Further Contributions to the Theory and Technique of Psychoanalysis

Sandor Ferenczi

• Editorial: Read & Co. Science
• Año: 2014
• ISBN:
  9781447495017
• Categoría: Psicologia
• Categoría: Psicoanalisi

This antiquarian volume contains a collection of psycho-analytical writings which constitute the author's personal contribution to the development of psycho-analysis. This collection furnishes a picture of the manifold interests which continually occupy the physician practicing psycho-analysis, and which bring him into touch with the most various fields of natural and mental sciences. The chapters of this book include: 'The Analytic Conception of the Psycho-Analysis'; 'Actual and Psycho-Neurosis in The Light of Freud's Investigations and Psycho-Analysis'; 'Suggestion and Psycho-Analysis'; 'On Forced Phantasies'; 'Disease- or Patho-Neurosies'; 'The Phenomena of Hysterical Materialization', etcetera. This book is being republished in an affordable, modern edition complete with a new prefatory biography of the author.

NOSOLOGY

I

THE ANALYTIC CONCEPTION OF THE PSYCHO-NEUROSES¹

THERE are many ways in which the flattering request of the Medical Association, that I should deliver a lecture reviewing the progress in the study of the neuroses, might be treated. I might discuss various functional neuroses seriatim and mention the novelties that have appeared among the individual kinds of neuroses in the course of the last few years. On a little reflection I rejected this plan, because if I mentioned merely the names of all the disease-phenomena nowadays included under the heading ‘functional neurosis’ it would create such a chaos of new Græco-Latin words that I should only increase the confusion reigning at present where the neuroses are concerned. I shall therefore try to carry out my task in a different way. Instead of going into details I shall review matters individually and give the general impression which a nerve specialist acquires of the present state of his department of medicine.

One of the wittiest of German writers, Georg Christian Lichtenberg, once asked the paradoxical question why did it never strike researchers that discoveries could be made not only with a magnifying glass but also, perhaps, with a diminishing lens? He obviously meant that the increasing search for details in which science gets tied up and loses its perspective over things as a whole might from time to time be given up for the consideration, individually and from a distance, of the results already achieved. He means, therefore, approximately the same thing that Herbert Spencer mentions as the necessary phase in all natural evolution, namely, that differentiation should occasionally be freed from the work of correlation and integration.

When, therefore, I consider the various neuroses through a diminishing lens, their multiplicity reduces itself to a twofold division that cannot be further integrated.

One kind of neurosis is, though it does not leave the mental life untouched (there is, indeed, no illness without psychic participation), mainly confined to the somatic domain. Another great group of the neuroses on the other hand, though not wholly without concomitant bodily phenomena, manifests itself chiefly in psychic changes—indeed, owes its origin exclusively to psychic shocks.

You will, perhaps, be surprised that such a dualistic division of diseases is possible to-day in this age of monism. I hasten also to add here that this nosological dualism agrees quite well with the agnostic monism of the philosophers, since the latter—as its name indicates—only postulates the uniform conformity to law throughout the whole of nature, but at the same time is frank enough to allow that we can say nothing about the nature of this conformity. In my opinion the monistic conception is in the meantime only a philosophic declaration of faith or an ideal that one would fain approach, but which is still so remote from the confines of our present knowledge that we are as yet unable to make practical use of its teachings. It is useless to attempt to palliate facts; as things stand to-day we can analyse one set of phenomena only physically and another set only psychologically. Psycho-physical parallelism, too, is certainly a possible but really very improbable philosophic theorem by which we need not let ourselves be misled in our observations. In a word, we call it disingenuous when—as is at present customary—psychic happenings are defined by anatomical and physiological conceptions, for the truth is that we know nothing of either the physiological side of psychic life or of the anatomical substratum of its mechanism. The most we learnt in this respect from natural science is the fact of cerebral localization of sensory functions and the recognition of individual co-ordinating centres for movements. Flechsig, indeed, attempted to construct a modern phrenology on the basis of the chronological sequence of the embryonic brain tissues, but the whole complicated system of the three to four dozen psychic centres and their projection and association fibres which he assumed is only an extremely unstable even if ingenious theoretical edifice about which the clinician need not greatly trouble himself.

So far, too, all search for the anatomical brain changes accompanying mental disease has remained quite fruitless, as has also the endeavour to correlate the pathological-anatomical findings with the mental symptoms noted during life for the purpose of drawing conclusions about the psychic functions of individual parts of the brain. Neither in mania nor in melancholia, in paranoia, hysteria nor in obsessional neurosis were any changes found on microscopical examination of the brain; in other diseases such as paralysis, alcoholism, and senile dementia, changes were certainly found, but the relation of the brain lesion to the psychic symptoms could not be stated, so that we may confidently say that we can to-day as little speak of a pathological anatomy of the psychoses and psycho-neuroses as of the material correlation of mental functioning in general.

