hysterical symptoms

Moreover, Gentlemen, this first disappointment we meet with in following Breuer’s method is immediately succeeded by another, and one that must be especially painful to us as physicians. When our procedure leads, as in the cases described above, to findings which are insufficient as an explanation both in respect to their suitability as determinants and to their traumatic effectiveness, we also fail to secure any therapeutic gain; the patient retains his symptoms unaltered, in spite of the initial result yielded by the analysis. You can understand how great the temptation is at this point to proceed no further with what is in any case a laborious piece of work.

But perhaps all we need is a new idea in order to help us out of our dilemma and lead to valuable results. The idea is this. As we know from Breuer, hysterical symptoms can be resolved if, starting from them, we are able to find the path back to the memory of a traumatic experience. If the memory which we have uncovered does not answer our expectations, it may be that we ought to pursue the same path a little further; perhaps behind the first traumatic scene there may be concealed the memory of a second, which satisfies our requirements better and whose reproduction has a greater therapeutic effect; so that the scene that was first discovered only has the significance of a connecting link in the chain of associations. And perhaps this situation may repeat itself; inoperative scenes may be interpolated more than once, as necessary transitions in the process of reproduction, until we finally make our way from the hysterical symptom to the scene which is really operative traumatically and which is satisfactory in every respect, both therapeutically and analytically. Well, Gentlemen, this supposition is correct. If the first-discovered scene is unsatisfactory, we tell our patient that this experience explains nothing, but that behind it there must be hidden a more significant, earlier, experience; and we direct his attention by the same technique to the associative thread which connects the two memories – the one that has been discovered and the one that has still to be discovered.(*) A continuation of the analysis then leads in every instance to the reproduction of new scenes of the character we expect. For example, let us take once again the case of hysterical vomiting which I selected before, and in which the analysis first led back to a fright from a railway accident – a scene which lacked suitability as a determinant. Further analysis showed that this accident had aroused in the patient the memory of another, earlier accident, which, it is true, he had not himself experienced but which had been the occasion of his having a ghastly and revolting sight of a dead body. It is as though the combined operation of the two scenes made the fulfilment of our postulates possible, the one experience supplying, through fright, the traumatic force and the other, from its content, the determining effect. The other case, in which the vomiting was traced back to eating an apple which had partly gone bad, was amplified by the analysis somewhat in the following way. The bad apple reminded the patient of an earlier experience: while he was picking up windfalls in an orchard he had accidentally come upon a dead animal in a revolting state.

I shall not return any further to these examples, for I have to confess that they are not derived from any case in my experience but are inventions of mine. Most probably, too, they are bad inventions. I even regard such solutions of hysterical symptoms as impossible. But I was obliged to make up fictitious examples for several reasons, one of which I can state at once. The real examples are all incomparably more complicated: to relate a single one of them in detail would occupy the whole period of this lecture. The chain of associations always has more than two links; and the traumatic scenes do not form a simple row, like a string of pearls, but ramify and are interconnected like genealogical trees, so that in any new experience two or more earlier ones come into operation as memories. In short, giving an account of the resolution of a single symptom would in fact amount to the task of relating an entire case history.

But we must not fail to lay special emphasis on one conclusion to which analytic work along these chains of memory has unexpectedly led. We have learned that *no hysterical experience can arise from a real experience alone, but that in every case the memory of earlier experiences awakened in association to it plays a part in causing the symptom*. If – as I believe – this proposition holds good without exception, it furthermore shows us the basis on which a psychological theory of hysteria must be built.

(*) I purposely leave out of this discussion the question of what the category is to which the association between the two memories belong, (whether it is an association by simultaneity, or by causal connections or by similarity of content), and of what psychological character is to be attributed to the various ‘memories’ (conscious or unconscious).

Sigmund Freud 1896 The Aetiology of Hysteria

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