A General Introduction to Psychoanalysis Part 20

So much I wanted to tell you about symptom development in the neuroses.

Yes, but do not let me neglect to emphasize this especially: everything I have said here relates to the symptom development in hysteria. Even in compulsion neuroses, which retain the same fundamentals, much is found that is different. The counter-siege directed against the claims of the instincts, of which we have spoken in connection with hysteria, press to the fore in compulsion neuroses, and control the clinical picture by means of so-called "reaction-formations." The same kind and more far-reaching variations are discoverable among the other neuroses, where the investigations as to the mechanism of symptom development have in no way been completed.

Before I leave you today I should like to have your attention for a while for an aspect of imaginative life which is worthy of the most general interest. For there is a way back from imagination to reality and that is--art. The artist is an incipient introvert who is not far from being a neurotic. He is impelled by too powerful instinctive needs.

He wants to achieve honor, power, riches, fame and the love of women.

But he lacks the means of achieving these satisfactions. So like any other unsatisfied person, he turns away from reality, and transfers all his interests, his libido, too, to the elaboration of his imaginary wishes, all of which might easily point the way to neurosis. A great many factors must combine to present this termination of his development; it is well known how often artists especially suffer from a partial inhibition of their capacities through neurosis. Apparently their const.i.tutions are strongly endowed with an ability to sublimize and to s.h.i.+ft the suppression determining their conflicts. The artist finds the way back to reality in this way. He is not the only one who has a life of imagination. The twilight-realm of phantasy is upheld by the sanction of humanity and every hungry soul looks here for help and sympathy. But for those who are not artists, the ability to obtain satisfaction from imaginative sources is very restricted. Their relentless suppressions force them to be satisfied with the spa.r.s.e day dreams which may become conscious. If one is a real artist he has more at his disposal. In the first place, he understands how to elaborate his day dreams so that they lose their essentially personal element, which would repel strangers, and yield satisfaction to others as well. He also knows how to disguise them so that they do not easily disclose their origin in their despised sources. He further possesses the puzzling ability of molding a specific material into a faithful image of the creatures of his imagination, and then he is able to attach to this representation of his unconscious phantasies so much pleasurable gratification that, for a time at least, it is able to outweigh and release the suppressions. If he is able to accomplish all this, he makes it possible for others, in their return, to obtain solace and consolation from their own unconscious sources of gratification which had become inaccessible. He wins grat.i.tude and admiration for himself and so, by means of his imagination, achieves the very things which had at first only an imaginary existence for him: honor, power, and the love of women.

TWENTY-FOURTH LECTURE

GENERAL THEORY OF THE NEUROSES

_Ordinary Nervousness_

In our last discussion we accomplish a difficult task. Now I shall temporarily leave our subject and address myself to you.

For I know quite well that you are dissatisfied. You thought that an introduction to psychoa.n.a.lysis would be quite a different matter. You expected to hear vivid ill.u.s.trations instead of theories. You will tell me that when I gave you the ill.u.s.tration of "on the ground floor in the first story," you had grasped something of the causation of neurosis, only of course this should have been a real observation and not an imaginary story. Or, when in the beginning I described two symptoms (not imaginary also, let us hope) whose a.n.a.lysis revealed a close connection with the life of the patient, you first came to grasp the meaning of the symptoms and you hoped that I would proceed in the same way. Instead I have given you theories--lengthy, difficult to see in perspective and incomplete, to which something new was constantly being added. I worked with conceptions that I had not previously presented to you, abandoned descriptive for dynamic conceptions, and these in turn for economic ones. I made it hard for you to understand how many of the artificial terms I made use of still carry the same meaning and are used interchangeably only for the sake of euphony. Finally, I allowed broad conceptions to pa.s.s in review before you: the principles of pleasure and of fact and their phylogenetically inherited possession; and then, instead of introducing you to definite facts, I allowed them to become increasingly vague till they seemed to fade into dim distances.

