Conditions of Nervous Anxiety and their Treatment

Wilhelm Stekel

• Publisher: Das Press
• Year: 2021
• Print ISBN: 9781447472902
• eBook ISBN: 9781528765060
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This antiquarian book contains Wilhelm Stekel's 1923 treatise on nervous anxiety, "Conditions of Nervous Anxiety and their Treatment". A fascinating and informative analysis on the subject, this book will appeal to those with an interest in psychology and psychoanalysis, and constitutes a worthy addition to collections of allied literature. Contents include: "The Nature of Repression", "Basic Concepts of Anxiety Neurosis", "Clinical Picture of Anxiety Neurosis: The Anxiety Attack", "Clinical Picture of Anxiety Neurosis: Anxiety Neurosis with Cardiac Phenomena", "Clinical Picture of Anxiety Neurosis: Digestive Disturbances", etcetera. Wilhelm Stekel (1868 - 1940) was an Austrian psychologist and physician. He was an early follower of the seminal Sigmund Freud, often described as Freud's most distinguished pupil and commonly hailed as one of the founding fathers of modern psychoanalytical methodology. Many vintage texts such as this are increasingly scarce and expensive, and it is with this in mind that we are republishing this volume now in an affordable, modern, high-quality edition. It comes complete with a specially commissioned new biography of the author.

SECOND PART

THE PHOBIAS

CHAPTER XVI

A FEW SIMPLE EXAMPLES OF PHOBIAS

WE have studied the effects of anxiety on the various organs and covered thereby practically the whole field of the neuroses, which were termed “Neurasthenia” by the old school. Freud tried to separate anxiety neurosis from this neurasthenia. In his opinion both diseases are “actual neuroses,” i.e., they arise from an injurious form of sexual life.

But when I brought the first analyses of anxiety neuroses to Freud, repeatedly proving the complaint to be “parapathia,” a disturbance of the affective life, he felt that his concept was losing ground and suggested as a compromise, that the anxiety neurosis engendered by somatic injury should be affiliated with a second neurosis, anxiety hysteria, which presents the familiar mechanism of hysteria.

The name “anxiety hysteria” was suggested to me by Freud. The difference between anxiety hysteria and anxiety neurosis is still sharply emphasized and adhered to by Freud. According to him, it is a qualitative one.¹ But in my view it is a quantitative one. Since according to my theory there is no room for the concept of actual neuroses it would have been more logical to describe only Anxiety hysteria, and to let the Anxiety neurosis become merged in that. All anxiety would be thus reduced to one Neurosis only, which, if you will, might be termed Hysteria. Personally, I have not adopted this course and prefer to preserve the distinction from didactic reasons.

The arguments put forward in the second edition (1912), have, as the result of many years of research, been amplified. They are no longer tenable in the form in which they have been presented up to the present. In the first place we have seen many cases of anxiety neurosis in which a distinct conversion was to be observed; in the second, there is no such thing as somatic conversion of the libido into anxiety, as conceived by Freud.

There is only one psychic conflict between various psychic currents, which are manifested as parapathia, i.e., disturbance of affect. Janet’s view that hysteria is the result of a dissociation of the personality, is the right one. The psychic conflict leads to a dissociation of consciousness, because the ego decides on one of the wishes (generally on the moral ego), while the other wishes remain unconscious (pre-conscious). But it may also happen, as I have demonstrated in other volumes of this work, that the ego decides for a moral life, and that the moral ego expresses itself as conscience in the unconscious.

In all parapathias disturbances of the affective life are to be observed i.e., a fight between two affects. It is never a question of two thoughts in conflict, but of two emotions. (The religious feeling strives against the sex-impulse, which manifests itself as love, and vice versa).

Phobia is a compromise in this conflict. It signifies a truce, enforced with the help of anxiety.

It is now my task to illustrate these facts by means of analyses. Let us begin with a case which will clearly demonstrate the difficulties of diagnosis, and enable us to understand the power of psychotherapeutic treatment.

No. 103.—A rather stout man of thirty-four, of healthy parentage, with slight struma, was troubled with violent attacks of palpitation, accompanied by very tormenting feelings of anxiety. Even in his student days he had had himself examined by a specialist in heart diseases, who had diagnosed “a clear case of hereditary tachycardia.” The last attack was associated with violent “angina lacunaris.” The patient was moreover an inveterate smoker. The Professor who was treating him pronounced him to be suffering from myocarditis infectiosa following angina in a fatty degenerate nicotine-poisoned heart, and prescribed a fat-reducing cure in Franzensbad after a few weeks’ rest. The patient followed this advice, left his office in the lurch—he was a Solicitor—and went to Franzensbad. After the first week there he was visited by a frightful attack of anxiety. He awoke in the night with a scream, awakened his wife, and alarmed the whole house. He felt as if his last hour had come. Several doctors and a professor stood round the patient’s bed in perplexity, while the latter issued his last instructions. The attack gradually subsided, and the patient returned to Vienna. There he at once went to bed again, and declared he could not walk another step. He was quite convinced that he would die if he went a step further. During every attack he held his wife tightly by the hand, and would not let her stir from his side. Another Professor diagnosed vagus-neurosis, and prescribed large doses of bromide, which gave the patient temporary relief. But he suffered for a considerable time from insomnia, and eventually could not exist without bromide.