Our learned men, even if they allow that they do not yet know the functional mechanism of ‘thinking matter’, show an extraordinary resistance against acknowledging their ignorance as regards the pathology of this matter. If it is a fallacy to speak of ‘molecular movements’ of the brain cells instead simply of feeling, thinking, and willing, then it is no less disingenuous to throw anatomical, physiological, physical, and chemical expressions about when describing the so-called functional psychoses and neuroses. Our learned men seem to be of the opinion that a docta ignorantia is more supportable than an indocta ignorantia, that, therefore, the naïve acknowledgement of our ignorance is more shameful than a lack of knowledge that cloaks itself in scientific language.

Let us suppose, however, that man at last manages to observe directly in himself the brain changes occurring parallel with his own sensations; the twofold division of the phenomenal series, the separation of what is observed from the exterior, and what is seen inwardly would nevertheless persist. Even the most accurate description of the movements of the brain molecules would not render introspective psychology superfluous.

For the understanding of the healthy and diseased mind, therefore, analysis of direct inner perception remains the chief source of psychological knowledge; indeed, it has more prospect of permanence than the purely materialistic point of view. It has been our experience that a few unforeseen discoveries have been able to shake physics to its foundations, while the principles of introspection always remain the same.

I could not spare you this philosophical excursion, although it constantly reminds me of another witty saying of the above-mentioned Lichtenberg, that one can as easily do oneself an injury with philosophy as with a sharp razor blade if one does not proceed with the utmost care. I, therefore, lay this dangerous weapon aside and confine myself to repeating once more that the dualistic division of the neuroses is, according to the present position of our knowledge, fully justified.

Amongst the organic neuroses, or, as I should like to call them, the physio-neuroses, we reckon, for instance, chorea, myxœdema, Basedow’s disease, neurasthenia and the anxiety neuroses in Freud’s sense and other conditions in which the cause of the disease is sought for or has already been found in disturbances of metabolism and such like. In my lecture to-day I should like to direct your attention exclusively towards the other great group of neuroses—to the psycho-neuroses—those neuroses whose causation, pathological nature, and symptomatology are at present open only to an introspective psychical scrutiny, and particularly to hysteria and obsessional neurosis. I would remark here at once that the psycho-neuroses cannot be sharply distinguished either from ‘normal’ mental functioning or from the functional psychoses; it is mainly practical considerations that compel the doctor to treat normality, psycho-neurosis, and psychosis as separate chapters in psychology. From the scientific point of view there is no fundamental difference between the outbursts of passion in the ‘normal’ person, the attacks of the hysteric, and the ravings of the insane.

The ‘psycho-genetic’ view of the psychoses and neuroses is of primeval antiquity.

The dominance of the materialistic and mechanistic point of view in the nineteenth century first misled psychologists and psycho-pathologists to renounce the naïve but honest introspective psychology and to imitate the experimental methods so successful in the natural sciences. Finally, it went so far that doctors and natural philosophers handed over as though unworthy of their consideration the great and little mental problems of humanity to the writers of belles lettres, and confined themselves more and more to the task of the registration of the physiology of the senses. Since Fechner and Wundt, hardly anyone has animated the dead matter of experimental psychology with an in any way informative idea. Freud’s exertions have succeeded recently in joining up the broken threads connecting scientific psychology and daily life, and in making a scientific field that had long lain fallow fruitful once more.

I have already had an opportunity of telling you, honoured colleagues, about the evolution of Freud’s theory and method—about psycho-analysis. This time I shall indicate the advances that the study of the psycho-neuroses owes to psycho-analysis.

This new psychology starts from a theory of instinct. The controller-in-chief of all our actions and thoughts is the ‘pleasure-principle’, the endeavour to escape if possible from unpleasant situations, the desire to obtain the greatest possible gratification with the smallest possible effort.

No person, however, can exist for himself alone, but must adapt himself to a complicated, almost unmodifiable milieu. Already in early childhood he must learn to renounce a great part of his natural impulses; when he is grown up, culture requires of him that he should even regard self-sacrifice for the community as something beautiful, good, and worth striving for. The greatest sacrifice the individual has to make in the interests of society, however, is in regard to his sexual desires. All educational factors work towards the suppression of these desires, and most people adapt themselves to these requirements without any particular injury.

Psycho-analysis proceeded to show that this adaptation occurred with the help of a peculiar psychic mechanism, the essential feature of which is that the unfulfillable wishes, and the ideas, memories, and thought-processes belonging thereto, are submerged in the unconscious. To put it more simply: one ‘forgets’ these wishes and all the thoughts associated with them. This forgetting, however, does not mean the complete destruction of those tendencies and ideational groups; the forgotten complexes continue to exist below the threshold of consciousness: they preserve their potential power and can in suitable circumstances appear again. The healthy person protects himself successfully against the return of these wishes and the sudden appearance of the objects of desire by erecting moral ramparts round these ‘repressed complexes’. Feelings of shame and disgust conceal from him all his life the fact that he still really cherishes those despised, disgusting, shameful things as wish-ideas. Things happen in this way, however, only with healthy people; but where, owing to some peculiarity of temperament or to too great a strain on those protective ramparts, the psychic mechanism of repression fails, a ‘return of the repressed material’ occurs, and with it the formation of symptoms of disease.