Why did I not begin my introduction to the theory of neurosis with the facts that you yourselves know about nervousness, with something that has always aroused your interest, with the peculiar temperament of nervous people, their incomprehensible reactions to external influences, to human intercourse, their irritability, their uselessness? Why did I not lead you step by step from the understanding of simple, everyday forms to the problems of mysterious and extreme manifestations of nervousness?

I cannot even say that you are wrong. I am not so infatuated with my art of representation as to see some special attraction in every blemish. I myself believe that I could have proceeded differently, to your better advantage, and this indeed had been my intention. But one cannot always carry out one's sensible intentions. The nature of the subject matter issues its own commands, and easily modifies our plans. Even so usual a performance as the organization of well-known material is not entirely subject to the particular purposes of the author. It forms itself as it will and later one wonders why it turned out so and not otherwise.

Probably one of the reasons is that the t.i.tle, _A General Introduction to Psychoa.n.a.lysis_, no longer applies to this part, which deals with the neuroses. The introduction to psychoa.n.a.lysis is found in the study of errors and the dream; the theory of neurosis is psychoa.n.a.lysis itself. I do not think that in so short a time I could have given you a knowledge of the theory of neurosis other than in concentrated form. It was necessary to present to you connectedly the meaning and interpretation of the symptoms, their external and internal conditions and their bearing on the mechanism of symptom formation. This I have attempted to do; it is practically the nucleus of the material that modern psychoa.n.a.lysis is able to offer. We had to say quite a good deal concerning the libido and its development, and something as well concerning the development of the ego. The introduction had already prepared you for the presuppositions of our technique, for the large aspects of the unconscious and of suppression (resistance). In a subsequent lecture you will learn from what points psychoa.n.a.lysis proceeds organically. For the present I have not sought to hide from you the fact that all our results are based on the study of a single group of nervous affections, the so-called transference neuroses. Though you have gained no positive knowledge and have not retained every detail, still I hope that you have a fair picture of the methods, the problems and the results of psychoa.n.a.lysis.

I have a.s.sumed that it was your wish for me to begin my presentation of neuroses with a description of nervous behavior, the nature of neurotic suffering, and the way in which the nervous meet the conditions of their illness and adapt themselves to these. Such subject matter is certainly interesting and well worth knowing. It is moreover not very hard to handle, yet it is not wise to begin with its consideration. There is danger of not discovering the unconscious, of overlooking the great significance of the libido, of judging all conditions as they appear to the ego of the nervous person. It is obvious that this ego is neither a reliable nor an impartial authority. For this very ego is the force that denies and suppresses the unconscious; when the unconscious is concerned, how then could we expect justice to be done? The rejected claims of s.e.xuality stand first in the line of these suppressions; it is natural that from the standpoint of the ego we can never learn their extent and significance. As soon as we attain to the point of view of suppression, we are sufficiently warned not to make one of the contending factions, above all not to make the victor judge of the struggle. We are prepared to find that the testimony of the ego may lead us astray. If one is to believe the evidence of the ego, it would appear to have been active all along, all its symptoms would have been actively willed and formed. Yet we know that it has pa.s.sively allowed a great deal to occur, a fact which it subsequently seeks to conceal and to palliate. To be sure, it does not always attempt this; in the case of the symptoms of compulsion neurosis it must admit that it is being opposed by something alien, which it can resist only with difficulty.

Whoever does not heed these warnings not to mistake the prevarications of the ego for truth, has clear sailing; he avoids all the resistances which oppose the psychoa.n.a.lytic emphasis upon the unconscious, on s.e.xuality, and on the pa.s.siveness of the ego. He will a.s.sert with Alfred Adler that the "nervous character" is the cause instead of the result of the neurosis, but he will not be able to explain a single detail of symptom formation or to interpret a single dream.

