New Conception of Hysteria

Hystérie

New conception of hysteria. Repression and resistance. The psychic conflict. The symptom is the substitute of a repressed idea. Psychoanalytic method.

At about the time when Breuer applied his “talking cure,” continued Charcot, the Salpetriere, his research on hysteria, which should lead to a new conception of this neurosis. The conclusion he reached was then unknown in Vienna. But when, ten years later, we published, Breuer and I, our preliminary communication on the psychic mechanism of hysterical phenomena, inspired by the results of the cathartic treatment of the first patient Breuer, we were right under the influence of works Charcot. Then we made our psychological traumas equivalent physical trauma which Charcot had established role in the determination of hysterical paralysis. And the assumption of hypnoid states Breuer is only an echo of the experiences of the French teacher on production, under hypnosis, paralysis similar in all respects to traumatic paralysis.

New Conception of HysteriaThe illustrious clinician, which I was a student in 1885-86, was reluctant to psychological conceptions. It was his disciple Pierre Janet who attempted to analyze closely the psychic process of hysteria, and we followed his example, making the mental division and dissociation of personality the backbone of our theory. Janet’s theory is based on the accepted doctrines in France concerning the role of heredity and degeneration in the origin of diseases. According to this author, hysteria is a degenerative form of alteration of the nervous system, manifested by a congenital weakness of psychic synthesis. Here is what he means by that: the hysterical would be unable to maintain a single bundle multiple psychic phenomena, and it would result in the tendency to mental dissociation. If I compare a little rough but clear hysterical Janet resembles a woman who is out for shopping and comes back loaded boxes and packages. But his two arms and ten fingers are not enough to properly kiss him all his baggage, and that a package that slides down.She bends down to pick it up, but it’s one that tumbles. And so on.

However, there are facts that do not fit very well with the theory of mental weakness. Thus, we see in hysterical certain capabilities that decrease, others rise, as if to compensate for a side which is reduced to the other. For example, at the time when Breuer’s patient had forgotten her mother tongue as well as all others, except English, she spoke it with such perfection it was capable when they were put into his hands a German book, open book to an excellent translation.

When later I undertook to continue only the research begun by Breuer, I soon formai a different opinion about the origin of hysterical dissociation (splitting of consciousness). Such divergence should happen, since I had not left, like Janet, laboratory experiments, but therapeutic needs.

What mattered to me most was the practice. The cathartic treatment, applied by Breuer, plongeât required that the patient in deep hypnosis as only hypnotic states allowed him to remember the pathogenic events that escaped him in the normal state. But I did not like hypnosis; this is an uncertain process that has something mystical.

But when I had found that despite all my efforts, I could not put under hypnosis a small part of my patients, I decided to abandon this process and apply the cathartic treatment. So I tried to make leaving patients in their normal state. It seemed at first a senseless enterprise and without chance of success. This was the patient learn something you did not know and that he himself did not know.

How could one hope to achieve this? Then I remembered a strange and instructive experience that I had seen in Bernheim at Nancy; Bernheim showed us that the subjects he had set hypnotic somnambulism and that he had to accomplish various acts, had apparently lost the memory of what they had seen and lived under hypnosis, and that it was possible to awaken in them the memories to the normal state. If asked, once awakened, what happened, these subjects first claim to know nothing; but if we do not give, if the press, if we assure them they can, then the forgotten memories reappear without fail.

I act the same with my patients. When they pretended not to know anything, I affirmed that they knew them, they had only to speak and I even made sure that the memory that their return when I put hand on their forehead would good. In this way I succeeded, without using hypnosis, learning sick all that was needed to establish the relationship between the forgotten pathogenic scenes and the symptoms that were the residues. But it was a painful and exhausting in the long process, which could emerge as a definite technique.

I left him, however, without having drawn any firm conclusions: it was proven that the forgotten memories are not lost, they remain in the possession of the patient, ready to emerge, associated with what he knows yet .

But there is a force that prevents them from becoming aware. The existence of this force can be considered as certain, because we feel an effort in trying to bring to consciousness the unconscious memories. This force, which keeps the disease state, it is experienced as a resistance of the patient.

It is on this idea of resistance that I based my conception of mental processes in hysteria. The removal of this resistance has proved essential to the recovery of the patient. According to the mechanism of healing, we can already get a very precise idea of the progress of the disease.

The same forces who today oppose the reinstatement of the forgotten in the conscious are certainly those at the time of the trauma caused this oversight and have repressed into the unconscious pathogens incidents. I called refoulement this process assumed by me and I considered proved by the undeniable existence of resistance. But one could still wonder what these forces and what were the conditions of this repression that we see today the pathogenic mechanism of hysteria. What the cathartic treatment had taught us allows us to answer this question. In all cases observed there is a strong desire was felt, which is found in complete opposition to the other desires of the individual, incompatible with the moral and aesthetic aspirations of person. A brief conflict ensued; at the end of this inner struggle, the irreconcilable desire has become the object of repression, he was driven out of consciousness and forgotten. Since the representation in question is incompatible with the “me” of the patient, the discharge occurs in the form of legal or other requirements on the part of the individual.

Acceptance of irreconcilable desire or prolongation of the conflict would have caused intense discomfort; refoulement savings this malaise, it thus appears as a way to protect the psychic person.

