215

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,
 216

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
 217

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 fact that the patient suffering from compulsion
neurosis is originally a most energetic character, often of extraordinary
obstinacy, as a rule intellectually gifted above the average. For the most
part he has attained a desirable stage of ethical development, is
overconscientious and more than usually correct. You can imagine that it
takes no inconsiderable piece of work to find one's way through this
maze of contradictory characteristics and symptoms. Indeed, for the
present our only object is to understand and to interpret some symptoms
of this disease.
 218

Perhaps in reference to our previous discussions, you would like to know

the position of present-day psychiatry to the problems of the compulsion
neurosis. This is covered in a very slim chapter. Psychiatry gives names
to the various forms of compulsion, but says nothing further concerning
them. Instead it emphasizes the fact that those who show these
symptoms are degenerates. That yields slight satisfaction, it is an ethical
judgment, a condemnation rather than an explanation. We are led to
suppose that it is in the unsound that all these peculiarities may be
found. Now we do believe that persons who develop such symptoms
must differ fundamentally from other people. But we would like to ask,
are they more "degenerate" than other nervous patients, those suffering,
for instance, from hysteria or other diseases of the mind? The
characterization is obviously too general. One may even doubt whether it
is at all justified, when one learns that such symptoms occur in excellent
men and women of especially great and universally recognized ability. In
general we glean very little intimate knowledge of the great men who
serve us as models. This is due both to their own discretion and to the
lying propensities of their biographers. Sometimes, however, a man is a
fanatic disciple of truth, such as Emile Zola, and then we hear from him
the strange compulsion habits from which he suffered all his life. 38

Psychiatry has resorted to the expedient of speaking of "superior

degenerates." Very well—but through psychoanalysis we have learned
that these peculiar compulsion symptoms may be permanently removed
just like any other disease of normal persons. I myself have frequently
succeeded in doing this.

I will give you two examples only of the analysis of compulsion

symptoms, one, an old observation, which cannot be replaced by
anything more complete, and one a recent study. I am limiting myself to
such a small number because in an account of this nature it is necessary
to be very explicit and to enter into every detail.

A lady about thirty years old suffered from the most severe compulsions.
I might indeed have helped her if caprice of fortune had not destroyed
my work—perhaps I will yet have occasion to tell you about it. In the
course of each day the patient often executed, among others, the
following strange compulsive act. She ran from her room into an

38 E. Toulouse, Emile Zola—Enquête medico-psychologique, Paris, 1896.

 219

adjoining one, placed herself in a definite spot beside a table which stood
in the middle of the room, rang for her maid, gave her a trivial errand to
do, or dismissed her without more ado, and then ran back again. This
was certainly not a severe symptom of disease, but it still deserved to
arouse curiosity. Its explanation was found, absolutely without any
assistance on the part of the physician, in the very simplest way, a way to
which no one can take exception. I hardly know how I alone could have
guessed the meaning of this compulsive act, or have found any
suggestion toward its interpretation. As often as I had asked the patient:
"Why do you do this? Of what use is it?" she had answered, "I don't
know." But one day after I had succeeded in surmounting a grave ethical
doubt of hers she suddenly saw the light and related the history of the
compulsive act. More than ten years prior she had married a man far
older than herself, who had proved impotent on the bridal night.
Countless times during the night he had run from his room to hers to
repeat the attempt, but each time without success. In the morning he
said angrily: "It is enough to make one ashamed before the maid who
does the beds," and took a bottle of red ink that happened to be in the
room, and poured its contents on the sheet, but not on the place where
such a stain would have been justifiable. At first I did not understand the
connection between this reminiscence and the compulsive act in
question, for the only agreement I could find between them was in the
running from one room into another,—possibly also in the appearance of
the maid. Then the patient led me to the table in the second room and let
me discover a large spot on the cover. She explained also that she placed
herself at the table in such a way that the maid could not miss seeing the
stain. Now it was no longer possible to doubt the intimate relation of the
scene after her bridal night and her present compulsive act, but there
were still a number of things to be learned about it.

In the first place, it is obvious that the patient identifies herself with her
husband, she is acting his part in her imitation of his running from one
room into the other. We must then admit—if she holds to this role—that
she replaces the bed and sheet by table and cover. This may seem
arbitrary, but we have not studied dream symbolism in vain. In dreams
also a table which must be interpreted as a bed, is frequently seen. "Bed
and board" together represent married life, one may therefore easily be
used to represent the other.
 220

The evidence that the compulsive act carries meaning would thus be
plain; it appears as a representation, a repetition of the original
significant scene. However, we are not forced to stop at this semblance of
a solution; when we examine more closely the relation between these two
people, we shall probably be enlightened concerning something of wider
importance, namely, the purpose of the compulsive act. The nucleus of
this purpose is evidently the summoning of the maid; to her she wishes
to show the stain and refute her husband's remark: "It is enough to
shame one before the maid." He—whose part she is playing—therefore
feels no shame before the maid, hence the stain must be in the right
place. So we see that she has not merely repeated the scene, rather she
has amplified it, corrected it and "turned it to the good." Thereby,
however, she also corrects something else,—the thing which was so
embarrassing that night and necessitated the use of the red ink—
impotence. The compulsive act then says: "No, it is not true, he did not
have to be ashamed before the maid, he was not impotent." After the
manner of a dream she represents the fulfillment of this wish in an overt
action, she is ruled by the desire to help her husband over that
unfortunate incident.