You will ask: Is it not possible to do justice to the part the ego plays in nervousness and in symptom formation without crudely neglecting the factors revealed by psychoa.n.a.lysis? I answer you: Surely it must be possible and at some time or other it will take place; but the methods by which we organize the work of psychoa.n.a.lysis do not favor our beginning with just this task. We can foresee the time when this task will claim the attention of psychoa.n.a.lysis. There are forms of neuroses, the so-called narcistic neuroses, in which the ego is far more deeply involved than in anything we have studied heretofore. The a.n.a.lytic investigation of these conditions will enable us to judge reliably and impartially the part that the ego plays in neurotic illness.

One of the relations which the ego bears to its neurosis is so obvious that it must be considered at the very outset. In no case does it seem to be absent, and it is most clearly recognizable in the traumatic neuroses, conditions which we do not as yet clearly understand. You must know that in the causation and mechanisms of all possible forms of neurosis, the same factors are active again and again; it is only the emphasis that is s.h.i.+fted from one to the other of these factors in symptom formation. The members of a company of actors each have certain parts to play--hero, villain, confidant, etc.--yet each will select a different drama for his benefit. Thus the phantasies which undergo conversion into symptoms are especially easy to detect in hysteria; compulsion neuroses are essentially dominated by the reactionary formations, or counter-seizures of the ego; what we designate as _secondary elaboration_ in dreams dominates paranoia in the form of delusions, etc.

In traumatic neuroses, particularly if they are caused by the horrors of war, we are especially impressed by a selfish ego-impulse which seeks protection and personal advantage. This in itself is not a sufficient cause for illness, but it can favor its beginning and also feed its needs once it has been established. This motive serves to protect the ego from the dangers whose imminence precipitated the disease, and does not permit convalescence until the recurrence of these dangers seems impossible, or until compensation has been obtained for the danger that has been undergone.

But the ego betrays similar interest in the origin and maintenance of all other neuroses. We have already said that the ego suffers the symptom to exist, because one of its phases gratifies the egoistic tendency toward suppression. Besides, the ending of the conflict by means of symptom development is the path of least resistance, and a most convenient solution for the principle of pleasure. Through symptom formation the ego is undoubtedly spared a severe and unpleasant inner task. There are cases where even the physician must admit that the resolution of the conflict into neurosis is the most harmless outcome and one most easily tolerated by society. Do not be surprised, then, to learn that occasionally even the physician takes the part of the illness he is battling against. He does not have to restrict himself to the role of the fanatic warrior for health in all situations of life. He knows that the world contains not only neurotic misery, but also real, incurable suffering. He knows that necessity may even require a human being to sacrifice his health, and he learns that by this sacrifice on the part of one individual untold wretchedness may be spared for many others. So if we say that the neurotic escapes the conflict _by taking refuge in illness_, we must admit that in some cases this escape is justifiable, and the physician who has diagnosed the state of affairs will retire silently and tactfully.

But let us not consider these special cases in our further discussion.

In average cases the ego, by having recourse to neurosis, obtains a certain inner _advantage from the disease_. Under certain conditions of life, there may also be derived a tangible external advantage, more or less valuable in reality. Let me direct your attention to the most frequent occurrences of this sort. Women who are brutally treated and mercilessly exploited by their husbands almost always adopt the evasion of the neurosis, provided that their predisposition permits this. This usually follows when the woman is too cowardly or too virtuous to seek secret solace in the arms of another, or when she dare not separate from her husband in the face of all opposition, when she has no prospect of maintaining herself or of finding a better husband and especially when her s.e.xual emotions still bind her to this brutal man. Her illness becomes a weapon in her struggle with him, one that she can use for self-protection and misuse for purposes of vengeance. She probably dare not complain of her marriage, but she can complain of her illness. The doctor becomes her a.s.sistant. She forces her inconsiderate husband to spare her, to attend to her wishes, to permit her absence from the house and thus free her from the oppressions of her married life. Wherever such external or accidental gain through illness is considerable and can find no subst.i.tute in fact, you can prophesy that the possibility of influencing neurosis through therapy is very slight.