I will limit myself to the presentation of a single case in which the conditions and the usefulness of repression are clearly revealed. Nevertheless, I still have to shorten this case and leave important assumptions side. – A young girl had recently lost a dearly loved father, after helping to treat – a situation similar to that of Breuer’s patient. Her older sister was married, she took a deep affection for his brother, who spent affection, however, for a simple intimacy such as is found among members of the same family. But soon this sister became ill and died for lack of our girl and her mother. These were hastily recalled, without being fully educated the painful event.

When the girl arrived at the bedside of his dead sister, she emerged in for a second, an idea that could express something like this: Now he is free and can marry me. It is certain that this idea, which betrayed the conscience of the girl intense love she felt unknowingly to his brother, revolted, and was immediately suppressed. The girl fell ill in turn, presented serious hysterical symptoms, and when I took the treatment, it appeared that it had completely forgotten that scene at the deathbed of her sister and the movement of hatred and selfishness had taken possession of her. She remembered it during the treatment, reproduced the incident with the signs of the most violent emotion, and treatment cures.

I will illustrate the process of repression and its necessary relation to resistance by a rough comparison. Suppose in the conference room, in my quiet and attentive audience, yet it is an individual who behaves so as to disturb me and troubles me by inappropriate laughter, chatter by his or tapping feet. I declare that I can not continue to profess well;this, some vigorous listeners will rise and after a brief struggle, the character will at the door. It will be “repressed” and I can continue my lecture. But for the trouble does not happen again, if the expelled try to enter the room, the people who came to my aid will go back against their chairs at the door and thus form as a “resistance”. If we now carries the psychic events in our example, if one of the conference room conscious, unconscious and vestibule, that’s a pretty good picture of repression.

This is where our concept differs from that of Janet. For us, the psychic dissociation not just an innate inability of the mental apparatus to synthesize; we dynamically explain the conflict of two psychic forces we see in it the result of active rebellion; two psychic constellations, the conscious and the unconscious, one against the other. This new approach raises many new problems. Thus the psychic conflict is indeed very common and the “me” seeks to defend against painful memories without cause provided a psychological dissociation. Force is to recognize that other conditions are still required to bring a dissociation. I readily grant that the hypothesis of non refoulement not the end but the beginning of a psychological theory; but we can only progress step by step, and it must give us time to deepen our idea.

Let us also keep trying to interpret the case of the girl Breuer using the theory of repression. The history of this patient it is not suitable, because the data were obtained by the hypnotic influence. Only by discarding hypnosis as we can see resistances and repressions and form an accurate representation of the actual pathogen evolution. In hypnosis, resistance is seen evil, because the door is open to the psychic background funds; Nevertheless, hypnosis increases the resistance border of this area, it makes it a fortification wall that makes all the rest unaffordable.

The most valuable result which led us observing Breuer was the discovery of the relationship of symptoms with the pathogenic events or psychological trauma. How do we interpret all this from the perspective of the theory of repression? At first, we really do not see how. But instead of delivering me to a complicated theoretical deduction, I’ll resume our comparison here just now. It is certain that the bad away that bothered about the lesson and placing sentinels at the door, all is not finished. It may well happen that the expelled, bitter and resolute, yet causes the disorder. It is no longer in the room, it is true; we got rid of his presence, his sneer, his remarks aloud; but in some ways, the repression has nevertheless remained ineffective because there than outside the deportee is an unbearable din; he shouts, gives fists against the door and disorder and the conference more than his previous attitude. In these conditions, he would be happy that the president wants the meeting well assume the role of mediator and peacemaker.It parlementerait with the recalcitrant character, then it would target listeners and propose them to let him go, taking upon himself to ensure better behavior. We decide to remove the discharge and the calm and peace reborn. That’s a fairly accurate picture of the task of the physician in the psychoanalytic treatment of neuroses.

Let us speak now pictures without consideration of other hysterical patients and other neurotics leads us to the conviction that they have failed to repress the idea that applied to their unbearable desire. They have clearly driven from their consciousness and memory, and are saved is, apparently, a great amount of suffering, but the repressed desire continues to exist in the unconscious; it awaits an opportunity to come forward and soon he reappears in the light, but in disguise that makes it unrecognizable; in other words, the idea is repressed replaced in consciousness by another that serves as a substitute, ersatz, and which come to attach all the malaise of impressions that were thought to be spread by repression . This substitute for the repressed idea – the symptom – is protected against new attacks by the “me”; and instead of a short conflict, now comes a continual suffering. Besides signs of disfigurement, the symptom has a rest resemblance to the repressed idea. substitutive formations of the processes themselves away during the psychoanalytic treatment of the patient, and it is necessary to cure the symptom is reduced by these means to the idea repressed. If we manage to bring what is repressed in daylight – this requires considerable resistance were overcome – then the psychic conflict born of this reinstatement, and the patient wanted to avoid, can be found under the guidance of the doctor, a better solution than that of repression. This method manages to vanish conflicts and neuroses. Sometimes the patient agrees that it was wrong to suppress the pathogen desire and accepts completely or partially the desire; sometimes the desire itself is directed towards a higher purpose and, therefore, less subject to criticism (that is what I call the sublimation of desire); sometimes we recognize that it was right to reject the desire, stupid or replace the automatic, therefore insufficient mechanism of repression by moral conviction made with the help of the highest spiritual bodies of man; is in full light that one triumph of desire.

I apologize for not having described more clearly and comprehensibly the main points of view of the treatment method now called psychoanalysis. The difficulties are not only attributable to the novelty of the subject. What is the nature unbearable desires which, despite repression, still know how to be heard from the depths of the unconscious? Under what conditions he fails refoulement and there as a substitute or symptom? We are going to see him.