In common with other sciences, psychology had to go through its scholastic-philosophic stage, and to some extent this has lasted on into the present time. This philosophic psychology has incurred our condemnation in that it decides _ex cathedra_ what is the nature of the soul, and whence and how it derives its attributes. The spirit of modern scientific investigation has summarily disposed of all these phantasies and in their place has established an exact empiric method. We owe to this our present-day experimental psychology or "_psychophysiology_," as the French call it. This new direction originated with Fechner, that Janus-minded spirit, who in his remarkable _Psychophysik_ (1860) embarked on the mighty enterprise of introducing the physical standpoint into the conception of psychical phenomena. The whole idea of this work--and not least its astonishing mistakes--proved most fruitful in results. For Wundt, Fechner's young contemporary, carried on his work, and it is Wundt's great erudition, enormous power of work and genius for elaborating methods of experimental research, which have given to modern psychology its prevailing direction.
Until quite recently experimental psychology remained essentially academic. The first notable attempt to utilise some few at any rate of its innumerable experimental methods in the service of practical psychology came from the psychiatrists of the former Heidelberg school (Kræpelin, Aschaffenburg, etc.); it is quite intelligible that the psychotherapists should be the first to feel the urgent need for more exact knowledge of psychic processes.
Next came pedagogy, making its own demands upon psychology. Out of this has recently grown up an "experimental pedagogy," and in this field Neumann in Germany and Binet in France have rendered signal services. The physician, the so-called "nerve-specialist," has the most urgent need of psychological knowledge if he would really help his patients, for neurotic disturbances, such as hysteria, and all things classed as "nervousness," are of psychic origin, and necessarily demand psychic treatment. Cold water, light, air, electricity, magnetism, etc., are only effective temporarily, and quite often are of no use at all. They are frequently introduced into treatment in a not very commendable fashion, simply because reliance is placed upon their suggestive effect. But it is in his soul that the patient is really sick; in those most complicated and lofty functions which we scarcely dare to include in the province of medicine. The doctor must needs, in such a case, be a psychologist, must needs understand the human soul. He cannot evade the urgent demand upon him. So he naturally turns for help to psychology, since his psychiatry text-books have nothing to offer him. But modern experimental psychology is very far from being able to afford him any connected insight into the most vital psychic processes, that is not its aim. As far as possible it tries to isolate those simple elementary phenomena which border on the physiological, and then study them in an isolated state. It quite ignores the infinite variation and movement of the mental life of the individual, and accordingly, its knowledge and its facts are so many isolated details, uninspired by any comprehensive idea capable of bringing them into co-ordination. Hence it comes about that the inquirer after the secrets of the human soul, learns rather less than nothing from experimental psychology. He would be better advised to abandon exact science, take off his scholar's gown, say farewell to his study, and then, strong in manly courage, set out to wander through the world; alike through the horrors of prisons, lunatic asylums and hospitals, through dreary outlying taverns, through brothels and gambling-halls, into elegant drawing-rooms, the Stock Exchanges, socialist meetings, churches, revival gatherings of strange religious sects, experiencing in his own person love and hate and every kind of suffering. He would return laden with richer knowledge than his yard-long text-books could ever have given him, and thus equipped, he can indeed be a physician to his patients, for he understands the soul of man. He may be pardoned if his respect for the "corner-stones" of experimental psychology is no longer very considerable. There is a great gulf fixed between what science calls "psychology," on the one hand, and what the practice of everyday life expects from psychology on the other.
This need became the starting-point of a new psychology whose inception we owe first and foremost to the genius of Sigmund Freud, of Vienna, to his researches into functional nervous disease. The new type of psychology might be described as "analytical psychology." Professor Bleuler has coined the name "Deep Psychology,"[217] to indicate that the Freudian psychology takes as its province the deeper regions, the "hinterland" of the soul, the "unconscious." Freud names his method of investigation "psychoanalysis."
Before we approach the matter more closely, we must first consider the relationship of the new psychology to the earlier science. Here we encounter a singular little farce which once again proves the truth of Anatole France's apothegm: "Les savants ne sont pas curieux."