Everything else that I could tell you about this case supports this clue
more specifically; all that we otherwise know about her tends to
strengthen this interpretation of a compulsive act incomprehensible in
itself. For years the woman has lived separated from her husband and is
struggling with the intention to obtain a legal divorce. But she is by no
means free from him; she forces herself to remain faithful to him, she
retires from the world to avoid temptation; in her imagination
she excuses and idealizes him. The deepest secret of her malady is that
by means of it she shields her husband from malicious gossip, justifies
her separation from him, and renders possible for him a comfortable
separate life. Thus the analysis of a harmless compulsive act leads to the
very heart of this case and at the same time reveals no inconsiderable
portion of the secret of the compulsion neurosis in general. I shall be
glad to have you dwell upon this instance, as it combines conditions that
one can scarcely demand in other cases. The interpretation of the
symptoms was discovered by the patient herself in one flash, without the
suggestion or interference of the analyst. It came about by the reference
to an experience, which did not, as is usually the case, belong to the half-
 221

forgotten period of childhood, but to the mature life of the patient, in

whose memory it had remained unobliterated. All the objections which
critics ordinarily offer to our interpretation of symptoms fail in this case.
Of course, we are not always so fortunate.

And one thing more! Have you not observed how this insignificant
compulsive act initiated us into the intimate life of the invalid? A woman
can scarcely relate anything more intimate than the story of her bridal
night, and is it without further significance that we just happened to
come on the intimacies of her sexual life? It might of course be the result
of the selection I have made in this instance. Let us not judge too quickly
and turn our attention to the second instance, one of an entirely different
kind, a sample of a frequently occurring variety, namely, the sleep ritual.

A nineteen-year old, well-developed, gifted girl, an only child, who was

superior to her parents in education and intellectual activity, had been
wild and mischievous in her childhood, but has become very nervous
during the last years without any apparent outward cause. She is
especially irritable with her mother, always discontented, depressed, has
a tendency toward indecision and doubt, and is finally forced to confess
that she can no longer walk alone on public squares or wide
thoroughfares. We shall not consider at length her complicated
condition, which requires at least two diagnoses—agoraphobia and
compulsion neurosis. We will dwell only upon the fact that this girl has
also developed a sleep ritual, under which she allows her parents to
suffer much discomfort. In a certain sense, we may say that every normal
person has a sleep ritual, in other words that he insists on certain
conditions, the absence of which hinders him from falling asleep; he has
created certain observances by which he bridges the transition from
waking to sleeping and these he repeats every evening in the same
manner. But everything that the healthy person demands in order to
obtain sleep is easily understandable and, above all, when external
conditions necessitate a change, he adapts himself easily and without
loss of time. But the pathological ritual is rigid, it persists by virtue of the
greatest sacrifices, it also masks itself with a reasonable justification and
seems, in the light of superficial observation, to differ from the normal
only by exaggerated pedantry. But under closer observation we notice
that the mask is transparent, for the ritual covers intentions that go far
beyond this reasonable justification, and other intentions as well that are
 222

in direct contradiction to this reasonable justification. Our patient cites

as the motive of her nightly precautions that she must have quiet in
order to sleep; therefore she excludes all sources of noise. To accomplish
this, she does two things: the large clock in her room is stopped, all other
clocks are removed; not even the wrist watch on her night-table is
suffered to remain. Flowerpots and vases are placed on her desk so that
they cannot fall down during the night, and in breaking disturb her
sleep. She knows that these precautions are scarcely justifiable for the
sake of quiet; the ticking of the small watch could not be heard even if it
should remain on the night-table, and moreover we all know that the
regular ticking of a clock is conducive to sleep rather than disturbing.
She does admit that there is not the least probability that flowerpots and
vases left in place might of their own accord fall and break during the
night. She drops the pretense of quiet for the other practice of this sleep
ritual. She seems on the contrary to release a source of disturbing noises
by the demand that the door between her own room and that of her
parents remain half open, and she insures this condition by placing
various objects in front of the open door. The most important
observances concern the bed itself. The large pillow at the head of the
bed may not touch the wooden back of the bed. The small pillow for her
head must lie on the large pillow to form a rhomb; she then places her
head exactly upon the diagonal of the rhomb. Before covering herself, the
featherbed must be shaken so that its foot end becomes quite flat, but
she never omits to press this down and redistribute the thickness.

Allow me to pass over the other trivial incidents of this ritual; they would
teach us nothing new and cause too great digression from our purpose.
Do not overlook, however, the fact that all this does not run its course
quite smoothly. Everything is pervaded by the anxiety that things have
not been done properly; they must be examined, repeated. Her doubts
seize first on one, then on another precaution, and the result is that one
or two hours elapse during which the girl cannot and the intimidated
parents dare not sleep.

These torments were not so easily analyzed as the compulsive act of our
former patient. In the working out of the interpretations I had to hint
and suggest to the girl, and was met on her part either by positive denial
or mocking doubt. This first reaction of denial, however, was followed by
a time when she occupied herself of her own accord with the possibilities
 223

that had been suggested, noted the associations they called out,
produced reminiscences, and established connections, until through her
own efforts she had reached and accepted all interpretations. In so far as
she did this, she desisted as well from the performance of her compulsive
rules, and even before the treatment had ended she had given up the
entire ritual. You must also know that the nature of present-day analysis
by no means enables us to follow out each individual symptom until its
meaning becomes clear. Rather it is necessary to abandon a given theme
again and again, yet with the certainty that we will be led back to it in
some other connection. The interpretation of the symptoms in this case,
which I am about to give you, is a synthesis of results, which, with the
interruptions of other work, needed weeks and months for their
compilation.

