Traumatic Fixation—The Unconscious

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Traumatic Fixation—The Unconscious

I said last time that we would not continue our work from the standpoint of our doubts, but on the basis of our results. We have not even touched upon two of the most interesting conclusions, derived equally from the same two sample analyses.

In the first place, both patients give us the impression of being fixated upon some very definite part of their past; they are unable to free themselves therefrom, and have therefore come to be completely estranged both from the present and the future. They are now isolated in their ailment, just as in earlier days people withdrew into monasteries there to carry along the burden of their unhappy fates. In the case of the first patient, it is her marriage with her husband, really abandoned, that has determined her lot. By means of her symptoms she continues to deal with her husband; we have learned to understand those voices which plead his case, which excuse him, exalt him, lament his loss. Although she is young and might be coveted by other men, she has seized upon all manner of real and imaginary (magic) precautions to safeguard her virtue for him. She will not appear before strangers, she neglects her personal appearance; furthermore, she cannot bring herself to get up readily from any chair on which she has been seated. She refuses to give her signature, and finally, since she is motivated by her desire not to let anyone have anything of hers, she is unable to give presents.

In the case of the second patient, the young girl, it is an erotic attachment for her father that had established itself in the years prior to puberty, which plays the same role in her life. She also has arrived at the conclusion that she may not marry so long as she is sick. We may suspect she became ill in order that she need not marry, and that she might stay with her father.

It is impossible to evade the question of how, in what manner, and driven by what motives, an individual may come by such a remarkable and unprofitable attitude toward life. Granted of course that this bearing is a general characteristic of neurosis, and not a special peculiarity of these two cases, it is nevertheless a general trait in every neurosis of very great importance in practice. Breuer's first hysterical patient was fixated in the same manner upon the time when she nursed her very sick father. In spite of her recuperation she has, in certain respects, since that time, been done with life; although she remained healthy and able, she did not enter on the normal life of women. In every one of our patients we may see, by the use of analysis, that in his disease-symptoms and their results he has gone back again into a definite period of his past. In the majority of cases he even chooses a very early phase of his life, sometime a childhood phase, indeed, laughable as it may appear, a phase of his very suckling existence.

The closest analogies to these conditions of our neurotics are furnished by the types of sickness which the war has just now made so frequent—the so-called traumatic neuroses. Even before the war there were such cases after railroad collisions and other frightful occurrences which endangered life. The traumatic neuroses are, fundamentally, not the same as the spontaneous neuroses which we have been analysing and treating; moreover, we have not yet succeeded in bringing them within our hypotheses, and I hope to be able to make clear to you wherein this limitation lies. Yet on one point we may emphasize the existence of a complete agreement between the two forms. The traumatic neuroses show clear indications that they are grounded in a fixation upon the moment of the traumatic disaster. In their dreams these patients regularly live over the traumatic situation; where there are attacks of an hysterical type, which permit of an analysis, we learn that the attack approximates a complete transposition into this situation. It is as if these patients had not yet gotten through with the traumatic situation, as if it were actually before them as a task which was not yet mastered. We take this view of the matter in all seriousness; it shows the way to an economic view of psychic occurrences. For the expression "traumatic" has no other than an economic meaning, and the disturbance permanently attacks the management of available energy. The traumatic experience is one which, in a very short space of time, is able to increase the strength of a given stimulus so enormously that its assimilation, or rather its elaboration, can no longer be effected by normal means.

This analogy tempts us to classify as traumatic those experiences as well upon which our neurotics appear to be fixated. Thus the possibility is held out to us of having found a simple determining factor for the neurosis. It would then be comparable to a traumatic disease, and would arise from the inability to meet an overpowering emotional experience. As a matter of fact this reads like the first formula, by which Breuer and I, in 1893-1895, accounted theoretically for our new observations. A case such as that of our first patient, the young woman separated from her husband, is very well explained by this conception. She was not able to get over the unfeasibility of her marriage, and has not been able to extricate herself from this trauma. But our very next, that of the girl attached to her father, shows us that the formula is not sufficiently comprehensive. On the one hand, such baby love of a little girl for her father is so usual, and so often outlived that the designation "traumatic" would carry no significance; on the other hand, the history of the patient teaches us that this first erotic fixation apparently passed by harmlessly at the time, and did not again appear until many years later in the symptoms of the compulsion neurosis. We see complications before us, the existence of a greater wealth of determining factors in the disease, but we also suspect that the traumatic viewpoint will not have to be given up as wrong; rather it will have to subordinate itself when it is fitted into a different context.