The first important piece of work[218] in this new field awakened only the faintest echo, in spite of the fact that it offered a new and fundamental conception of the neuroses. Certain writers expressed their approbation, and then, on the next page, proceeded to explain their cases of hysteria in the good old way. It was much as if a man should subscribe fully to the idea of the earth's being spherical, and yet continue to represent it as flat. Freud's next publications[219] were practically unnoticed, although they contributed findings of immeasurable importance to the domain of psychiatry. When in 1900 he produced the first real psychological elucidation of the dream[220] (previously there had reigned over this territory a suitable nocturnal darkness), he was ridiculed; and when in the middle of the last decade he began to illumine the psychology of sexuality itself,[221] and at the same time the "Zürich school" decided to range itself on his side, a storm of abuse, sometimes of the coarsest kind, burst upon him, nor has it yet ceased to rage. At the last South-West German Congress of alienists in Baden-Baden, the adherents of the new psychology had the pleasure of hearing Hoche, University Professor of Psychiatry at Freiburg in Breisgau, describe the movement in a long and much-applauded address, as an outbreak of mental aberration _among doctors_. The old proverb: "Medicus medicum non decimat" was here quite put to shame. How carefully the question had been studied was shewn by the naïve remark of one of the most distinguished neurologists of Paris, which I myself heard at the International Congress in 1907: "It is true I have not read Freud's works (he did not happen to know any German!), but as for his theories, they are nothing but a "mauvaise plaisanterie." Freud, dignified, masterly, once said to me, I first became clearly conscious of the value of my discoveries when they were met everywhere with resistance and anger; since that time I have judged the value of my work according to the degree of opposition provoked. It is against my sexual theory that the greatest indignation is felt, so it would seem therein lies my best work. Perhaps after all the real benefactors of mankind are its false teachers, for opposition to the false doctrine pushes men willy nilly into truth. Your truth-teller is a pernicious fellow, he drives men into error."
The reader must now calmly accept the idea that in this psychology he is dealing with something quite unique, if not indeed with some altogether irrational, sectarian, or occult wisdom; for what else could possibly provoke all the scientific authorities to turn away on the very threshold and utterly refuse to cross it?
Accordingly, we must look more closely into this psychology. As long ago as Charcot's time it was recognised that neurotic symptoms are "psychogenic," that is, that they have their origin in the psyche. It was also known, thanks mainly to the work of the Nancy School, that every hysterical symptom can be exactly reproduced by means of suggestion. But _how_ a hysterical system arises, and its relationship to psychic causes, were altogether unknown. In the beginning of the eighties Dr. Breuer, an old Viennese doctor, made a discovery[222] which was really the true starting-point of the new psychology. He had a very intelligent young patient (a woman) suffering from hysteria, who exhibited the following symptoms among others: A spastic paralysis of the right arm, occasional disturbances of consciousness or twilight-states, and loss of the power of speech in so far as she no longer retained any knowledge of her mother-tongue, and could only express herself in English (so-called systematic aphasia). They sought at that time, and still seek, in such a case to establish some theory of anatomical disturbance, although there was just as little disturbance in the arm-centre in the brain as in that of any normal man who boxes another's ears. The symptomatology of hysteria is full of anatomical impossibilities; such as the case of the lady who had lost her hearing completely through some hysterical malady. None the less she often used to sing, and once when she was singing her doctor sat down at the piano unnoticed by her and softly accompanied her. Passing from one strophe to another he suddenly altered the key, and she, quite unconscious of what she was doing, sang on in the altered key. Thus she heard--yet did not hear. The various forms of systematic blindness present similar phenomena. We have the case of a man suffering from complete hysterical blindness. In the course of the treatment he recovers his sight, but at first, and for some long time, only partially: he could see everything with one exception--people's heads. He saw all the people around him without heads. Thus he saw--yet did not see. From a large number of like experiences it has long been concluded that it is only the patient's consciousness which does not see, does not hear, but the sense-function has nothing at all the matter with it. This state of affairs is directly contradictory to the essence of an organic disturbance, which always materially involves the function.
After this digression let us return to Breuer's case. Since there was no organic cause for the disturbance, the case was clearly to be regarded as hysterical, that is, psychogenic. Dr. Breuer had noticed that if during her twilight-states (whether spontaneous or artificially induced) he let the patient freely express the reminiscences and phantasies that thronged in upon her, her condition was afterwards much improved for some hours. He made systematic use of this observation in her further treatment. The patient herself invented the appropriate name for it of "talking cure" or, in jest, "chimney sweeping."
