Albert Llussà i Torra : A reading of the neuro-psychoses of defence

An atempt at a psychological theory of acquired hysteria, of many phobias and obsessions and of certain hallucinatory psychoses

 Introduction

In The Neuro-Psychoses of Defence Freud articulates the origin of phobias and obsessions, formulates a change to the theory of hysteria, and identifies an important characteristic that is common to both these neuroses as well as to the psychoses which he classifies as hallucinatory confusion. This common characteristic of all conditions is that they are brought about by an act of the ego in its attempt to defend itself from an incompatible idea.

Freud writes this essay in January 1894, a year after the Preliminary Communication and a year before the Studies of Hysteria, both of which co-authored with Joseph Breuer. At the time, Freud is still trying to articulate a psychological theory of the neuroses from a neurological point of view. He believes that neuroses can be explained by reference to what occurs physically in the brain and, specifically, in the chain of neurones which form the nervous system.[1]

The working hypothesis upon which Freud’s theory of the neuroses is based is enunciated in the second-last paragraph of this essay as follows:-

That in mental functions something is to be distinguished – a quota of affect or sum of excitation – which possesses all the characteristics of a quantity (though we have no means of measuring it), which is capable of increase, diminution, displacement and discharge, and which is spread over the memory-traces of ideas somewhat as an electric charge is spread over the surface of a body.[2]

This is a formulation of the theory of ‘cathexis’ (Besetzung[3]) in a purely physiological sense. Freud then regards these cathectic processes as material events, presupposing two basic assumptions: one, the validity of the recent histological discovery that the nervous system consisted of chains of neurones; and two, the idea that excitation of the neurones was to be regarded as ‘a quantity, subject to the general laws of motion’. A ‘cathected’ neurone is one filled with a certain quantity, though at other times it may be empty. Although cathexis is here used primarily as a neurological event, Freud’s thoughts are being more and more diverted to psychology. In the Project[4], written eighteen months later, he attempts to state the facts of psychology in neurological terms, but the attempt failed.[5]

References to expressions such as “quota of affect” or “sum of excitation”, “quantity (though unmeasurable)”, “capable of increase, diminution, displacement and discharge”, “spread over memory-traces of ideas” must therefore be understood as describing in a physical, neurological sense, the mental processes underlying the neuroses which are the subject of study.

The paper is divided in three sections: the first one deals with hysteria, the second with obsession and phobias, whereas the third explores hallucinatory confusion.

I

Hysteria

The view then commonly held was that what defined hysteria was a splitting of consciousness, accompanied by the formation of separate psychical groups. Different opinions existed, however, as to the origin of this splitting of consciousness and the part it played in the structure of hysterical neurosis.

For Janet the splitting of consciousness was a primary feature of hysteria. Hysteria was based on an innate weakness of the capacity for psychical synthesis, on the narrowness of the ‘field of consciousness’, which evidenced the degeneracy of hysterical individuals.

For Breuer the splitting of consciousness was secondary, acquired, whereas ‘the basis and sine qua non of hysteria’ was the occurrence of peculiar dream-like states of consciousness with a restricted capacity for association. These Breuer called hypnoid states. The splitting of consciousness comes about because the ideas which emerge in hypnoid states are cut off from associative communication with the rest of the content of consciousness.

Freud refers to two other forms of hysteria in which the splitting of consciousness is not a primary feature: defence hysteria¸ in which the splitting of the content of consciousness is the result of an act of will on the part of the patient; and retention hysteria, in which the splitting of consciousness plays an insignificant part or none at all. Whereas in defence hysteria the symptom is the result of the ego’s reaction to traumatic stimuli, in retention hysteria the reaction to traumatic stimuli fails to occur. In addition, for Freud defence hysteria is acquired, not hereditary or degenerative.