Here again we must leave the road we have been traveling. For the time being, it leads us no further and we have many other things to find out before we can go on again. But before we leave this subject let us note that the fixation on some particular phase of the past has bearings which extend far beyond the neurosis. Every neurosis contains such a fixation, but every fixation does not lead to a neurosis, nor fall into the same class with neuroses, nor even set the conditions for the development of a neurosis. Mourning is a type of emotional fixation on a theory of the past, which also brings with it the most complete alienation from the present and the future. But mourning is sharply distinguished from neuroses that may be designated as pathological forms of mourning.

It also happens that men are brought to complete deadlock by a traumatic experience that has so completely shaken the foundations on which they have built their lives that they give up all interest in the present and future, and become completely absorbed in their retrospections; but these unhappy persons are not necessarily neurotic. We must not overestimate this one feature as a diagnostic for a neurosis, no matter how invariable and potent it may be.

Now let us turn to the second conclusion of our analysis, which however we will hardly need to limit subsequently. We have spoken of the senseless compulsive activities of our first patient, and what intimate memories she disclosed as belonging to them; later we also investigated the connection between experience and symptom and thus discovered the purpose hidden behind the compulsive activity. But we have entirely omitted one factor that deserves our whole attention. As long as the patient kept repeating the compulsive activity she did not know that it was in any way related with the experience in question. The connection between the two was hidden from her, she truthfully answered that she did not know what compelled her to do this. Once, suddenly, under the influence of the cure, she hit upon the connection and was able to tell it to us. But still she did not know of the end in the service of which she performed the compulsive activities, the purpose to correct a painful part of the past and to place the husband, still loved by her, upon a higher level. It took quite a long time and a great deal of trouble for her to grasp and admit to me that such a motive alone could have been the motive force of the compulsive activity.

The relation between the scene after the unhappy bridal night and the tender motive of the patient yield what we have called the meaning of the compulsive activity. But both the "whence" and the "why" remained hidden from her as long as she continued to carry out the compulsive act. Psychological processes had been going on within her for which the compulsive act found an expression. She could, in a normal frame of mind, observe their effect, but none of the psychological antecedents of her action had come to the knowledge of her consciousness. She had acted in just the same manner as a hypnotized person to whom Bernheim had given the injunction that five minutes after his awakening in the ward he was to open an umbrella, and he had carried out this order on awakening, but could give no motive for his so doing. We have exactly such facts in mind when we speak of the existence of unconscious psychological processes. Let anyone in the world account for these facts in a more correct scientific manner, and we will gladly withdraw completely our assumption of unconscious psychological processes. Until then, however, we shall continue to use this assumption, and when anyone wants to bring forward the objection that the unconscious can have no reality for science and is a mere makeshift, (une façon de parler), we must simply shrug our shoulders and reject his incomprehensible statement resignedly. A strange unreality which can call out such real and palpable effects as a compulsion symptom!

In our second patient we meet with fundamentally the same thing. She had created a decree which she must follow: the pillow must not touch the head of the bed; yet she does not know how it originated, what its meaning is, nor to what motive it owes the source of its power. It is immaterial whether she looks upon it with indifference or struggles against it, storms against it, determines to overcome it. She must nevertheless follow it and carry out its ordinance, though she asks herself, in vain, why. One must admit that these symptoms of compulsion neurosis offer the clearest evidence for a special sphere of psychological activity, cut off from the rest. What else could be back of these images and impulses, which appear from one knows not where, which have such great resistance to all the influences of an otherwise normal psychic life; which give the patient himself the impression that here are super-powerful guests from another world, immortals mixing in the affairs of mortals. Neurotic symptoms lead unmistakably to a conviction of the existence of an unconscious psychology, and for that very reason clinical psychiatry, which recognizes only a conscious psychology, has no explanation other than that they are present as indications of a particular kind of degeneration. To be sure, the compulsive images and impulses are not themselves unconscious—no more so than the carrying out of the compulsive-acts escapes conscious observation. They would not have been symptoms had they not penetrated through into consciousness. But their psychological antecedents as disclosed by the analysis, the associations into which we place them by our interpretations, are unconscious, at least until we have made them known to the patient during the course of the analysis.