The question is often asked why psycho-analysis ascribes so great a part in the ætiology of the psycho-neuroses precisely to sexual repression. But those who ask this forget that since the beginning of time ‘hunger and love’ have ruled the world, that the impulses for self- and race-preservation are equally powerful instincts in every living creature. Were there a society in which the taking of food was as shameful a manifestation of life as coitus is with us, that is to say, something that one must indeed do but about which one may not speak, of which one may scarcely think, and were the manner of eating there as sternly restricted as sexual gratification is with us, then perhaps the repression of the instinct of self-preservation would play there the chief part in the ætiology of the psycho-neuroses. The predominance of sexuality in the origination of mental disease is therefore in great part due to social causes.

These are of course entirely novel views, standing in the utmost conceivable contrast to everything that has been so far taught by a neurology dealing with anatomical and physiological conceptions. Claude Bernard, indeed, clearly said that when new facts contradicted old theories it was the theories that had to go. It is quite possible, too, that this new libido theory of the neuroses is not the last word that can be said about the neuroses; such a ‘last word’ is unknown to science. It is my conviction, however, that at the present time there is no theory better adapted to the facts and everything associated with them than the psycho-analytic one.

How then does psycho-analysis classify the psycho-neuroses? What is the basis upon which it constructs its nosology? The answer is simple: it distinguishes the disease groups according to the special way in which the ‘complexes’ that have been warded off and have returned from repression manifest themselves as symptoms of disease. The patient suffering from obsessional neurosis knows how to displace the affective value of the complex ideas upon other but more harmless thoughts. In this way apparently quite meaningless obsessional ideas are formed that constantly obtrude themselves.

The hysteric goes still further; he can suffer amongst his thoughts not even these harmless substitutes for the repressed instinctive impulses, and creates a symbol for them in his physical body. He therefore represents by means of motor and sensory symptoms both the desires that are unable to become conscious as well as the defence set up against them. Hysterical anæsthesias, pains, paralyses, and spasms are nothing but symbols of repressed thoughts.

There are other forms of defence against unpleasant ideational complexes. In paranoia, for instance, the patient simply sets the ideas that have become insupportable free from his ‘ego’ and projects them upon other people.

The boundary between ‘ego’ and external world can be displaced; the tendency to attribute unpleasant ideas to others is often seen, even in healthy people. The paranoiac does the same, but of course to a far greater extent. Instead of acknowledging certain forms of love and hate in himself, he allows himself to consider that these feelings and thoughts, which are insupportable for his self-regard, are whispered in his ear by invisible spirits, or he reads them in the countenances or the movements of his fellow-men.

We find a fourth form of self-defence against the complexes referred to in dementia præcox. Since the fundamental work of Jung and Abraham, we know that people who suffer from this trouble do not dement in the sense that they are incapable of logical thought, but that they withdraw their libido so completely from the external world that, so to say, it ceases to exist for them.

The dement transfers the whole of the interest and the affective cathexis that he withdraws from the external world to himself; hence his childish ideas of megalomania, his infantile habits, the revival of auto-erotic forms of gratification, the recklessness in regard to cultural requirements, particularly his utter disregard and carelessness of the external world.

All the kinds of flight from unpleasant ideas referred to are found also in ‘normal’ people. The bodily manifestations of ‘normal’ emotional outbursts have much in common with hysteria; a lover can transfer his love affect to every object, to every person who has an associative connection with the real object of his feelings, and this has no more meaning than an obsessional neurotic displacement of affect; does not the distrustful and the jealous person often simply project the idea of his own good-for-nothingness or unlovableness upon others? and if anyone has been deceived in people, does he not become an egoist, a person turned in upon himself who observes, without sharing, the labour and toil of others, whose sole interest is in his own well-being, his own bodily and mental gratification?

The famous saying of Brücke the physiologist, ‘disease is only life under changed conditions’, applies also, therefore, to the psycho-neuroses. Functional psychoses and psycho-neuroses are distinguished from normal mental activity only by a matter of degrees.

A few words now about the ætiology of these neuroses. No amount of brain anatomy could dissuade novelists, who view life naïvely but with sharp eyes, from the idea that mental excitement of itself was capable of occasioning a mental illness. While we doctors were thrashing the empty straw of physiological catchwords, Ibsen in his ‘Lady from the Sea’ had ma...