Sigmund Freud

“ He whose mind is occupied with the hundred different tasks of nursing which succeed each other continuously for weeks and months, becomes accustomed, on the one hand, to suppress all signs of his own emotions, and on the other, his attention is soon turned away from his own impressions because he has neither the time nor strength to do them justice. Thus the nurse accumulates for himself an overabundance of affective impressions which he barely perceived clearly enough; at any rate they were not weakened by ab-reaction, that is, he creates for himself the material for a retention hysteria. ”

“ In our discussion thus far, the idea of resistance has thrust itself to the foreground. I have shown how, in the therapeutic work, one is led to the conception that hysteria originates through the repression of an unbearable idea from a motive of defense, that the repressed idea remains as a weak (mildly intensive) reminiscence, and that the affect snatched from it is used for a somatic innervation, that is, conversion of the excitement. By virtue of its repression the idea becomes the cause of morbid symptoms, that is pathogenic. ”

“ The urging of the strange and inexperienced physician does not suffice for the “association resistance” in a grave hysteria. One must resort to more forceful means.
In the first place I make use of a small technical artifice. I inform the patient that I will in the next moment exert pressure on his forehead, I assure him that during this pressure he will see some reminiscence in the form of a picture, or some thought will occur to him, and I oblige him to communicate to me this picture or this thought, no matter what it may be. ”

“ We frequently deal not with a single hysterical symptom but with a number of the same which are partially independent of one another and partially connected. We must not expect a single traumatic reminiscence whose nucleus is a single pathogenic idea, but we must be ready to assume a series of partial traumas and a concatenation of pathogenic streams of thought. The monosymptomatic traumatic hysteria is, as it were, an elementary organism, it is a single being in comparison to the complicated structure of a grave hysterical neurosis as is generally encountered. ”

“ Depending on whether the memory content of the reproachful action alone forces an entrance into consciousness or whether it takes with it the accompanying reproachful affect, we have two forms of compulsion neurosis. The first represents the typical obsessions, the content of which attracts the patient’s attention; only an indefinite displeasure is perceived as an affect, whereas, for the content of the obsession the only suitable affect would be one of reproach. ”

“ When one undertakes a cathartic treatment he at first asks himself whether the patient understands the origin and cause of her suffering. If that is so one does not need any special technique to cause her to reproduce the history of her ailment. The interest shown in her, the understanding which we foreshadow, the hope of recovery extended to her, all these will induce the patient to give up her secrets. ”

“ It is for that reason that the state of neurotic illness is not sharply separated from the normal. The disease is the result of a summation, and the measure of the etiological determinations can be completed from any one part. To seek the etiology of the neurosis exclusively in heredity or in the constitution would be no less one sided than to attempt to raise to the etiology the accidental influences of sexuality alone, even though the explanations show that the essence of this malady lies only in a disturbance of the sexual processes of the organism. ”

“ I do not wish to be misunderstood and give the impression that I refuse to accept hysteria as an independent neurotic affection, that I conceive it only as a psychic manifestation of the anxiety neurosis, that I ascribe to it “ideogenous” symptoms only, and that I attribute the somatic symptoms, like hysterogenic points and anesthesias, to the anxiety neurosis. None of these statements are true. I believe that hysteria, purified of all admixtures, can be treated independently in every respect except in therapy. ”

“ By virtue of the great numher of existing causal connections every unadjusted pathogenic idea acts as a motive for the complete creation of the neurosis, and only with the last word of the analysis does the whole picture of the disease disappear, just as happens in the behavior of the individual reproduced reminiscence. ”

“ The first and strongest impression which one gains through such an analysis is surely the fact that the pathogenic psychic material, apparently forgotten and not at the disposal of the ego, playing no rôle in the association and in memory, still lies ready in some manner and in proper and good order. All that is necessary is to remove the resistances blocking the way. Barring that, everything is known as we know anything else, the proper connections of the individual ideas among themselves and with the nonpathogenic are frequently recalled and are present ”

“ If any one should be surprised at the associative connection between physical pain and psychic affect, thinking it to be too manifold and artificial, I should answer that such surprise is just as unfair as to be surprised over the fact “that just the richest in the world possess most money.” Where prolific connections do not exist there is naturally no formation of hysterical symptoms, and conversion does not find its way. ”

“ Why should just the pains in the legs be selected to represent the psychic pains? The circumstances of the case point to the fact that this somatic pain was not created by the neurosis but was merely utilized, aggravated, and retained by it. I will add that in most of the cases of hysterical algias into which I have been able to gain an insight the conditions were similar, that is, there was to begin with always a real organically founded pain. It is always the most common, the most widespread pains of humanity that seem to be most frequently called upon to play a part in hysteria. ”

“ Our unconscious is not quite the same as that of the philosophers and what is more, most philosophers wish to know nothing of the “psychical unconscious.” But if you will put yourselves in our position, you will understand that the interpretation of this unconscious, in patients’ psychic life, into the conscious, must result in a correction of their deviation from the normal, and in an abrogation of the compulsion controlling their psychic life. ”

“ I have made use of such experiences in the therapy of phobias and obsessions, and despite the patient's resistances I have redirected the attention to the repressed sexual ideas, and wherever feasible I have blocked the sources from which the same originated. To be sure I cannot maintain that all phobias and obsessions originate in the manner here revealed; first, my experience, in proportion to the abundance of these neuroses, embraces only a limited amount, and second, I, myself, know that these "psychasthenic" symptoms (according to Janet's designation) are not all of the same value. ”

“ I could not conceive myself entering deeply into the psychic mechanism of a hysteria in a person who appeared to me common and disagreeable, and who would not, on closer acquaintanceship, be able to awaken in me human sympathy; whereas I can well treat a tabetic or a rheumatic patient regardless of such personal liking. ”

“ For as a matter of fact such wild analysts do more harm to the subject than to the individual patient. It has often been my experience that such an awkward procedure, even if it at first caused an aggravation of the symptoms, has nevertheless achieved a cure in the end. Not always, but quite often. After the patient has railed against the physician long enough and feels himself far enough removed from his influence his symptoms abate, or he decides to take a step which leads to the road of recovery. ”

“ You not only work in the service of science by making use of the only and never returning opportunity for fathoming the mysteries of neuroses. You not only give the patient for his suffering the most effective treatment now at our disposal, but you also contribute your share to that enlightenment of the multitude from which we expect, indirectly, the most thorough prophylaxis against neurotic diseases. ”

“ Over the road leading from the patient’s exertion of the will to the origin of a neurotic symptom I formed a conception which in the current psychological abstractions may be thus expressed: The task assumed by the defensive ego to treat the incompatible idea as “non arrivée” can not be directly accomplished. The memory trace as well as the affect adhering to the idea are here and can not be exterminated. The task can however, be brought to an approximate solution if it is possible to change the strong idea into a weak one and to take away the affect or sum of excitement which adheres to it. ”

“ I must discuss the significance of these moments for the conception of the whole neurosis. However, I think that the assumption of a defense hysteria (abwehr hysterie) includes the requisite that at least one such moment has already occurred. For consciousness does not know in advance when such an unbearable idea will present itself. The unbearable idea which with its appendix is later excluded for the formation of a separate psychic group must have been originally in the mind, otherwise no conflict would have resulted leading to its exclusion. ”

“ You doctors, all of you, constantly practice psychotherapy, even when you do not know it, or do not intend it, but it has one disadvantage, you leave entirely to the patient the psychic factor of your influence. ”