Our patient gradually learns to understand that she has banished clocks
and watches from her room during the night because the clock is the
symbol of the female genital. The clock, which we have learned to
interpret as a symbol for other things also, receives this role of the
genital organ through its relation to periodic occurrences at equal
intervals. A woman may for instance be found to boast that her
menstruation is as regular as clockwork. The special fear of our patient,
however, was that the ticking of the clock would disturb her in her sleep.
The ticking of the clock may be compared to the throbbing of the clitoris
during sexual excitement. Frequently she had actually been awakened by
this painful sensation and now this fear of an erection of the clitoris
caused her to remove all ticking clocks during the night. Flowerpots and
vases are, as are all vessels, also female symbols. The precaution,
therefore, that they should not fall and break at night, was not without
meaning. We know the widespread custom of breaking a plate or dish
when an engagement is celebrated. The fragment of which each guest
possesses himself symbolizes his renunciation of his claim to the bride, a
renunciation which we may assume as based on the monogamous
marriage law. Furthermore, to this part of her ceremonial our patient
adds a reminiscence and several associations. As a child she had slipped
once and fallen with a bowl of glass or clay, had cut her finger, and bled
violently. As she grew up and learned the facts of sexual intercourse, she
developed the fear that she might not bleed during her bridal night and
so not prove to be a virgin. Her precaution against the breaking of vases
 224

was a rejection of the entire virginity complex, including the bleeding

connected with the first cohabitation. She rejected both the fear to bleed
and the contradictory fear not to bleed. Indeed her precautions had very
little to do with a prevention of noise.

One day she guessed the central idea of her ceremonial, when she
suddenly understood her rule not to let the pillow come in contact with
the bed. The pillows always had seemed a woman to her, the erect back
of the bed a man. By means of magic, we may say, she wished to keep
apart man and wife; it was her parents she wished to separate, so to
prevent their marital intercourse. She had sought to attain the same end
by more direct methods in earlier years, before the institution of her
ceremonial. She had simulated fear or exploited a genuine timidity in
order to keep open the door between the parents' bedroom and the
nursery. This demand had been retained in her present ceremonial. Thus
she had gained the opportunity of overhearing her parents, a proceeding
which at one time subjected her to months of sleeplessness. Not content
with this disturbance to her parents, she was at that time occasionally
able to gain her point and sleep between father and mother in their very
bed. Then "pillow" and "wooden wall" could really not come in contact.
Finally when she became so big that her presence between the parents
could not longer be borne comfortably, she consciously simulated fear
and actually succeeded in changing places with her mother and taking
her place at her father's side. This situation was undoubtedly the starting
point for the phantasies, whose after-effects made themselves felt in her
ritual.

If a pillow represented a woman, then the shaking of the featherbed till

all the feathers were lumped at one end, rounding it into a prominence,
must have its meaning also. It meant the impregnation of the wife; the
ceremonial, however, never failed to provide for the annulment, of this
pregnancy by the flattening down of the feathers. Indeed, for years our
patient had feared that the intercourse between her parents might result
in another child which would be her rival. Now, where the large pillow
represents a woman, the mother, then the small pillow could be nothing
but the daughter. Why did this pillow have to be placed so as to form a
rhomb; and why did the girl's head have to rest exactly upon the
diagonal? It was easy to remind the patient that the rhomb on all walls is
the rune used to represent the open female genital. She herself then
 225

played the part of the man, the father, and her head took the place of the
male organ. (Cf. the symbol of beheading to represent castration.)

Wild ideas, you will say, to run riot in the head of a virgin girl. I admit it,
but do not forget that I have not created these ideas but merely
interpreted them. A sleep ritual of this kind is itself very strange, and you
cannot deny the correspondence between the ritual and the phantasies
that yielded us the interpretation. For my part I am most anxious that
you observe in this connection that no single phantasy was projected in
the ceremonial, but a number of them had to be integrated,—they must
have their nodal points somewhere in space. Observe also that the
observance of the ritual reproduce the sexual desire now positively, now
negatively, and serve in part as their rejection, again as their
representation.

It would be possible to make a better analysis of this ritual by relating it

to other symptoms of the patient. But we cannot digress in that
direction. Let the suggestion suffice that the girl is subject to an erotic
attachment to her father, the beginning of which goes back to her earliest
childhood. That perhaps is the reason for her unfriendly attitude toward
her mother. Also we cannot escape the fact that the analysis of this
symptom again points to the sexual life of the patient. The more we
penetrate to the meaning and purpose of neurotic symptoms, the less
surprising will this seem to us.