Consider now, in addition, that the facts established in our two cases are confirmed in all the symptoms of all neurotic diseases, that always and everywhere the meaning of the symptoms is unknown to the sufferer, that analysis shows without fail that these symptoms are derivatives of unconscious experiences which can, under various favorable conditions, become conscious. You will understand then that in psychoanalysis we cannot do without this unconscious psyche, and are accustomed to deal with it as with something tangible. Perhaps you will also be able to understand how those who know the unconscious only as an idea, who have never analyzed, never interpreted dreams, or never translated neurotic symptoms into meaning and purpose, are most ill-suited to pass an opinion on this subject. Let us express our point of view once more. Our ability to give meaning to neurotic symptoms by means of analytic interpretation is an irrefutable indication of the existence of unconscious psychological processes—or, if you prefer, an irrefutable proof of the necessity for their assumption.

But that is not all. Thanks to a second discovery of Breuer's, for which he alone deserves credit and which appears to me to be even more far-reaching, we are able to learn still more concerning the relationship between the unconscious and the neurotic symptom. Not alone is the meaning of the symptoms invariably hidden in the unconscious; but the very existence of the symptom is conditioned by its relation to this unconscious. You will soon understand me. With Breuer I maintain the following: Every time we hit upon a symptom we may conclude that the patient cherishes definite unconscious experiences which withhold the meaning of the symptoms. Vice versa, in order that the symptoms may come into being, it is also essential that this meaning be unconscious. Symptoms are not built up out of conscious experiences; as soon as the unconscious processes in question become conscious, the symptom disappears. You will at once recognize here the approach to our therapy, a way to make symptoms disappear. It was by these means that Breuer actually achieved the recovery of his patient, that is, freed her of her symptoms; he found a technique for bringing into her consciousness the unconscious experiences that carried the meaning of her symptoms, and the symptoms disappeared.

This discovery of Breuer's was not the result of a speculation, but of a felicitous observation made possible by the coöperation of the patient. You should therefore not trouble yourself to find things you already know to which you can compare these occurrences, rather you should recognize herein a new fundamental fact which in itself is capable of much wider application. Toward this further end permit me to go over this ground again in a different way.

The symptom develops as a substitution for something else that has remained suppressed. Certain psychological experiences should normally have become so far elaborated that consciousness would have attained knowledge of them. This did not take place, however, but out of these interrupted and disturbed processes, imprisoned in the unconscious, the symptom arose. That is to say, something in the nature of an interchange had been effected; as often as therapeutic measures are successful in again reversing this transposition, psychoanalytic therapy solves the problem of the neurotic symptom.

Accordingly, Breuer's discovery still remains the foundation of psychoanalytic therapy. The assertion that the symptoms disappear when one has made their unconscious connections conscious, has been borne out by all subsequent research, although the most extraordinary and unexpected complications have been met with in its practical execution. Our therapy does its work by means of changing the unconscious into the conscious, and is effective only in so far as it has the opportunity of bringing about this transformation.