Her illness began whilst she was nursing her dying father. It is easy to understand that her phantasies busied themselves mainly with this disturbing time. In the twilight-states memories of this period reappeared with photographic fidelity, distinct in every detail: no waking recollection is ever so plastically and exactly reproduced. The term hypermnesia is applied to this heightening of the power of memory, which occurs without difficulty in certain states of contracted consciousness. Remarkable things now came to light. Out of the many things told, one ran somewhat as follows.[223]
On a certain night she was in a state of great anxiety about her father's high temperature. She sat by his bed, waiting for the surgeon who was coming from Vienna to perform an operation. Her mother had gone out of the room for a little while, and Anna (the patient) sat by the bed, with her right arm hanging over the back of her chair. She fell into a kind of waking-dream in which she saw a black snake come out from the wall and approach the sick man, prepared to bite. (It is very probable that some real snakes had been seen in the fields behind the house, and that she had been frightened by them; this would furnish the material for her hallucination.) She wanted to drive the creature away, but felt paralysed; her right arm, hanging over the chair, had "gone to sleep," was anæsthetic and paretic, and as she looked her fingers turned into little snakes with death's heads (the nails). Probably she tried to drive the snake away with her paralysed right hand, and thereby the anæsthesia and paralysis became associated with the snake-hallucination. Even after the snake had disappeared, her terror remained great. She tried to pray, but found she had no words in any language, until at length she managed to remember some English nursery rhymes, and then she could go on thinking and praying in that language.
This was the actual scene in which the paralysis and speech-disturbance arose; the describing it served to remove the speech-trouble, and in this same fashion the case was finally completely cured.
I must restrict myself to this one instance. In Breuer and Freud's book there is a wealth of similar examples. It is easy to understand that scenes such as these make a very strong impression, and accordingly there is an inclination to attribute a causal significance to them in the genesis of the symptoms. The then current conception of hysteria, arising from the English "nervous shock" theory, which Charcot strongly supported, came in conveniently to elucidate Breuer's discovery, hence arose the _trauma-theory_ maintaining that the hysterical symptom and in so far as the symptoms comprise the disease, hysteria itself, arises from some _psychic injury_ (or _trauma_), the effect of which is retained in the unconscious indefinitely. Freud, working as Breuer's colleague, amply confirmed this discovery. It was fully demonstrated that not one out of the many hundred hysterical symptoms came down ready made from heaven; they had already been conditioned by past psychic experiences. To some extent, therefore, this new conception opened up a field of very important empirical work. But Freud's tireless spirit of inquiry could not long rest content at this superficial layer, since already there obtruded deeper and more difficult problems. It is obvious enough that moments of great fear and anxiety, such as Breuer's patient went through, would leave behind a lasting effect, but how is it that these happenings are themselves already deeply stamped with the mark of morbidity? Must we suppose that the trying sick-nursing in itself produce such a result? If so, such effects should occur much more frequently, for there are, unfortunately, many trying cases of sick-nursing, and the nurse's nervous constitution is by no means always of the soundest. To this problem medicine gives its admirable answer; the "x" in the calculation is _predisposition_; there is a tendency to these things. But for Freud the problem was, what exactly constitutes this predisposition? This question led logically to an investigation of all that had preceded the psychic trauma. It is a matter of common observation that distressing scenes have markedly different effects upon the different participants, and that things which to some are quite indifferent or even pleasant, such as frogs, mice, snakes, cats, excite the greatest aversion in others. There are the cases of women who can calmly be present at a very bad operation, but who tremble all over with horror and nausea at the touch of a cat. By way of illustration let me give the case of a young lady suffering from severe hysteria following a sudden fright.[224] She had been at a social gathering, and was on her way home at midnight accompanied by several acquaintances, when a carriage came up behind them at full speed. All the others moved out of the way, but she, beside herself with fright, ran down the middle of the road just in front of the horses. The coachman cracked his whip and cursed and swore in vain. She ran down the whole length of the street till a bridge was reached. There her strength failed her, and to escape the horses' feet in her despair she would have jumped into the water had not passers-by prevented her. This same lady happened to be in Petrograd during that sanguinary Revolution of the 22nd of January, and saw a street cleared by the volleys of soldiers. All around her people were dropping down dead or wounded, but she retained her calmness and self-possession, and caught sight of a door which gave her escape into another street. These terrible moments agitated her neither at the time nor later on. She was quite well afterwards, indeed felt better than usual.