By means of two selected illustrations I have demonstrated to you that

neurotic symptoms carry just as much meaning as do errors and the
dream, and that they are intimately connected with the experience of the
patient. Can I expect you to believe this vitally significant statement on
the strength of two examples? No. But can you expect me to cite further
illustrations until you declare yourself convinced? That too is impossible,
since considering the explicitness with which I treat each individual case,
I would require a five-hour full semester course for the explanation of
this one point in the theory of the neuroses. I must content myself then
with having given you one proof for my assertion and refer you for the
rest to the literature of the subject, above all to the classical
interpretation of symptoms in Breuer's first case (hysteria) as well as to
the striking clarification of obscure symptoms in the so-called dementia
praecox by C. G. Jung, dating from the time when this scholar was still
 226

content to be a mere psychoanalyst—and did not yet want to be a

prophet; and to all the articles that have subsequently appeared in our
periodicals. It is precisely investigations of this sort which are plentiful.
Psychoanalysts have felt themselves so much attracted by the analysis,
interpretation and translation of neurotic symptoms, that by contrast
they seem temporarily to have neglected other problems of neurosis.

Whoever among you takes the trouble to look into the matter will
undoubtedly be deeply impressed by the wealth of evidential material.
But he will also encounter difficulties. We have learned that the meaning
of a symptom is found in its relation to the experience of the patient. The
more highly individualized the symptom is, the sooner we may hope to
establish these relations. Therefore the task resolves itself specifically
into the discovery for every nonsensical idea and useless action of a past
situation wherein the idea had been justified and the action purposeful.
A perfect example for this kind of symptom is the compulsive act of our
patient who ran to the table and rang for the maid. But there are
symptoms of a very different nature which are by no means rare. They
must be called typical symptoms of the disease, for they are
approximately alike in all cases, in which the individual differences
disappear or shrivel to such an extent that it is difficult to connect them
with the specific experiences of the patient and to relate them to the
particular situations of his past. Let us again direct our attention to the
compulsion neurosis. The sleep ritual of our second patient is already
quite typical, but bears enough individual features to render possible
what may be called an historic interpretation. But all compulsive
patients tend to repeat, to isolate their actions from others and to subject
them to a rhythmic sequence. Most of them wash too much. Agoraphobia
(topophobia, fear of spaces), a malady which is no longer grouped with
the compulsion neurosis, but is now called anxiety hysteria, invariably
shows the same pathological picture; it repeats with exhausting
monotony the same feature, the patient's fear of closed spaces, of large
open squares, of long stretched streets and parkways, and their feeling of
safety when acquaintances accompany them, when a carriage drives after
them, etc. On this identical groundwork, however, the individual
differences between the patients are superimposed—moods one might
almost call them, which are sharply contrasted in the various cases. The
one fears only narrow streets, the other only wide ones, the one can go
 227

out walking only when there are few people abroad, the other when there
are many. Hysteria also, aside from its wealth of individual features, has
a superfluity of common typical symptoms that appear to resist any
facile historical methods of tracing them. But do not let us forget that it
is by these typical symptoms that we get our bearings in reaching a
diagnosis. When, in one case of hysteria we have finally traced back a
typical symptom to an experience or a series of similar experiences, for
instance followed back an hysterical vomiting to its origin in a succession
of disgust impressions, another case of vomiting will confuse us by
revealing an entirely different chain of experiences, seemingly just as
effective. It seems almost as though hysterical patients must vomit for
some reason as yet unknown, and that the historic factors, revealed by
analysis, are chance pretexts, seized on as opportunity best offered to
serve the purposes of a deeper need.

Thus we soon reach the discouraging conclusion that although we can

satisfactorily explain the individual neurotic symptom by relating it to an
experience, our science fails us when it comes to the typical symptoms
that occur far more frequently. In addition, remember that I am not
going into all the detailed difficulties which come up in the course of
resolutely hunting down an historic interpretation of the symptom. I
have no intention of doing this, for though I want to keep nothing from
you, and so paint everything in its true colors, I still do not wish to
confuse and discourage you at the very outset of our studies. It is true
that we have only begun to understand the interpretation of symptoms,
but we wish to hold fast to the results we have achieved, and struggle
forward step by step toward the mastery of the still unintelligible data. I
therefore try to cheer you with the thought that a fundamental between
the two kinds of symptoms can scarcely be assumed. Since the individual
symptoms are so obviously dependent upon the experience of the
patient, there is a possibility that the typical symptoms revert to an
experience that is in itself typical and common to all humanity. Other
regularly recurring features of neurosis, such as the repetition and doubt
of the compulsion neurosis, may be universal reactions which are forced
upon the patient by the very nature of the abnormal change. In short, we
have no reason to be prematurely discouraged; we shall see what our
further results will yield.
 228

We meet a very similar difficulty in the theory of dreams, which in our

previous discussion of the dream I could not go into. The manifest
content of dreams is most profuse and individually varied, and I have
shown very explicitly what analysis may glean from this content. But side
by side with these dreams there are others which may also be termed
"typical" and which occur similarly in all people. These are dreams of
identical content which offer the same difficulties for their interpretation
as the typical symptom. They are the dreams of falling, flying, floating,
swimming, of being hemmed in, of nakedness, and various other anxiety
dreams that yield first one and then another interpretation for the
different patients, without resulting in an explanation of their
monotonous and typical recurrence. In the matter of these dreams also,
we see a fundamental groundwork enriched by individual additions.
Probably they as well can be fitted into the theory of dream life, built up
on the basis of other dreams,—not however by straining the point, but by
the gradual broadening of our views.
 229

EIGHTEENTH LECTURE: GENERAL THEORY OF THE

NEUROSES: TRAUMATIC FIXATION—THE UNCONSCIOUS

I SAID last time that we would not continue our work from the
standpoint of our doubts, but on the basis of our results. We have not
even touched upon two of the most interesting conclusions, derived
equally from the same two sample analyses.