Now we shall make a hasty digression so that you do not by any chance imagine that this therapeutic work is too easy. From all we have learned so far, the neurosis would appear as the result of a sort of ignorance, the incognizance of psychological processes that we should know of. We would thus very closely approximate the well-known Socratic teachings, according to which evil itself is the result of ignorance. Now the experienced physician will, as a rule, discover fairly readily what psychic impulses in his several patients have remained unconscious. Accordingly it would seem easy for him to cure the patient by imparting this knowledge to him and freeing him of his ignorance. At least the part played by the unconscious meaning of the symptoms could easily be discovered in this manner, and it would only be in dealing with the relationship of the symptoms to the experiences of the patient that the physician would be handicapped. In the face of these experiences, of course, he is the ignorant one of the two, for he did not go through these experiences, and must wait until the patient remembers them and tells them to him. But in many cases this difficulty could be readily overcome. One can question the relatives of the patient concerning these experiences, and they will often be in a position to point out those that carry any traumatic significance; they may even be able to inform the analyst of experiences of which the patient knows nothing because they occurred in the very early years of his life. By a combination of such means it would seem that the pathogenic ignorance of the patient could be cleared up in a short time and without much trouble.

If only that were all! We have made discoveries for which we were at first unprepared. Knowing and knowing is not always the same thing; there are various kinds of knowing that are psychologically by no means comparable. "Il y a fagots et fagots,"[39] as Molière says. The knowledge of the physician is not the same as that of the patient and cannot bring about the same results. The physician can gain no results by transferring his knowledge to the patient in so many words. This is perhaps putting it incorrectly, for though the transference does not result in dissolving the symptoms, it does set the analysis in motion, and calls out an energetic denial, the first sign usually that this has taken place. The patient has learned something that he did not know up to that time, the meaning of his symptoms, and yet he knows it as little as before. So we discover there is more than one kind of ignorance. It will require a deepening of our psychological insight to make clear to us wherein the difference lies. But our assertion nevertheless remains true that the symptoms disappear with the knowledge of their meaning. For there is only one limiting condition; the knowledge must be founded on an inner change in the patient which can be attained only through psychic labors directed toward a definite end. We have here been confronted by problems which will soon lead us to the elaboration of a dynamics of symptom formation.

I must stop to ask you whether this is not all too vague and too complicated? Do I not confuse you by so often retracting my words and restricting them, spinning out trains of thought and then rejecting them? I should be sorry if this were the case. However, I strongly dislike simplification at the expense of truth, and am not averse to having you receive the full impression of how many-sided and complicated the subject is. I also think that there is no harm done if I say more on every point than you can at the moment make use of. I know that every hearer and reader arranges what is offered him in his own thoughts, shortens it, simplifies it and extracts what he wishes to retain. Within a given measure it is true that the more we begin with the more we have left. Let me hope that, despite all the by-play, you have clearly grasped the essential parts of my remarks, those about the meaning of symptoms, about the unconscious, and the relation between the two. You probably have also understood that our further efforts are to take two directions: first, the clinical problem—to discover how persons become sick, how they later on accomplish a neurotic adaptation toward life; secondly, a problem of psychic dynamics, the evolution of the neurotic symptoms themselves from the prerequisites of the neuroses. We will undoubtedly somewhere come on a point of contact for these two problems.