Essentially similar reactions can quite often be observed. Hence it follows that the intensity of the trauma is of small pathogenic importance; the peculiar circumstances determine its pathogenic effect. Here, then, we have the key which enables us to unlock at least one of the anterooms to an understanding of predisposition. We must now ask what were the unusual circumstances in this carriage scene? The terror and apprehension began as soon as the lady heard the trampling horses. For a moment she thought this portended some terrible fate, her death, or something equally frightful; the next, she lost all sense of what she was doing.
This powerful impression was evidently connected in some way with the horses. The predisposition of the patient to react in such an exaggerated fashion to a not very remarkable incident, might result from the fact that horses had some special significance for her. It might be suspected that she had experienced some dangerous accident with them; this actually turned out to be the case. When a child of about seven years old she was out for a drive with the coachman; the horses shied and galloped at full speed towards a steep river-bank. The coachman jumped down, and shouted to her to do the same, but in her extreme terror she could scarcely bring herself to obey. She did, however, just manage to jump out in the nick of time, whilst the horses and carriage were dashed to pieces below. No proof is needed that such an experience must leave a lasting impression behind it. But it does not offer any explanation for such an exaggerated reaction to an inadequate stimulus. So far we only know that this later symptom had its prologue in childhood, but its pathological aspect remains obscure. To penetrate into the heart of such a mystery it was necessary to accumulate further material. And the greater our experience the clearer does it become that in all cases with such traumatic experiences analysed up to the present, there co-exists a special kind of disturbance which can only be described as a derangement in the sphere of _love_. Not all of us give due credit to the anomalous nature of love, reaching high as heaven, sinking low as hell, uniting in itself all extremes of good and evil, of lofty and low.[225]
As soon as Freud recognised this, a decisive change came about in his view. In his earlier researches, whilst more or less dominated by Charcot's trauma-theory, he had sought for the origin of the neurosis in actual traumatic experiences; but now the centre of gravity shifted to a very different point. This is best demonstrated by reference to our case; we can understand that horses might easily play a significant part in the patient's life, but it is not clear why there should be this later reaction, so exaggerated, so uncalled for. It is not her fear of horses which forms the morbid factor in this curious story; to get at the real truth we must remember our empirical conclusion, that, side by side with traumatic experiences, there is also invariably present some disturbance in the sphere of love. We must now go on to inquire whether perhaps there is anything unsatisfactory in this respect in the case under review.
Our patient has a young man friend, to whom she is thinking of becoming engaged, she loves him and expects to be happy with him. At first nothing more is discoverable; but the investigator must not let himself be deterred by a negative result in the beginning of this preliminary questioning. When the direct way does not lead to the desired end, an indirect way may be taken. We accordingly turn our attention back to that strange moment when she ran away in front of the horses. We inquire who were her companions and what kind of social gathering was it, and find it was a farewell-party to her best friend, on her departure to a foreign health-resort on account of a nervous breakdown. We are told this friend is happily married and is the mother of one child. We may well doubt the assertion that she is happy. If she really were so, it is hardly to be supposed she would be "nervous" and in need of a cure. When I attacked the situation from a different vantage-ground, I learnt that our patient--after this episode--had been taken by her friends to the nearest safe place--her host's house. In her exhausted state he took charge of her. When the patient came to this part of her story, she suddenly broke off, was embarrassed, fidgeted and tried to turn the subject. Evidently some disagreeable reminiscences had suddenly cropped up. After obstinate resistances had been overcome, she admitted something very strange had happened that night. Her host had made her a passionate declaration of love, thus occasioning a situation that, in the absence of his wife, might well be considered both painful and difficult. Ostensibly this declaration came upon her like a "bolt from the blue." But a small dose of criticism applied to such an assertion soon apprises us that these things never do drop suddenly from the sky; they always have their previous history. It was a task of the following weeks to dig out piecemeal a long love-story. I will attempt to sketch in the picture as it appeared finally.