In the first place, both patients give us the impression of

being fixated upon some very definite part of their past; they are unable
to free themselves therefrom, and have therefore come to be completely
estranged both from the present and the future. They are now isolated in
their ailment, just as in earlier days people withdrew into monasteries
there to carry along the burden of their unhappy fates. In the case of the
first patient, it is her marriage with her husband, really abandoned, that
has determined her lot. By means of her symptoms she continues to deal
with her husband; we have learned to understand those voices which
plead his case, which excuse him, exalt him, lament his loss. Although
she is young and might be coveted by other men, she has seized upon all
manner of real and imaginary (magic) precautions to safeguard her
virtue for him. She will not appear before strangers, she neglects her
personal appearance; furthermore, she cannot bring herself to get up
readily from any chair on which she has been seated. She refuses to give
her signature, and finally, since she is motivated by her desire not to let
anyone have anything of hers, she is unable to give presents.

In the case of the second patient, the young girl, it is an erotic

attachment for her father that had established itself in the years prior to
puberty, which plays the same role in her life. She also has arrived at the
conclusion that she may not marry so long as she is sick. We may suspect
she became ill in order that she need not marry, and that she might stay
with her father.

It is impossible to evade the question of how, in what manner, and

driven by what motives, an individual may come by such a remarkable
and unprofitable attitude toward life. Granted of course that this bearing
is a general characteristic of neurosis, and not a special peculiarity of
these two cases, it is nevertheless a general trait in every neurosis of very
 230

great importance in practice. Breuer's first hysterical patient was fixated

in the same manner upon the time when she nursed her very sick father.
In spite of her recuperation she has, in certain respects, since that time,
been done with life; although she remained healthy and able, she did not
enter on the normal life of women. In every one of our patients we may
see, by the use of analysis, that in his disease-symptoms and their results
he has gone back again into a definite period of his past. In the majority
of cases he even chooses a very early phase of his life, sometime a
childhood phase, indeed, laughable as it may appear, a phase of his very
suckling existence.

The closest analogies to these conditions of our neurotics are furnished

by the types of sickness which the war has just now made so frequent—
the so-called traumatic neuroses. Even before the war there were such
cases after railroad collisions and other frightful occurrences which
endangered life. The traumatic neuroses are, fundamentally, not the
same as the spontaneous neuroses which we have been analysing and
treating; moreover, we have not yet succeeded in bringing them within
our hypotheses, and I hope to be able to make clear to you wherein this
limitation lies. Yet on one point we may emphasize the existence of a
complete agreement between the two forms. The traumatic neuroses
show clear indications that they are grounded in a fixation upon the
moment of the traumatic disaster. In their dreams these patients
regularly live over the traumatic situation; where there are attacks of an
hysterical type, which permit of an analysis, we learn that the attack
approximates a complete transposition into this situation. It is as if these
patients had not yet gotten through with the traumatic situation, as if it
were actually before them as a task which was not yet mastered. We take
this view of the matter in all seriousness; it shows the way to
an economic view of psychic occurrences. For the expression "traumatic"
has no other than an economic meaning, and the disturbance
permanently attacks the management of available energy. The traumatic
experience is one which, in a very short space of time, is able to increase
the strength of a given stimulus so enormously that its assimilation, or
rather its elaboration, can no longer be effected by normal means.

This analogy tempts us to classify as traumatic those experiences as well

upon which our neurotics appear to be fixated. Thus the possibility is
held out to us of having found a simple determining factor for the
 231

neurosis. It would then be comparable to a traumatic disease, and would

arise from the inability to meet an overpowering emotional experience.
As a matter of fact this reads like the first formula, by which Breuer and
I, in 1893-1895, accounted theoretically for our new observations. A case
such as that of our first patient, the young woman separated from her
husband, is very well explained by this conception. She was not able to
get over the unfeasibility of her marriage, and has not been able to
extricate herself from this trauma. But our very next, that of the girl
attached to her father, shows us that the formula is not sufficiently
comprehensive. On the one hand, such baby love of a little girl for her
father is so usual, and so often outlived that the designation "traumatic"
would carry no significance; on the other hand, the history of the patient
teaches us that this first erotic fixation apparently passed by harmlessly
at the time, and did not again appear until many years later in the
symptoms of the compulsion neurosis. We see complications before us,
the existence of a greater wealth of determining factors in the disease,
but we also suspect that the traumatic viewpoint will not have to be given
up as wrong; rather it will have to subordinate itself when it is fitted into
a different context.

Here again we must leave the road we have been traveling. For the time
being, it leads us no further and we have many other things to find out
before we can go on again. But before we leave this subject let us note
that the fixation on some particular phase of the past has bearings which
extend far beyond the neurosis. Every neurosis contains such a fixation,
but every fixation does not lead to a neurosis, nor fall into the same class
with neuroses, nor even set the conditions for the development of a
neurosis. Mourning is a type of emotional fixation on a theory of the
past, which also brings with it the most complete alienation from the
present and the future. But mourning is sharply distinguished from
neuroses that may be designated as pathological forms of mourning.