You will tell me that what I have said about the advantage gained from the disease speaks entirely for the hypothesis I have rejected, namely, that the ego itself wills and creates the neurosis. Just a moment! It probably does not mean more than that the ego pa.s.sively suffers the neurosis to exist, which it is unable to prevent anyway. It makes the most of the neurosis, if anything can be made of it at all. This is only one side of the question, the advantageous side. The ego is willing to endure the advantages of the neurosis, but there are not only advantages. As a rule it soon appears that the ego has made a poor deal in accepting the neurosis. It has paid too high a price for the mitigation of the conflict; and the sensations of suffering which the symptoms bring with them are perhaps every bit as bad as the agonies of conflict, usually they cause even greater discomfort. The ego wants to rid itself of the pain of the symptoms without relinquis.h.i.+ng the gain of illness, and that is impossible. Thus the ego is discovered as by no means so active as it had thought itself to be, and this we want to keep in mind.

If you were to come into contact with neurotics as a physician, you would soon cease to expect that those who complain most woefully of their illness are the ones who will oppose its therapy with the least resistance or who will welcome any help. On the contrary, you would readily understand that everything contributing to the advantage derived from the disease will strengthen the resistance to the suppression and heighten the difficulty of the therapy. We must also add another and later advantage to the gain of illness which is born with the symptom.

If a psychic organization, such as this illness, has persisted for a long time, it finally behaves as an independent unit, it expresses something like self-preservation, attains a kind of _modus vivendi_ between itself and other parts of psychic life, even those that are fundamentally hostile to it. And occasions will probably arise where it can prove again to be both useful and valuable, by which it will attain a _secondary function_, which gives strength to its existence. Instead of an ill.u.s.tration from pathology take a striking example from everyday life. An efficient workman who earns his living is crippled for his occupation by some disaster; his work is over for him. After a while, however, he receives a small accident insurance, and learns to exploit his injury by begging. His new existence, though most undesirable, is based upon the very thing that robbed him of his former maintenance. If you could cure his defect, he would be without a means of subsistence, he would have no livelihood. The question would arise: Is he capable of resuming his former work? That which corresponds to such secondary exploitation of illness in neurosis we may add to the primary benefit derived therefrom and may term it a _secondary_ advantage of disease.

In general I should like to warn you not to underestimate the practical significance of the advantage from illness and yet not to be too much impressed by it theoretically. Aside from the previously recognized exceptions, I am always reminded of Oberlander's pictures on "the intelligence of animals" which appeared in the _Fliegende Blatter_. An Arab is riding a camel on a narrow path cut through a steep mountain side. At a turn of the trail he is suddenly confronted by a lion who makes ready to spring. He sees no way out, on one side the precipice, on the other the abyss; retreat and flight--both are impossible; he gives himself up as lost. Not so the camel. He leaps into the abyss with his rider--and the lion is left in the lurch. The help of neurosis is as a rule no kinder to the rider. It may be due to the fact that the settlement of the conflict through symptom development is nevertheless an automatic process, not able to meet the demands of life, and for whose sake man renounces the use of his best and loftiest powers. If it were possible to choose, it were indeed best to perish in an honorable struggle with destiny.

I still owe you further explanation as to why, in my presentation of the theory of neurosis, I did not proceed from ordinary nervousness as a starting point. You may a.s.sume that, had I done this, the proof of the s.e.xual origin of neurosis would have been more difficult for me, and so I refrained. There you are mistaken. In transference neurosis we must work at interpretations of the symptoms to arrive at this conclusion. In the ordinary forms of the so-called true neuroses, however, the etiological significance of s.e.xual life is a crude fact open to observation. I discovered it twenty years ago when I asked myself one day why we regularly barred out questions concerning s.e.xual activity in examining nervous patients. At that time I sacrificed my popularity among my patients to my investigations, yet after a brief effort I could state that no neurosis, no true neurosis at least, is present with a normal s.e.xual life. Of course, this statement pa.s.ses too lightly over the individual differences, it is unclear through the vagueness with which it uses the term "normal," but even to-day it retains its value for purposes of rough orientation. At that time I reached the point of drawing comparisons between certain forms of nervousness and s.e.xual abnormalities, and I do not doubt that I could repeat the same observations now, if similar material were at my disposal. I frequently noticed that a man who contented himself with incomplete s.e.xual gratification, with manual ononism, for instance, would suffer from a true neurosis, and that this neurosis would promptly give way to another form, if another s.e.xual regime no less harmful were subst.i.tuted. From the change in the condition of the patient I was able to guess the change in the mode of his s.e.xual life. At that time I learned to hold obstinately to my conjectures until I had overcome the patient's prevarications and had forced him to confirm my suppositions. To be sure, then he preferred to consult other physicians who did not inquire so insistently into his s.e.xual life.