Three years later I took him in hand. With the exception of the slight degree of tachycardia already mentioned, I could discover, in corde objectiv, nothing of a pathological nature, diagnosed “anxiety-hysteria,” and suggested psychotherapeutic treatment. The patient consented, and, after a short time, was completely cured.

Despite certain unpleasant symptoms resulting from abstinence, he gave up the bromide which he had been taking daily, on the advice of the professors, for three years. (About six kilogrammes of bromide altogether!)

Analysis disclosed a number of remarkable factors which all played a considerable part in the generation of anxiety hysteria. Before the outbreak of his illness he had practised coitus interruptus for six years, and in such a manner that ejaculation was postponed in order to effect his wife’s full satisfaction. But this did not exhaust the etiology of this case. During the great attack in Franzensbad he had the sensation of standing for trial in a Court of Law. The attack was, in fact, connected with this dream. Sanctis¹ would have called this a case of dream neurosis—for he actually speaks of dream psychoses (reversing cause and effect). Our patient dreamed he was being tried before a judge and jury. Despite the fact that he had informed the doctors in Franzensbad of this dream, it was regarded as a result of his heart affection, and the psychic root of his anxiety was not sought for. The psychanalysis of this case afforded us a full explanation. That the trouble was centred in the heart can be explained, in Adler’s sense, by the fact that it was an inferior organ. The patient had suffered since his student days from tachycardia; a brother was similarly afflicted with heart neurosis and tachycardia. Coitus interruptus was the original cause of the anxiety neurosis.

A new and important psychic factor was added in the shape of a painful occurrence which initiated the illness. The lawyer had behaved badly to one of the lady clients of his office. This became known to strangers who threatened to inform the magistrate and bring him to Court. His whole position was threatened. He felt as if he had fallen into the hands of blackmailers. The scene in Court of which he had dreamed was merely the anticipation of his waking fears. His anxiety was fear of a social death. He could not remain in Franzensbad because he was afraid that in the meantime action might be taken against him in Vienna, without his being able to retaliate in time. He could not leave his house because, from various indications, he imagined—certainly without foundation—that his neighbours knew something of the affair. Because, in fact, he was ashamed of himself.

Each of his neurotic symptoms was, therefore, of “conscious” origin. But the power of his repression was so great that he was continually transferring them to his organic malady. He said nothing about these unpleasant circumstances to his doctors, simply because they did not ask him about them.

But the analysis revealed still more. He once had a dream in which he saw himself lying beside himself, bloated, cyanotic, with the death rattle, at his last gasp. He awoke out of this dream with palpitations and anxiety. The interpretation was easy. Who was that part of him, his “second self,” that he saw lying beside him? Just his wife, whom he grasped tightly during the anxiety attack, to whom, in fact, he absolutely clung. In the dream he saw her as a cyanotic dying woman in her last hour. This dream denotes a powerful unconscious desire. His wife had been dangerously ill several times with an ulcus ventriculi. The wish²—if she would only die—was on several occasions nearly fulfilled. He had married his ugly wife when she was a poor girl, out of love. He was intensely interested in painting; was more artist than amateur, and she stood in the way of his artistic endeavours. She was an obstacle to his love affairs. It was for this reason that he toyed unconsciously with the thought, “supposing she were dead.” The reaction thereto was manifested by exaggerated tenderness. He clung to her with the cry: “Do not leave me!” because he desired the contrary. Criminal impulses may possibly have played their part also. I did not investigate on those lines, but I thought I detected a criminal poison-complex from his neurotic dread of nicotine poisoning. The dream of the rattling body seems to point in that direction also.

This is a phenomenon which is found in every case of anxiety hysteria. We have only to investigate, and a death-thought will always make itself manifest. It generally concerns the death of the other partner, but sometimes also that of the children or of relatives. The anxiety neurotic mercilessly disposes of all obstacles in his dreams. He plays with death. His anxiety is the suppressed wish and conforms with the secret play of psychic powers which desire the annihilation of an otherwise beloved individual. It is, in short, the “guilty conscience.”

Investigation of the deeper layers brought to light the fact that the patient, and his brother as well, suffered from remarkable attacks of suffocation, which only occurred during the night. He awoke with shortness of breath and whooping a few times. This seemed horrible but was soon over. These attacks of laryngospasmus familiaris were a simulation of a sound which he had heard his father make at home during intercourse. Hence their occurrence in the night, during sleep, and hence their occurrence in his brother, who had shared the same youthful impressions. It was therefore an hereditary trouble due to environment, which obviously played a much greater part than the much maligned hereditary trouble originating in the germ-cell.