It also happens that men are brought to complete deadlock by a

traumatic experience that has so completely shaken the foundations on
which they have built their lives that they give up all interest in the
present and future, and become completely absorbed in their
retrospections; but these unhappy persons are not necessarily neurotic.
We must not overestimate this one feature as a diagnostic for a neurosis,
no matter how invariable and potent it may be.
 232

Now let us turn to the second conclusion of our analysis, which however
we will hardly need to limit subsequently. We have spoken of the
senseless compulsive activities of our first patient, and what intimate
memories she disclosed as belonging to them; later we also investigated
the connection between experience and symptom and thus discovered
the purpose hidden behind the compulsive activity. But we have entirely
omitted one factor that deserves our whole attention. As long as the
patient kept repeating the compulsive activity she did not know that it
was in any way related with the experience in question. The connection
between the two was hidden from her, she truthfully answered that she
did not know what compelled her to do this. Once, suddenly, under the
influence of the cure, she hit upon the connection and was able to tell it
to us. But still she did not know of the end in the service of which she
performed the compulsive activities, the purpose to correct a painful part
of the past and to place the husband, still loved by her, upon a higher
level. It took quite a long time and a great deal of trouble for her to grasp
and admit to me that such a motive alone could have been the motive
force of the compulsive activity.

The relation between the scene after the unhappy bridal night and the
tender motive of the patient yield what we have called the meaning of the
compulsive activity. But both the "whence" and the "why" remained
hidden from her as long as she continued to carry out the compulsive act.
Psychological processes had been going on within her for which the
compulsive act found an expression. She could, in a normal frame of
mind, observe their effect, but none of the psychological antecedents of
her action had come to the knowledge of her consciousness. She had
acted in just the same manner as a hypnotized person to whom
Bernheim had given the injunction that five minutes after his awakening
in the ward he was to open an umbrella, and he had carried out this
order on awakening, but could give no motive for his so doing. We have
exactly such facts in mind when we speak of the existence of unconscious
psychological processes. Let anyone in the world account for these facts
in a more correct scientific manner, and we will gladly withdraw
completely our assumption of unconscious psychological processes.
Until then, however, we shall continue to use this assumption, and when
anyone wants to bring forward the objection that the unconscious can
have no reality for science and is a mere makeshift, (une façon de
 233

parler), we must simply shrug our shoulders and reject his

incomprehensible statement resignedly. A strange unreality which can
call out such real and palpable effects as a compulsion symptom!

In our second patient we meet with fundamentally the same thing. She
had created a decree which she must follow: the pillow must not touch
the head of the bed; yet she does not know how it originated, what its
meaning is, nor to what motive it owes the source of its power. It is
immaterial whether she looks upon it with indifference or struggles
against it, storms against it, determines to overcome it. She must
nevertheless follow it and carry out its ordinance, though she asks
herself, in vain, why. One must admit that these symptoms of
compulsion neurosis offer the clearest evidence for a special sphere of
psychological activity, cut off from the rest. What else could be back of
these images and impulses, which appear from one knows not where,
which have such great resistance to all the influences of an otherwise
normal psychic life; which give the patient himself the impression that
here are super-powerful guests from another world, immortals mixing in
the affairs of mortals. Neurotic symptoms lead unmistakably to a
conviction of the existence of an unconscious psychology, and for that
very reason clinical psychiatry, which recognizes only a conscious
psychology, has no explanation other than that they are present as
indications of a particular kind of degeneration. To be sure, the
compulsive images and impulses are not themselves unconscious—no
more so than the carrying out of the compulsive-acts escapes
conscious observation. They would not have been symptoms had they
not penetrated through into consciousness. But their psychological
antecedents as disclosed by the analysis, the associations into which we
place them by our interpretations, are unconscious, at least until we have
made them known to the patient during the course of the analysis.

Consider now, in addition, that the facts established in our two cases are
confirmed in all the symptoms of all neurotic diseases, that always and
everywhere the meaning of the symptoms is unknown to the sufferer,
that analysis shows without fail that these symptoms are derivatives of
unconscious experiences which can, under various favorable conditions,
become conscious. You will understand then that in psychoanalysis we
cannot do without this unconscious psyche, and are accustomed to deal
with it as with something tangible. Perhaps you will also be able to
 234

understand how those who know the unconscious only as an idea, who
have never analyzed, never interpreted dreams, or never translated
neurotic symptoms into meaning and purpose, are most ill-suited to pass
an opinion on this subject. Let us express our point of view once more.
Our ability to give meaning to neurotic symptoms by means of analytic
interpretation is an irrefutable indication of the existence of unconscious
psychological processes—or, if you prefer, an irrefutable proof of the
necessity for their assumption.

But that is not all. Thanks to a second discovery of Breuer's, for which he
alone deserves credit and which appears to me to be even more far-
reaching, we are able to learn still more concerning the relationship
between the unconscious and the neurotic symptom. Not alone is the
meaning of the symptoms invariably hidden in the unconscious; but the
very existence of the symptom is conditioned by its relation to this
unconscious. You will soon understand me. With Breuer I maintain the
following: Every time we hit upon a symptom we may conclude that the
patient cherishes definite unconscious experiences which withhold the
meaning of the symptoms. Vice versa, in order that the symptoms may
come into being, it is also essential that this meaning be unconscious.
Symptoms are not built up out of conscious experiences; as soon as the
unconscious processes in question become conscious, the symptom
disappears. You will at once recognize here the approach to our therapy,
a way to make symptoms disappear. It was by these means that Breuer
actually achieved the recovery of his patient, that is, freed her of her
symptoms; he found a technique for bringing into her consciousness the
unconscious experiences that carried the meaning of her symptoms, and
the symptoms disappeared.