At that time it did not escape my notice that the origin of the disease could not always be traced back to s.e.xual life; s.e.xual abnormality would cause the illness in one person, while another would fall ill because he had lost his fortune or had suffered an exhausting organic disease. We gained insight into this variation by means of the interrelations between the ego and the libido, and the more profound our insight became, the more satisfactory were the results. A person begins to suffer from neurosis when his ego has lost the capacity of accommodating the libido. The stronger the ego, the easier the solution of the problem; a weakening of the ego from any cause whatsoever has the same effect as a superlative increase of the claims of the libido. There are other and more intimate relations between the ego and the libido which I shall not discuss, as we are not concerned with them here. To us it is of enlightening significance that in every case, regardless of the way in which the illness was caused, the symptoms of neurosis were opposed by the libido and thus gave evidence for its abnormal use.

Now, however, I want to draw your attention to the difference between the symptoms of the true neuroses and the psychoneuroses, the first group of which, the transference neurosis, has occupied us considerably.

In both cases the symptoms proceed from the libido. They are accordingly abnormal uses of it, subst.i.tutes for gratification. But the symptoms of the true neurosis--such as pressure in the head, sensations of pain, irritability of an organ, weakening or inhibition of a function--these have no meaning, no psychic significance. They are manifested not only in the body, as for instance hysteric symptoms, but are in themselves physical processes whose creation is devoid of all the complicated psychic mechanism with which we have become acquainted. They really embody the character that has so long been attributed to the psychoneurotic symptom. But how can they then correspond to uses of the libido, which we have come to know as a psychological force? That is quite simple. Let me recall one of the very first objections that was made to psychoa.n.a.lysis. It was stated that psychoa.n.a.lysis was concerned with a purely psychological theory of neurotic manifestations; that this was a hopeless outlook since psychological theories could never explain illness. The objectors chose to forget that the s.e.xual function is neither purely psychic nor merely somatic. It influences physical as well as psychic life. In the symptoms of the psychoneuroses we have recognized the expression of a disturbance in psychic processes. And so we shall not be surprised to discover that the true neuroses are the direct somatic consequences of s.e.xual disturbances.

The medical clinic gives us a valuable suggestion (observed by many research workers) for the comprehension of the true neuroses. In all the details of their symptomatology, and as well in their characteristic power to influence all organic systems and all functions, the true neuroses reveal a marked similarity to the conditions of those diseases which originate through the chronic influence of foreign poisons and as well through their acute diminution; with conditions prevalent in intoxication and abstinence. The two groups of conditions are brought still closer together by the relation of intermediate conditions, which, following M. Basedowi, we have learned to attribute to the influence of toxic substances, but of toxins, however, which are not introduced into the body from without, but arise in its own metabolism. These a.n.a.logies, I think, lead us directly to the consideration of these neuroses as disturbances in s.e.xual metabolism. It may be that more s.e.xual toxins are produced than the individual can dispose of, or that inner, even psychic conditions, stand in the way of the proper elaboration of these substances. The language of the people has always favored such a.s.sumptions as to the nature of s.e.xual desires. It calls love an "intoxication"; it will have love-madness aroused through potions, and thus sees the motive force removed, as it were, to the outer world. For the rest, the phrase "s.e.xual metabolism" or "chemism of s.e.xuality" is a chapter-head without content. We know nothing about it and cannot even decide whether we are to a.s.sume two s.e.xual substances, the male and the female, or, if there is only _one_ s.e.xual toxin, which to consider the carrier of all the stimulating power of the libido. The structure of psychoa.n.a.lysis that we have erected is really only a superstructure which at some future time must be placed upon its organic foundation; but what this is we do not know as yet.