As a child the patient was a thorough tomboy, loved boys' boisterous games, laughed at her own sex, and would have nothing to do with feminine ways or occupations. After puberty, just when the sex-issue should have meant much to her, she began to shun all society; she seemingly hated and despised everything which could remind her even remotely of the biological destiny of mankind, and lived in a world of phantasy which had nothing in common with rude reality. Thus, till her twenty-fourth year, she escaped all the little adventures, hopes and expectations which ordinarily move a girl at this age. But finally she got to know the two men who were destined to destroy the thorny hedge which had grown up around her. Mr. A. was her best friend's husband; Mr. B. was their bachelor-friend. She liked both; but pretty soon found B. the more sympathetic, and an intimacy grew up between them which made an engagement seem likely. Through her friendship with him and with Mrs. A., she often met Mr. A. His presence excited her inexplicably, made her nervous. Just at this time she went to a big party. All her friends were there. She became lost in thought, and in a reverie was playing with her ring, when suddenly it slipped out of her hand and rolled under the table. Both men tried to find it and Mr. B. managed to get it. With a meaning smile he put the ring back on her finger, and said, "You know what that means!" Overcome by some strange, irresistible feeling, she tore the ring from her finger and flung it out of the open window. Naturally a painful moment for all ensued, and she soon went away, much depressed. A little while after, so-called chance brought her for her summer holidays to the health-resort where A. and his wife were staying. It was then that Mrs. A. began to suffer from nerve-trouble, and frequently felt too unwell to leave the house. So our patient could often go out for walks alone with A. One day they were out in a small boat. She was boisterously merry and fell overboard. Mr. A. saved her with difficulty as she could not swim, and he managed to lift her into the boat in a half-unconscious state. Then he kissed her. This romantic event wove fast the bonds between them. In self-defence she did her best to get herself engaged to B. and to persuade herself that she loved him. Of course this queer comedy could not escape the sharp eye of feminine jealousy. Mrs. A., her friend, guessed the secret, and was so much upset by it that her nervous condition grew bad enough to necessitate her trying a cure at a foreign health-resort. At the farewell gathering the demon came to our patient and whispered: "To-night he will be alone, something must happen to you so that you can go to his house." And so indeed it came about; her strange behaviour made her friends take her to his house, and thus she achieved her desire.
After this explanation the reader will probably be inclined to assume that only diabolical subtlety could think out and set in motion such a chain of circumstances. There is no doubt about the subtlety, but the moral evaluation is less certain. I desire to lay special emphasis upon the fact that the patient was _in no sense conscious of the motives_ of this dramatic performance. The incident apparently just came about of itself without any conscious motive whatsoever. But the whole previous history makes it perfectly clear that everything was most ingeniously directed towards the other aim; whilst the conscious self was apparently working to bring about the engagement to Mr. B., the unconscious compulsion to take the other road was still stronger.
So once more we must return to our original question, whence comes the pathological, the peculiar and exaggerated reaction to the trauma? Relying on a conclusion obtained from other analogous experiences, we ventured the conjecture that in the present case we had to do with a disturbance in the love-life, in addition to the trauma. This supposition was thoroughly borne out; the trauma, which was apparently the cause of the illness, was merely the _occasion_ for some factor, till then unconscious, to manifest itself. This was the _significant erotic conflict_. With this finding the trauma loses its pathogenic significance and is replaced by a much deeper and more comprehensive conception, which regards the erotic conflict as the pathogenic agent. This conception may be described as the sexual theory of the neurosis.
I am often asked why it is just the erotic conflict rather than any other which is the cause of the neurosis. There is but one answer to this. No one asserts that this ought necessarily to be the case, but as a simple matter of fact it is always found to be so, notwithstanding all the cousins and aunts, godparents, and teachers, who rage against it. Despite all the indignant assertions to the contrary, the problem and conflicts of love are of fundamental importance for humanity,[226] and with increasingly careful study, it comes out ever more clearly that the love-life is of immensely greater importance than the individual suspects.
As a consequence of the recognition that the true root of the neurosis is not the trauma, but the hidden erotic conflict, the trauma loses its pathogenic significance.