This discovery of Breuer's was not the result of a speculation, but of a

felicitous observation made possible by the coöperation of the patient.
You should therefore not trouble yourself to find things you already
know to which you can compare these occurrences, rather you should
recognize herein a new fundamental fact which in itself is capable of
much wider application. Toward this further end permit me to go over
this ground again in a different way.

The symptom develops as a substitution for something else that has

remained suppressed. Certain psychological experiences should
 235

normally have become so far elaborated that consciousness would have

attained knowledge of them. This did not take place, however, but out of
these interrupted and disturbed processes, imprisoned in the
unconscious, the symptom arose. That is to say, something in the nature
of an interchange had been effected; as often as therapeutic measures are
successful in again reversing this transposition, psychoanalytic therapy
solves the problem of the neurotic symptom.

Accordingly, Breuer's discovery still remains the foundation of

psychoanalytic therapy. The assertion that the symptoms disappear
when one has made their unconscious connections conscious, has been
borne out by all subsequent research, although the most extraordinary
and unexpected complications have been met with in its practical
execution. Our therapy does its work by means of changing the
unconscious into the conscious, and is effective only in so far as it has the
opportunity of bringing about this transformation.

Now we shall make a hasty digression so that you do not by any chance
imagine that this therapeutic work is too easy. From all we have learned
so far, the neurosis would appear as the result of a sort of ignorance, the
incognizance of psychological processes that we should know of. We
would thus very closely approximate the well-known Socratic teachings,
according to which evil itself is the result of ignorance. Now the
experienced physician will, as a rule, discover fairly readily what psychic
impulses in his several patients have remained unconscious. Accordingly
it would seem easy for him to cure the patient by imparting this
knowledge to him and freeing him of his ignorance. At least the part
played by the unconscious meaning of the symptoms could easily be
discovered in this manner, and it would only be in dealing with the
relationship of the symptoms to the experiences of the patient that the
physician would be handicapped. In the face of these experiences, of
course, he is the ignorant one of the two, for he did not go through these
experiences, and must wait until the patient remembers them and tells
them to him. But in many cases this difficulty could be readily overcome.
One can question the relatives of the patient concerning these
experiences, and they will often be in a position to point out those that
carry any traumatic significance; they may even be able to inform the
analyst of experiences of which the patient knows nothing because they
occurred in the very early years of his life. By a combination of such
 236

means it would seem that the pathogenic ignorance of the patient could
be cleared up in a short time and without much trouble.

If only that were all! We have made discoveries for which we were at first
unprepared. Knowing and knowing is not always the same thing; there
are various kinds of knowing that are psychologically by no means
comparable. "Il y a fagots et fagots," 39 as Molière says. The knowledge
of the physician is not the same as that of the patient and cannot bring
about the same results. The physician can gain no results by transferring
his knowledge to the patient in so many words. This is perhaps putting it
incorrectly, for though the transference does not result in dissolving the
symptoms, it does set the analysis in motion, and calls out an energetic
denial, the first sign usually that this has taken place. The patient has
learned something that he did not know up to that time, the meaning of
his symptoms, and yet he knows it as little as before. So we discover
there is more than one kind of ignorance. It will require a deepening of
our psychological insight to make clear to us wherein the difference lies.
But our assertion nevertheless remains true that the symptoms
disappear with the knowledge of their meaning. For there is only one
limiting condition; the knowledge must be founded on an inner change
in the patient which can be attained only through psychic labors directed
toward a definite end. We have here been confronted by problems which
will soon lead us to the elaboration of a dynamics of symptom formation.

I must stop to ask you whether this is not all too vague and too
complicated? Do I not confuse you by so often retracting my words and
restricting them, spinning out trains of thought and then rejecting them?
I should be sorry if this were the case. However, I strongly dislike
simplification at the expense of truth, and am not averse to having you
receive the full impression of how many-sided and complicated the
subject is. I also think that there is no harm done if I say more on every
point than you can at the moment make use of. I know that every hearer
and reader arranges what is offered him in his own thoughts, shortens it,
simplifies it and extracts what he wishes to retain. Within a given
measure it is true that the more we begin with the more we have left. Let
me hope that, despite all the by-play, you have clearly grasped the
essential parts of my remarks, those about the meaning of symptoms,

39 There are fagots and fagots.

 237

about the unconscious, and the relation between the two. You probably
have also understood that our further efforts are to take two directions:
first, the clinical problem—to discover how persons become sick, how
they later on accomplish a neurotic adaptation toward life; secondly, a
problem of psychic dynamics, the evolution of the neurotic symptoms
themselves from the prerequisites of the neuroses. We will undoubtedly
somewhere come on a point of contact for these two problems.