Psychoa.n.a.lysis is characterized as a science, not by reason of the subject matter it handles but by the technique it employs. This can be employed in dealing with the history of civilization, the science of religion or mythology, as well as with the theory of neurosis, without altering its character. The revealing of the unconscious in psychic life is all it aims to accomplish. The problems of the true neuroses, whose symptoms probably originate in direct toxic damage, yield no point of attack to psychoa.n.a.lysis. Psychoa.n.a.lysis can do little for their elucidation, and must leave the task to biological-medical research.

Perhaps you understand now why I did not choose to organize my material differently. If I had given to you an _Introduction to the Theory of the Neuroses_ as you wished, it would unquestionably have been correct to proceed from the simple forms of the true neuroses to those complex illnesses caused by a disturbance of the libido. In discussing the true neuroses I would have had to bring together the facts we have gleaned from various quarters and present what we think we know of them. Only later, under the psychoneuroses, would psychoa.n.a.lysis have been discussed as the most important technical aid for insight into these conditions. I had, however, intended and announced _A General Introduction to Psychoa.n.a.lysis_, and it seemed to me more important to give you an idea of psychoa.n.a.lysis than to present certain positive facts about neuroses; and so I could not place the true neuroses into the foreground, for they prove sterile for the purposes of psychoa.n.a.lysis. I believe that I have made the wiser choice for you, since psychoa.n.a.lysis deserves the interest of every educated person because of its profound hypotheses and far-reaching connections. The theory of neurosis, on the other hand, is a chapter of medicine like any other.

You are, however, justified in expecting some interest on our part in the true neuroses. Because of their intimate connection with psychoneuroses we find this decidedly necessary. I shall tell you then that we distinguish three pure forms of true neuroses: _neurasthenia_, _anxiety neurosis_ and _hypochondria_. Even this cla.s.sification has not remained uncontradicted. The terms are all widely used, but their connotation is vague and uncertain. Besides, there are in this world of confusion physicians who object to any distinctions between manifestations, any emphasis of clinical detail, who do not even recognize the separation of true neuroses and psychoneuroses. I think they have gone too far and have not chosen the road which leads to progress. The types of neuroses we have mentioned occur occasionally in pure form; more often they are blended with one another or with a psychoneurotic condition. This need not discourage us to the extent of abandoning the task of distinction. Think of the difference between the study of minerals and that of ores in mineralogy. Minerals are described as individuals; frequently of course they occur as crystals, separated sharply from their surroundings. Ores consist of an aggregate of minerals which have coalesced not accidentally, but as a result of the conditions of their origin. We understand too little of the process of development of neuroses, to create anything similar to the study of ores. But we are surely working in the right direction when we isolate the known clinical factors, comparable to the separate minerals, from the great ma.s.s.

A noteworthy connection between the symptoms of the true neuroses and the psychoneuroses adds a valuable contribution to our knowledge of symptom formation in the latter. The symptom in the true neuroses is frequently the nucleus and incipient stage of development of the psychoneurotic symptom. Such a connection is most easily observed between neurasthenia and the transference neuroses, which are termed conversion hysteria, between anxiety neurosis and anxiety hysteria, but also between hypochondria and paraphrenia (dementia praec.o.x and paranoia), forms of neuroses of which we shall speak subsequently. Let us take as an ill.u.s.tration the hysteric headache or backache. a.n.a.lysis shows that through elaboration and displacement this pain has become the gratification subst.i.tute for a whole series of libidinous phantasies or reminiscences. But once upon a time this pain was real, a direct s.e.xual toxic symptom, the physical expression of libidinous excitation. We do not wish to a.s.sert, by any means, that all hysteric symptoms can be traced to such a nucleus, but it is true that this is frequently the case, and that all influences upon the body through libidinous excitation, whether normal or pathological, are especially significant for the symptom development in hysteria. They play the part of the grain of sand which the mollusc has enveloped in mother-of-pearl. In the same way pa.s.sing signs of s.e.xual excitation, which accompany the s.e.xual act, are used by psychoneurosis as the most convenient and appropriate material for symptom formation.