We see from this example how many factors contribute to the generation of anxiety hysteria—for this was obviously such a case. The coitus interruptus, which was the cause of the feeling of dissatisfaction, the well-founded dread of a painful law-suit, the severe psychic conflict between ethical inhibitions and criminal death wishes, the burden of a sexually exciting impression of his youth.

There are certain types of anxiety hysteria which are only revealed to the doctor through dream pictures. I could give at least a dozen examples of this description. Let us take one of my list at random.

No. 104.—A woman who suffered from the phobia that she could not go out alone. She could not even remain alone in a room. She was an elderly lady, and had already two big sons over twenty. She sat for years in her room, and could hardly be persuaded to go out in the evening, the explanation she gave being that “she would be taken ill in the street,” she would get another “attack.” She had had several attacks in the street and in her room, which the doctors declared to be due to her nerves. She used to stand and tremble, turn pale, and complained of palpitation. She felt as if she were dying. Her condition temporarily improved at a health resort, and she was able to take long walks and on one occasion even went to a concert at which she managed to stand for two hours in a dense crowd (!) After this passing improvement, her condition grew worse. A psychotherapeutic attempt to treat the patient met with strong opposition. She related an insignificant anamnesia of no importance, obviously concealing the chief part. She had practised coitus interruptus for fourteen years, and had become, of late years, totally anæsthetic. This is a condition very frequently found in women who habitually practise coitus interruptus. They protect themselves against the injurious effects of frustrated excitation by complete anæsthesia, which will not admit of any excitement. It is just these people who can deceive the nerve specialist who seeks to investigate their sexual life, by protesting: “I am absolutely cold and unfeeling, it is a matter of complete indifference to me whether my husband cohabits with me or not.” We are in this way enabled to detect a whole series of anxiety neuroses, whereas a superficial analysis might lead to the inference that there is no connection between sexuality and anxiety. In reality, however, the anaesthesia is only relative, that is, it is confined to one object, the one who performs the act of coitus, and to this particular form of the vita sexualis. If we do not allow ourselves to be deterred by opposition and proceed carefully with our investigations, or if the patient brings us one of her dreams, which she will do unsuspectingly the first time, it transpires that the phantasy life of these patients is occupied essentially with sexual things and to an altogether hypertrophic extent, and that behind the apparent anaesthesia, unrestrained sexual phantasies flourish in profusion, and especially those concerning incest and perversions. Needless to say these inmost secrets are not very easy to confess. But if we succeed in lifting the veil, and releasing the repressions, we are enabled to effect a distinct improvement in the condition.

In the present case the patient emphatically emphasized her sexual indifference. The motives for the anxiety states were not discoverable until she brought me her first dream. It ran as follows:

“I see my son lying on a sofa without a head; I am quite horrified. He says, ‘Fear nothing, the doctor will give me another head.’” She awoke with a frightened scream.

The dream was connected with the events of the previous day. Mother and son had had a violent dispute. He had said excitedly: “You can’t set another head on my shoulders.” She decided to complain to me about her son. We see how this wish was completely fulfilled in the dream. The son gets me to set a new head on his shoulders (for I am the doctor of the dream). Since he said it himself, it is a proof that he accepted this service. But this by no means solves the riddle of the dream. If this dream fulfils her wish, why did she awake with a cry of fear? Anxiety is a repressed wish, generally of a sexual character. Where is the repression in this dream? I asked her why she cried out. She then recalled the fact that the head lying on the ground had begun to scream. It was not till then that she felt afraid. This brings to her mind her son’s circumcision; the child screamed dreadfully on that occasion also. The operator was very unskilful and had nearly cut away a portion of the head (glans penis). Now let us not lose sight of the fact that the head (through transference from below to above) is a symbol of the tail. The dream was then much more intelligible. It had, like all dreams, a multiplicity of determining factors, and was open to several interpretations. It was a reminiscence of the circumcision at which a portion of the head had been cut off and sewn on again by a doctor. But if this event made such a lasting impression that it was able to form the plastic material of a dream after twenty-five years, the only explanation is that her unconscious thoughts were occupied with the son. In others words, that repressed incestuous thoughts were the cause of the phobia. This was actually the case. She was secretly obsessed with the fear that her son should contract some sexual disease which would eat away the member, as she had seen it depicted in a medical atlas of a lodger. He would then be obliged “to live without a “tail.” On the other hand she had heard that diseases of this nature were now very easily cured if a doctor were consulted in time.

This case throws a remarkable light on the peculiar train of thought of an hysteric. Her husband had neglected her for years, spending his time in restaurants or tea-shops without giving much consideration to her. She now revenges herself for this treatment on her son, whom she lo...

Table of contents

• Cover
• Title
• Copyright
• Contents
• First Part—Anxiety Neurosis
• Second Part—The Phobias
• Third Part—General