I do not wish to go any further to-day, but since our time is not yet up I
intend to call your attention to another characteristic of our two
analyses, namely, the memory gaps or amnesias, whose full appreciation
will be possible later. You have heard that it is possible to express the
object of psychoanalytic treatment in a formula: all pathogenic
unconscious experience must be transposed into consciousness. You will
perhaps be surprised to learn that this formula can be replaced by
another: all the memory gaps of the patient must be filled out, his
amnesias must be abolished. Practically this amounts to the same thing.
Therefore an important role in the development of his symptoms must
be accredited to the amnesias of the neurotic. The analysis of our first
case, however, will hardly justify this valuation of the amnesia. The
patient has not forgotten the scene from which the compulsion act
derives—on the contrary, she remembers it vividly, nor is there any other
forgotten factor which comes into play in the development of these
symptoms. Less clear, but entirely analogous, is the situation in the case
of our second patient, the girl with the compulsive ritual. She, too, has
not really forgotten the behavior of her early years, the fact that she
insisted that the door between her bedroom and that of her parents be
kept open, and that she banished her mother out of her place in her
parents' bed. She recalls all this very clearly, although hesitatingly and
unwillingly. Only one factor stands out strikingly in our first case, that
though the patient carries out her compulsive act innumerable times, she
is not once reminded of its similarity with the experience after the bridal-
night; nor was this memory even suggested when by direct questions she
was asked to search for its motivation. The same is true of the girl, for in
her case not only her ritual, but the situation which provoked it, is
repeated identically night after night. In neither case is there any actual
amnesia, no lapse of memory, but an association is broken off which
should have called out a reproduction, a revival in the memory. Such a
 238

disturbance is enough to bring on a compulsion neurosis. Hysteria,

however, shows a different picture, for it is usually characterized by most
grandiose amnesias. As a rule, in the analysis of each hysterical
symptom, one is led back to a whole chain of impressions which, upon
their recovery, are expressly designated as forgotten up to the moment.
On the one hand this chain extends back to the earliest years of life, so
that the hysterical amnesias may be regarded as the direct continuation
of the infantile amnesias, which hides the beginnings of our psychic life
from those of us who are normal. On the other hand, we discover with
surprise that the most recent experiences of the patient are blurred by
these losses of memory—that especially the provocations which favored
or brought on the illness are, if not entirely wiped out by the amnesia, at
least partially obliterated. Without fail important details have
disappeared from the general picture of such a recent memory, or are
placed by false memories. Indeed it happens almost regularly that just
before the completion of an analysis, certain memories of recent
experiences suddenly come to light. They had been held back all this
time, and had left noticeable gaps in the context.

We have pointed out that such a crippling of the ability to recall is

characteristic of hysteria. In hysteria symptomatic conditions also arise
(hysterical attacks) which need leave no trace in the memory. If these
things do not occur in compulsion-neuroses, you are justified in
concluding that these amnesias exhibit psychological characteristics of
the hysterical change, and not a general trait of the neuroses. The
significance of this difference will be more closely limited by the
following observations. We have combined two things as the meaning of
a symptom, its "whence," on the one hand, and its "whither" or "why," on
the other. By these we mean to indicate the impressions and experiences
whence the symptom arises, and the purpose the symptom serves. The
"whence" of a symptom is traced back to impressions which have come
from without, which have therefore necessarily been conscious at some
time, but which may have sunk into the unconscious—that is, have been
forgotten. The "why" of the symptom, its tendency, is in every case an
endopsychic process, developed from within, which may or may not have
become conscious at first, but could just as readily never have entered
consciousness at all and have been unconscious from its inception. It is,
after all, not so very significant that, as happens in the hysterias, amnesia
 239

has covered over the "whence" of the symptom, the experience upon
which it is based; for it is the "why," the tendency of the symptom, which
establishes its dependence on the unconscious, and indeed no less so in
the compulsion neuroses than in hysteria. In both cases the "why" may
have been unconscious from the very first.

By thus bringing into prominence the unconscious in psychic life, we

have raised the most evil spirits of criticism against psychoanalysis. Do
not be surprised at this, and do not believe that the opposition is directed
only against the difficulties offered by the conception of the unconscious
or against the relative inaccessibility of the experiences which represent
it. I believe it comes from another source.

Humanity, in the course of time, has had to endure from the hands of
science two great outrages against its naive self-love. The first was when
humanity discovered that our earth was not the center of the universe,
but only a tiny speck in a world-system hardly conceivable in its
magnitude.

This is associated in our minds with the name "Copernicus," although

Alexandrian science had taught much the same thing. The second
occurred when biological research robbed man of his apparent
superiority under special creation, and rebuked him with his descent
from the animal kingdom, and his ineradicable animal nature.

This re-valuation, under the influence of Charles Darwin, Wallace and

their predecessors, was not accomplished without the most violent
opposition of their contemporaries. But the third and most irritating
insult is flung at the human mania of greatness by present-day
psychological research, which wants to prove to the "I" that it is not even
master in its own home, but is dependent upon the most scanty
information concerning all that goes on unconsciously in its psychic life.

We psychoanalysts were neither the first, nor the only ones to announce
this admonition to look within ourselves. It appears that we are fated to
represent it most insistently and to confirm it by means of empirical data
which are of importance to every single person. This is the reason for the
widespread revolt against our science, the omission of all considerations
of academic urbanity, and emancipation of the opposition from all
restraints of impartial logic. We were compelled to disturb the peace of
 240

the world, in addition, in another manner, of which you will soon come
to know.