A similar procedure is of diagnostic and therapeutic interest especially. Persons who are disposed to be neurotic, without suffering from a flouris.h.i.+ng neurosis, frequently set in motion the work of symptom development as the result of an abnormal physical change--often an inflammation or an injury. This development rapidly makes the symptom given by reality the representative of the unconscious phantasies that had been lurking for an opportunity to seize upon a means of expression.

In such a case the physician will try different ways of therapy. Either he will try to do away with the organic basis without bothering about its noisy neurotic elaboration, or he will struggle with the neurosis brought out by the occasion, and ignore its organic cause. The result will justify now one, now the other method of procedure; no general laws can be laid down for such mixed cases.

TWENTY-FIFTH LECTURE

GENERAL THEORY OF THE NEUROSES

_Fear and Anxiety_

Probably you will term what I told you about ordinary nervousness in my last lecture most fragmentary and unsatisfactory information. I know this, and I think you were probably most surprised that I did not mention fear, which most nervous people complain of and describe as their greatest source of suffering. It can attain a terrible intensity which may result in the wildest enterprises. But I do not wish to fall short of your expectations in this matter. I intend, on the contrary, to treat the problem of the fear of nervous people with great accuracy and to discuss it with you at some length.

Fear itself needs no introduction; everyone has at some time or other known this sensation or, more precisely, this effect. It seems to me that we never seriously inquired why the nervous suffered so much more and so much more intensely under this condition. Perhaps it was thought a matter of course; it is usual to confuse the words "nervous" and "anxious" as though they meant the same thing. That is unjustifiable; there are anxious people who are not nervous, and nervous people who suffer from many symptoms, but not from the tendency to anxiety.

However that may be, it is certain that the problem of fear is the meeting point of many important questions, an enigma whose complete solution would cast a flood of light upon psychic life. I do not claim that I can furnish you with this complete solution, but you will certainly expect psychoa.n.a.lysis to deal with this theme in a manner different from that of the schools of medicine. These schools seem to be interested primarily in the anatomical cause of the condition of fear.

They say the medulla oblongata is irritated, and the patient learns that he is suffering from neurosis of the nervus vague. The medulla oblongata is a very serious and beautiful object. I remember exactly how much time and trouble I devoted to the study of it, years ago. But today I must say that I know of nothing more indifferent to me for the psychological comprehension of fear, than knowledge of the nerve pa.s.sage through which these sensations must pa.s.s.

One can talk about fear for a long time without even touching upon nervousness. You will understand me without more ado, when I term this fear _real_ fear in contrast to _neurotic_ fear. Real fear seems quite rational and comprehensible to us. We may testify that it is a reaction to the perception of external danger, viz., harm that is expected and foreseen. It is related to the flight reflex and may be regarded as an expression of the instinct of self-preservation. And so the occasions, viz., the objects and situations which arouse fear, will depend largely on our knowledge of and our feeling of power over the outer world. We deem it quite a matter of course that the savage fears a cannon or an eclipse of the sun, while the white man, who can handle the instrument and prophesy the phenomenon, does not fear these things. At other times superior knowledge promulgates fear, because it recognizes the danger earlier. The savage, for instance, will recoil before a footprint in the woods, meaningless to the uninstructed, which reveals to him the proximity of an animal of prey; the experienced sailor will notice a little cloud, which tells him of a coming hurricane, with terror, while to the pa.s.senger it seems insignificant.

After further consideration, we must say to ourselves that the verdict on real fear, whether it be rational or purposeful, must be thoroughly revised. For the only purposeful behavior in the face of imminent danger would be the cool appraisal of one's own strength in comparison with the extent of the threatening danger, and then decide which would presage a happier ending: flight, defense, or possibly even attack. Under such a proceeding fear has absolutely no place; everything that happens would be consummated just as well and better without the development of fear.

