A General Introduction to Psychoanalysis

Psychoanalysis 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 psychoanalysis. Psychoanalysis 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 psychoanalysis have been discussed as the most important technical aid for insight into these conditions. I had, however, intended and announced A General Introduction to Psychoanalysis, and it seemed to me more important to give you an idea of psychoanalysis 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 psychoanalysis. I believe that I have made the wiser choice for you, since psychoanalysis 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 classification 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 mass.

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 praecox and paranoia), forms of neuroses of which we shall speak subsequently. Let us take as an illustration the hysteric headache or backache. Analysis shows that through elaboration and displacement this pain has become the gratification substitute for a whole series of libidinous phantasies or reminiscences. But once upon a time this pain was real, a direct sexual toxic symptom, the physical expression of libidinous excitation. We do not wish to assert, 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 passing signs of sexual excitation, which accompany the sexual 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 flourishing 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 psychoanalysis 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 passage through which these sensations must pass.

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 passenger 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 repetition 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 assume 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 psychoanalysis. What psychology has to say about emotions – the James-Lange theory, for instance – is absolutely incomprehensible for us psychoanalysts, 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 repetition 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.

Perhaps it will interest you to hear how the idea that birth is the source and prototype of the emotion of fear, happened to occur to me. Speculation plays the smallest part in it; I borrowed it from the native train of thought of the people. Many years ago we were sitting around the dinner table – a number of young physicians – when an assistant in the obstetrical clinic told a jolly story of what had happened in the last examination for midwives. A candidate was asked what it implied if during delivery the foeces of the newborn was present in the discharge of waters, and she answered promptly "the child is afraid." She was laughed at and "flunked." But I silently took her part and began to suspect that the poor woman of the people had, with sound perception, revealed an important connection.

Proceeding now to neurotic fear, what are its manifestations and conditions? There is much to be described. In the first place we find a general condition of anxiety, a condition of free-floating fear as it were, which is ready to attach itself to any appropriate idea, to influence judgment, to give rise to expectations, in fact to seize any opportunity to make itself felt. We call this condition "expectant fear" or "anxious expectation." Persons who suffer from this sort of fear always prophesy the most terrible of all possibilities, interpret every coincidence as an evil omen, and ascribe a dreadful meaning to all uncertainty. Many persons who cannot be termed ill show this tendency to anticipate disaster. We blame them for being over-anxious or pessimistic. A striking amount of expectant fear is characteristic of a nervous condition which I have named "anxiety neurosis," and which I group with the true neuroses.

A second form of fear in contrast to the one we have just described is psychologically more circumscribed and bound up with certain objects or situations. It is the fear of the manifold and frequently very peculiar phobias. Stanley Hall, the distinguished American psychologist, has recently taken the trouble to present a whole series of these phobias in gorgeous Greek terminology. They sound like the enumeration of the ten Egyptian plagues, except that their number exceeds ten, by far. Just listen to all the things which may become the objects of contents of a phobia: Darkness, open air, open squares, cats, spiders, caterpillars, snakes, mice, thunder-storms, sharp points, blood, enclosed spaces, crowds, solitude, passing over a bridge, travel on land and sea, etc. A first attempt at orientation in this chaos leads readily to a division into three groups. Some of the fearful objects and situations have something gruesome for normal people too, a relation to danger, and so, though they are exaggerated in intensity, they do not seem incomprehensible to us. Most of us, for instance, experience a feeling of repulsion in the presence of a snake. One may say that snakephobia is common to all human beings, and Charles Darwin has described most impressively how he was unable to control his fear of a snake pointing for him, though he knew he was separated from it by a thick pane of glass. The second group consists of cases which still bear a relation to danger, but this is of a kind which we are disposed to belittle rather than to overestimate. Most of the situation-phobia belong here. We know that by taking a railroad journey we entail greater chance of disaster than by staying at home. A collision, for instance, may occur, or a ship sink, when as a rule we must drown; yet we do not think of these dangers, and free from fear we travel on train and boat. We cannot deny that if a bridge should collapse at the moment we are crossing it, we would fall into the river, but that is such a rare occurrence that we do not take the danger into account. Solitude too has its dangers and we avoid it under certain conditions; but it is by no means a matter of being unable to suffer it for a single moment. The same is true for the crowd, the enclosed space, the thunder-storm, etc. It is not at all the content but the intensity of these neurotic phobias that appears strange to us. The fear of the phobia cannot even be described. Sometimes we almost receive the impression that the neurotic is not really afraid of the same things and situations that can arouse fear in us, and which he calls by the same name.