I do not wish to go any further to-day, but since our time is not yet up I intend to call your attention to another characteristic of our two analyses, namely, the memory gaps or amnesias, whose full appreciation will be possible later. You have heard that it is possible to express the object of psychoanalytic treatment in a formula: all pathogenic unconscious experience must be transposed into consciousness. You will perhaps be surprised to learn that this formula can be replaced by another: all the memory gaps of the patient must be filled out, his amnesias must be abolished. Practically this amounts to the same thing. Therefore an important role in the development of his symptoms must be accredited to the amnesias of the neurotic. The analysis of our first case, however, will hardly justify this valuation of the amnesia. The patient has not forgotten the scene from which the compulsion act derives—on the contrary, she remembers it vividly, nor is there any other forgotten factor which comes into play in the development of these symptoms. Less clear, but entirely analogous, is the situation in the case of our second patient, the girl with the compulsive ritual. She, too, has not really forgotten the behavior of her early years, the fact that she insisted that the door between her bedroom and that of her parents be kept open, and that she banished her mother out of her place in her parents' bed. She recalls all this very clearly, although hesitatingly and unwillingly. Only one factor stands out strikingly in our first case, that though the patient carries out her compulsive act innumerable times, she is not once reminded of its similarity with the experience after the bridal-night; nor was this memory even suggested when by direct questions she was asked to search for its motivation. The same is true of the girl, for in her case not only her ritual, but the situation which provoked it, is repeated identically night after night. In neither case is there any actual amnesia, no lapse of memory, but an association is broken off which should have called out a reproduction, a revival in the memory. Such a disturbance is enough to bring on a compulsion neurosis. Hysteria, however, shows a different picture, for it is usually characterized by most grandiose amnesias. As a rule, in the analysis of each hysterical symptom, one is led back to a whole chain of impressions which, upon their recovery, are expressly designated as forgotten up to the moment. On the one hand this chain extends back to the earliest years of life, so that the hysterical amnesias may be regarded as the direct continuation of the infantile amnesias, which hides the beginnings of our psychic life from those of us who are normal. On the other hand, we discover with surprise that the most recent experiences of the patient are blurred by these losses of memory—that especially the provocations which favored or brought on the illness are, if not entirely wiped out by the amnesia, at least partially obliterated. Without fail important details have disappeared from the general picture of such a recent memory, or are placed by false memories. Indeed it happens almost regularly that just before the completion of an analysis, certain memories of recent experiences suddenly come to light. They had been held back all this time, and had left noticeable gaps in the context.

We have pointed out that such a crippling of the ability to recall is characteristic of hysteria. In hysteria symptomatic conditions also arise (hysterical attacks) which need leave no trace in the memory. If these things do not occur in compulsion-neuroses, you are justified in concluding that these amnesias exhibit psychological characteristics of the hysterical change, and not a general trait of the neuroses. The significance of this difference will be more closely limited by the following observations. We have combined two things as the meaning of a symptom, its "whence," on the one hand, and its "whither" or "why," on the other. By these we mean to indicate the impressions and experiences whence the symptom arises, and the purpose the symptom serves. The "whence" of a symptom is traced back to impressions which have come from without, which have therefore necessarily been conscious at some time, but which may have sunk into the unconscious—that is, have been forgotten. The "why" of the symptom, its tendency, is in every case an endopsychic process, developed from within, which may or may not have become conscious at first, but could just as readily never have entered consciousness at all and have been unconscious from its inception. It is, after all, not so very significant that, as happens in the hysterias, amnesia has covered over the "whence" of the symptom, the experience upon which it is based; for it is the "why," the tendency of the symptom, which establishes its dependence on the unconscious, and indeed no less so in the compulsion neuroses than in hysteria. In both cases the "why" may have been unconscious from the very first.

By thus bringing into prominence the unconscious in psychic life, we have raised the most evil spirits of criticism against psychoanalysis. Do not be surprised at this, and do not believe that the opposition is directed only against the difficulties offered by the conception of the unconscious or against the relative inaccessibility of the experiences which represent it. I believe it comes from another source. Humanity, in the course of time, has had to endure from the hands of science two great outrages against its naive self-love. The first was when humanity discovered that our earth was not the center of the universe, but only a tiny speck in a world-system hardly conceivable in its magnitude. This is associated in our minds with the name "Copernicus," although Alexandrian science had taught much the same thing. The second occurred when biological research robbed man of his apparent superiority under special creation, and rebuked him with his descent from the animal kingdom, and his ineradicable animal nature. This re-valuation, under the influence of Charles Darwin, Wallace and their predecessors, was not accomplished without the most violent opposition of their contemporaries. But the third and most irritating insult is flung at the human mania of greatness by present-day psychological research, which wants to prove to the "I" that it is not even master in its own home, but is dependent upon the most scanty information concerning all that goes on unconsciously in its psychic life. We psychoanalysts were neither the first, nor the only ones to announce this admonition to look within ourselves. It appears that we are fated to represent it most insistently and to confirm it by means of empirical data which are of importance to every single person. This is the reason for the widespread revolt against our science, the omission of all considerations of academic urbanity, and emancipation of the opposition from all restraints of impartial logic. We were compelled to disturb the peace of the world, in addition, in another manner, of which you will soon come to know.

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