You know that if fear is too strong, it proves absolutely useless and paralyzes every action, even flight. Generally the reaction against danger consists in a mixture of fear and resistance. The frightened animal is afraid and flees. But the purposeful factor in such a case is not fear but flight.

We are therefore tempted to claim that the development of fear is never purposeful. Perhaps closer examination will give us greater insight into the fear situation. The first factor is the expectancy of danger which expresses itself in heightened sensory attention and in motor tension.

This expectancy is undoubtedly advantageous; its absence may be responsible for serious consequences. On the one hand, it gives rise to motor activity, primarily to flight, and on a higher plane to active defense; on the other hand, it gives rise to something which we consider the condition of fear. In so far as the development is still incipient, and is restricted to a mere signal, the more undisturbed the conversion of the readiness to be afraid into action the more purposeful the entire proceeding. The readiness to be afraid seems to be the purposeful aspect; evolution of fear itself, the element that defeats its own object.

I avoid entering upon a discussion as to whether our language means the same or distinct things by the words anxiety, fear or fright. I think that anxiety is used in connection with a condition regardless of any objective, while fear is essentially directed toward an object. Fright, on the other hand, seems really to possess a special meaning, which emphasizes the effects of a danger which is precipitated without any expectance or readiness of fear. Thus we might say that anxiety protects man from fright.

You have probably noticed the ambiguity and vagueness in the use of the word "anxiety." Generally one means a subjective condition, caused by the perception that an "evolution of fear" has been consummated. Such a condition may be called an emotion. What is an emotion in the dynamic sense? Certainly something very complex. An emotion, in the first place, includes indefinite motor innervations or discharges; secondly, definite sensations which moreover are of two kinds, the perception of motor activities that have already taken place, and the direct sensations of pleasure and pain, which give the effect of what we call its feeling tone. But I do not think that the true nature of the emotion has been fathomed by these enumerations. We have gained deeper insight into some emotions and realize that the thread which binds together such a complex as we have described is the repet.i.tion of a certain significant experience. This experience might be an early impression of a very general sort, which belongs to the antecedent history of the species rather than to that of the individual. To be more clear: the emotional condition has a structure similar to that of an hysterical attack; it is the upshot of a reminiscence. The hysteric attack, then, is comparable to a newly formed individual emotion, the normal emotion to an hysteria which has become a universal heritage.

Do not a.s.sume that what I have said here about emotions is derived from normal psychology. On the contrary, these are conceptions that have grown up with and are at home only in psychoa.n.a.lysis. What psychology has to say about emotions--the James-Lange theory, for instance--is absolutely incomprehensible for us psychoa.n.a.lysts, and cannot be discussed. Of course, we do not consider our knowledge about emotions very certain; it is a preliminary attempt to become oriented in this obscure region. To continue: We believe we know the early impression which the emotion of fear repeats. We think it is birth itself which combines that complex of painful feelings, of a discharge of impulses, of physical sensations, which has become the prototype for the effect of danger to life, and is ever after repeated within us as a condition of fear. The tremendous heightening of irritability through the interruption of the circulation (internal respiration) was at the time the cause of the experience of fear; the first fear was therefore toxic.

The name anxiety--angustial--narrowness, emphasizes the characteristic tightening of the breath, which was at the time a consequence of an actual situation and is henceforth repeated almost regularly in the emotion. We shall also recognize how significant it is that this first condition of fear appeared during the separation from the mother. Of course, we are convinced that the tendency to repet.i.tion of the first condition of fear has been so deeply ingrained in the organism through countless generations, that not a single individual can escape the emotion of fear; not even the mythical Macduff who was "cut out of his mother's womb," and therefore did not experience birth itself. We do not know the prototype of the condition of fear in the case of other mammals, and so we do not know the complex of emotions that in them is the equivalent of our fear.