There remains a third group of phobias which is entirely unintelligible to us. When a strong, adult man is afraid to cross a street or a square of his own home town, when a healthy, well-developed woman becomes almost senseless with fear because a cat has brushed the hem of her dress or a mouse has scurried through the room – how are we to establish the relation to danger that obviously exists under the phobia? In these animal phobias it cannot possibly be a question of the heightening of common human antipathies. For, as an illustration of the antithesis, there are numerous persons who cannot pass a cat without calling and petting it. The mouse of which women are so much afraid, is at the same time a first class pet name. Many a girl who has been gratified to have her lover call her so, screams when she sees the cunning little creature itself. The behavior of the man who is afraid to cross the street or the square can only be explained by saying that he acts like a little child. A child is really taught to avoid a situation of this sort as dangerous, and our agoraphobist is actually relieved of his fear if some one goes with him across the square or street.

The two forms of fear that have been described, free-floating fear and the fear which is bound up with phobias, are independent of one another. The one is by no means a higher development of the other; only in exceptional cases, almost by accident, do they occur simultaneously. The strongest condition of general anxiety need not manifest itself in phobias; and persons whose entire life is hemmed in by agoraphobia can be entirely free of pessimistic expectant fear. Some phobias, such as the fear of squares or of trains, are acquired only in later life, while others, the fear of darkness, storms and animals, exist from the very beginning. The former signify serious illness, the latter appear rather as peculiarities, moods. Yet whoever is burdened with fear of this second kind may be expected to harbor other and similar phobias. I must add that we group all these phobias under anxiety hysteria, and therefore regard it as a condition closely related to the well-known conversion hysteria.

The third form of neurotic fear confronts us with an enigma; we loose sight entirely of the connection between fear and threatening danger. This anxiety occurs in hysteria, for instance, as the accompaniment of hysteric symptoms, or under certain conditions of excitement, where we would expect an emotional manifestation, but least of all of fear, or without reference to any known circumstance, unintelligible to us and to the patient. Neither far nor near can we discover a danger or a cause which might have been exaggerated to such significance. Through these spontaneous attacks we learn that the complex which we call the condition of anxiety can be resolved into its components. The whole attack may be represented by a single intensively developed symptom, such as a trembling, dizziness, palpitation of the heart, or tightening of breath; the general undertone by which we usually recognize fear may be utterly lacking or vague. And yet these conditions, which we describe as "anxiety equivalents," are comparable to anxiety in all its clinical and etiological relations.

Two questions arise. Can we relate neurotic fear, in which danger plays so small a part or none at all, to real fear, which is always a reaction to danger? And what can we understand as the basis of neurotic fear? For the present we want to hold to our expectations: "Wherever there is fear, there must be a cause for it."

Clinical observation yields several suggestions for the comprehension of neurotic fear, the significance of which I shall discuss with you.

1. It is not difficult to determine that expectant fear or general anxiety is closely connected with certain processes in sexual life, let us say with certain types of libido. Utilization, the simplest and most instructive case of this kind, results when persons expose themselves to frustrated excitation, viz., if their sexual excitation does not meet with sufficient relief and is not brought to a satisfactory conclusion, in men, during the time of their engagement to marry, for instance, or in women whose husbands are not sufficiently potent or who, from caution, execute the sexual act in a shortened or mutilated form. Under these circumstances libidinous excitement disappears and anxiety takes its place, both in the form of expectant fear and in attacks and anxiety equivalents. The cautious interruption of the sexual act, when practiced as the customary sexual regime, so frequently causes the anxiety neurosis in men, and especially in women, that physicians are wise in such cases to examine primarily this etiology. On innumerable occasions we have learned that anxiety neurosis vanishes when the sexual misuse is abandoned.

