this much-attacked psychoanalysis has now found some friends among you who are anxious to see it justify itself as well from another aspect, namely, the therapeutic side. You know that the therapy of psychiatry has hitherto not been able to influence obsessions. Can psychoanalysis perhaps do so, thanks to its insight into the mechanism of these symptoms? No, ladies and gentlemen, it cannot; for the present at least it is just as powerless in the face of these maladies as every other therapy. We can understand what it was that happened within the patient, but we have no means of making the patient himself understand this. In fact, I told you that I could not extend the analysis of the obsession beyond the first steps. Would you therefore assert that analysis is objectionable in such cases because it remains without result? I think not. We have the right, indeed we have the duty to pursue scientific research without regard to an immediate practical effect. Some day, though we do not know when or where, every little scrap of knowledge will have been translated into skill, even into therapeutic skill. If psychoanalysis were as unsuccessful in all other forms of nervous and psychological disease as it is in the case of the obsession, it would nevertheless remain fully justified as an irreplaceable method of scientific research. It is true that we would then not be in a position to practice it, for the human subjects from which we must learn, live and will in their own right; they must have motives of their own in order to assist in the work, but they would deny themselves to us. Therefore let me conclude this session by telling you that there are comprehensive groups of nervous diseases concerning which our better understanding has actually been translated into therapeutic power; moreover, that in disturbances which are most difficult to reach we can under certain conditions secure results which are second to none in the field of internal therapeutics.
37. Compare S. Freud, Totem and Taboo, 1913.
SEVENTEENTH LECTURE
GENERAL THEORY OF THE NEUROSES
THE MEANING OF THE SYMPTOMS
In the last lecture I explained to you that clinical psychiatry concerns itself very little with the form under which the symptoms appear or with the burden they carry, but that it is precisely here that psychoanalysis steps in and shows that the symptom carries a meaning and is connected with the experience of the patient. The meaning of neurotic symptoms was first discovered by J. Breuer in the study and felicitous cure of a case of hysteria which has since become famous (1880–82). It is true that P. Janet independently reached the same result; literary priority must in fact be accorded to the French scholar, since Breuer published his observations more than a decade later (1893–95) during his period of collaboration with me. On the whole it may be of small importance to us who is responsible for this discovery, for you know that every discovery is made more than once, that none is made all at once, and that success is not meted out according to deserts. America is not named after Columbus. Before Breuer and Janet, the great psychiatrist Leuret expressed the opinion that even for the deliria of the insane, if we only understood how to interpret them, a meaning could be found. I confess that for a considerable period of time I was willing to estimate very highly the credit due to P. Janet in the explanation of neurotic symptoms, because he saw in them the expression of subconscious ideas (idées inconscientes) with which the patients were obsessed. But since then Janet has expressed himself most conservatively, as though he wanted to confess that the term “subconscious” had been for him nothing more than a mode of speech, a shift, “une façon de parler,” by the use of which he had nothing definite in mind. I now no longer understand Janet’s discussions, but I believe that he has needlessly deprived himself of high credit.
The neurotic symptoms then have their meaning just like errors and the dream, and like these they are related to the lives of the persons in whom they appear. The importance of this insight into the nature of the symptom can best be brought home to you by way of examples. That it is borne out always and in all cases, I can only assert, not prove. He who gathers his own experience will be convinced of it. For certain reasons, however, I shall draw my instances not from hysteria, but from another fundamentally related and very curious neurosis concerning which I wish to say a few introductory words to you. This so-called compulsion neurosis is not so popular as the widely known hysteria; it is, if I may use the expression, not so noisily ostentatious, behaves more as a private concern of the patient, renounces bodily manifestations almost entirely and creates all its symptoms psychologically. Compulsion neurosis and hysteria are those forms of neurotic disease by the study of which psychoanalysis has been built up, and in whose treatment as well the therapy celebrates its triumphs. Of these the compulsion neurosis, which does not take that mysterious leap from the psychic to the physical, has through psychoanalytic research become more intimately comprehensible and transparent to us than hysteria, and we have come to understand that it reveals far more vividly certain extreme characteristics of the neuroses.
The chief manifestations of compulsion neurosis are these: the patient is occupied by thoughts that in reality do not interest him, is moved by impulses that appear alien to him, and is impelled to actions which, to be sure, afford him no pleasure, but the performance of which he cannot possibly resist. The thoughts may be absurd in themselves or thoroughly indifferent to the individual, often they are absolutely childish and in all cases they are the result of strained thinking, which exhausts the patient, who surrenders himself to them most unwillingly. Against his will he is forced to brood and speculate as though it were a matter of life or death to him. The impulses, which the patient feels within himself, may also give a childish or ridiculous impression, but for the most part they bear the terrifying aspect of temptations to fearful crimes, so that the patient not only denies them, but flees from them in horror and protects himself from actual execution of his desires through inhibitory renunciations and restrictions upon his personal liberty. As a matter of fact he never, not a single time, carries any of these impulses into effect; the result is always that his evasion and precaution triumph. The patient really carries out only very harmless trivial acts, so-called compulsive acts, for the most part repetitions and ceremonious additions to the occupations of every-day life, through which its necessary performances — going to bed, washing, dressing, walking — become long-winded problems of almost insuperable difficulty. The abnormal ideas, impulses and actions are in nowise equally potent in individual forms and cases of compulsion neurosis; it is the rule, rather, that one or the other of these manifestations is the dominating factor and gives the name to the disease; that all these forms, however, have a great deal in common is quite undeniable.
Surely this means violent suffering. I believe that the wildest psychiatric phantasy could not have succeeded in deriving anything comparable, and if one did not actually see it every day, one could hardly bring oneself to believe it. Do not think, however, that you give the patient any help when you coax him to divert himself, to put aside these stupid ideas and to set himself to something useful in the place of his whimsical occupations. This is just what he would like of his own accord, for he possesses all his senses, shares your opinion of his compulsion symptoms, in fact volunteers it quite readily. But he cannot do otherwise; whatever activities actually are released under compulsion neurosis are carried along by a driving energy, such as is probably never met with in normal psychic life. He has only one remedy — to transfer and change. In place of one stupid idea he can think of a somewhat milder absurdity, he can proceed from one precaution and prohibition to another, or carry through another ceremonial. He may shift, but he cannot annul the compulsion. One of the chief characteristics of the sickness is the instability of the symptoms; they can be shifted very far from their original form. It is moreover striking that the contrasts present in all psychological experience are so very sharply drawn in this condition. In addition to the compulsion of positive and negative content, an intellectual doubt makes itself felt that gradually attacks the most ordinary and assured certainties. All these things merge into steadily increasing uncertainty, lack of energy, curtailment of personal liberty, despite the
