychoanalytic investigation, that all of these affectionate impulses were originally of a completely sexual nature but have become inhibited in their aim or sublimated. The manner in which the sexual instincts can thus be influenced and diverted enables them to be employed for cultural activities of every kind, to which indeed they bring the most important contributions.

My surprising discoveries as to the sexuality of children were made in the first instance through the analysis of adults. But later (from about 1908 onwards) it became possible to confirm them in the most satisfactory way and in every detail by direct observations upon children. Indeed, it is so easy to convince oneself of the regular sexual activities of children, that one cannot help asking in astonishment how the human race can have succeeded in over-looking the facts and in maintaining for so long the agreeable legend of the asexuality of childhood. This surprising circumstance must be connected with the amnesia which, just as with the majority of adults, hides their own infancy.