So far as I know, the connection between sexual restraint and conditions of anxiety is no longer questioned even by physicians who have nothing to do with psychoanalysis. But I can well imagine that they do not desist from reversing the connection and saying that these persons have exhibited a tendency to anxiety from the outset and therefore practice reserve in sexual matters. The behavior of women whose sexual conduct is passive, viz., is determined by the treatment of the husband, contradicts this supposition. The more temperamental, that is, the more disposed toward sexual intercourse and capable of gratification is the woman, the more will she react to the impotence of the man, or to the coitus interruptus, by anxiety manifestations. In anaesthetic or only slightly libidinous women, such misuse will not carry such consequences.

Sexual abstinence, recommended so warmly by the physicians of to-day, has the same significance in the development of conditions of anxiety only when the libido, to which satisfactory relief is denied, is sufficiently strong and not for the most part accounted for by sublimation. The decision whether illness is to result always depends upon the quantitative factors. Even where character formation and not disease is concerned, we easily recognize that sexual constraint goes hand in hand with a certain anxiety, a certain caution, while fearlessness and bold daring arise from free gratification of sexual desires. However much these relations are altered by various influences of civilization, for the average human being it is true that anxiety and sexual constraint belong together.

I have by no means mentioned all the observations that speak for the genetic relation of the libido to fear. The influence on the development of neurotic fear of certain phases of life, such as puberty and the period of menopause, when the production of libido is materially heightened, belongs here too. In some conditions of excitement we may observe the mixture of anxiety and libido and the final substitution of anxiety for libido. These facts give us a twofold impression, first that we are concerned with an accumulation of libido, which is diverted from its normal channel, second that we are working with somatic processes. Just how anxiety originates from the libido we do not know; we can only ascertain that the libido is in abeyance, and that we observe anxiety in its place.

2. We glean a second hint from the analysis of the psychoneuroses, especially of hysteria. We have heard that in addition to the symptoms, fear frequently accompanies this condition; this, however, is free floating fear, which is manifested either as an attack or becomes a permanent condition. The patients cannot tell what they are afraid of and connect their fear, through an unmistakable secondary elaboration, with phobias nearest at hand; death, insanity, paralysis. When we analyze the situation which gave rise to the anxiety or to symptoms accompanied by it, we can generally tell which normal psychologic process has been omitted and has been replaced by the phenomenon of fear. Let me express it differently: we reconstruct the unconscious process as though it had not experienced suppression and had continued its way into consciousness uninterruptedly. Under these conditions as well this process would have been accompanied by an emotion, and we now learn with surprise that when suppression has occurred the emotion accompanying the normal process has been replaced by fear, regardless of its original quality. In hysteric conditions of fear, its unconscious correlative may be either an impulse of similar character, such as fear, shame, embarrassment or positive libidinous excitation, or hostile and aggressive emotion such as fury or rage. Fear then is the common currency for which all emotional impulses can be exchanged, provided that the idea with which it has been associated has been subject to suppression.

3. Patients suffering from compulsive acts are remarkably devoid of fear. They yield us the data for our third point. If we try to hinder them in the performance of their compulsive acts, of their washing or their ceremonials, or if they themselves dare to give up one of their compulsions, they are seized with terrible fear that again exacts obedience to the compulsion. We understand that the compulsive act had veiled fear and had been performed only to avoid it. In compulsion neurosis then, fear, which would otherwise be present, is replaced by symptom development. Similar results are yielded by hysteria. Following the process of suppression we find the development, either of anxiety alone or of anxiety and symptom development, or finally a more complete symptom development and no anxiety. In an abstract sense, then, it would be correct to say that symptoms are formed only to evade development of fear, which otherwise could not be escaped. According to this conception, fear is seen to occupy the center of the stage in the problems of neurosis.

Our observations on anxiety neuroses led to the conclusion that when the libido was diverted from its normal use and anxiety thus released, it occurred on the basis of somatic processes. The analyses of hysteria and compulsion neuroses furnish the correlative observations that similar diversion with similar results may also be the consequence of a constraint of psychic forces. Such then is our knowledge of the origin of neurotic fear; it still sounds rather vague. But as yet I know no path that would lead us further. The second task we have set ourselves is still more difficult to accomplish. It is the establishment of a connection between neurotic fear, which is misused libido, and real fear, which is a reaction to danger. You may believe that these things are quite distinct and yet we have no criterion for distinguishing the sensations of real and neurotic fear.