Further, Freud observed a connection between, on the one hand, defence hysteria and, on the other, phobias and obsessions in his patients, which he describes in these terms:-

[T]hese patients whom I analysed had enjoyed good mental health up until the moment at which an occurrence of incompatibility took place in their ideational life – that is to say, until their ego was faced with an experience, an idea or a feeling which aroused such a distressing affect that the subject decided to forget about it because he had no confidence in his power to resolve the contradiction between that incompatible idea and his ego by means of thought-activity.[6]

In other words, the subject is faced with an experience, idea or feeling of great distressing affect. There is a contradiction between the incompatible idea and the ego which the subject cannot resolve by means of thought-activity. For this reason he decides to forget about it.

Freud says that in females, these incompatible ideas are usually in relation to sexual experience and sensation. The patients try to defend themselves by ‘pushing the idea away’, by not thinking of it, by suppressing it. He refers to the case histories of Fräulein Elisabeth von R and Miss Lucy R.

Perhaps not all efforts of will to thrust things out of one’s thoughts are pathological acts, and perhaps a healthy person might actually also fail at intentionally forgetting them; but all the patients analysed by Freud did not succeed in forgetting these thoughts; rather they developed pathological reactions in the form of hysteria or obsession or hallucinatory psychosis.

The developing of one of these conditions, Freud says, indicates a pathological disposition, but such disposition is not necessarily identical with ‘degeneracy’.

How does the person’s effort of will lead to the onset of a neurotic symptom? What happens is that the ego tries, but fails to completely suppress, push away, an incompatible idea.[7] Both the memory-trace and the affect are there[8] once and for all and cannot be eradicated.

The ego however can try to turn this powerful distressing idea into a weak one. How? By robbing it of the affect –the sum of excitation- with which it is loaded. If it succeeds, the ego will get close to reaching its objective of keeping at bay the incompatible, distressing idea. When this occurs, the weak idea will then have virtually no demands to make on the work of association,[9] but the sum of excitation, the affect, will have to be put to another use.

But to which use is it put? Where does this ‘sum of excitation’, this affect, go? And how does it get there?

Up until this point, hysteria, phobias and obsessions share the same process: the subject’s ego, through an act of will, pushes the incompatible idea thereby causing its memory-trace and its affect to become dissociated. From now on, however, the paths of these different neuroses diverge.

In hysteria the affect is transformed, converted, into something somatic. The conversion proceeds to a motor or sensory innervation[10], related to the traumatic experience. In this way, the ego succeeds in freeing itself from the contradiction, but instead it has burdened itself with a mnemic symbol. This remains in consciousness, like a sort of parasite, either in the form of an unresolvable motor innervation or as a constantly recurring hallucinatory sensation, and which persists until a conversion in the opposite direction takes place. The memory-trace of the repressed idea has, after all, not been dissolved, but rather it forms the nucleus of a second psychical group.

After describing the circumstances in which such a nucleus of a second psychical group can be increased at other traumatic moments, Freud states:-

The excitation which is forced into a wrong channel (into somatic innervation) now and then finds its way back to the idea from which it has been detached, and it then compels the subject either to work over the idea associatively or to get rid of it in hysterical attacks.[11]

Freud alludes to the therapeutic power of speaking which can be achieved through Breuer’s cathartic method by saying that it leads the excitation from the somatic back to the psychical sphere deliberately, forcing the subject to bring about a settlement of the contradiction between the incompatible idea and the ego by means of thought-activity and a discharge of the excitation by talking.

The theory that the splitting of consciousness which occurs in acquired hysteria is based upon an act of will explains why hypnosis regularly widens the restricted consciousness of a hysteric and allows access to the physical group that has been split off: this is because all states resembling sleep such as hypnosis suspend the distribution of excitation on which the ‘will’ of the conscious personality is based.

In other words, in hypnosis and other states resembling sleep, the will is suspended. Without the will, the subject can be led to access the psychical group that has been split off and which is inaccessible to the subject in the waking state, that is, because the ego puts up a defence against the incompatible idea causing the splitting of consciousness into two separate psychical groups.

Thus, what characterises hysteria is not the splitting of consciousness but the capacity for conversion. Freud further states that a psycho-physical aptitude for transposing very large sums of excitation into the somatic innervation may explain a disposition to hysteria. This physical aptitude, however, does not exclude psychical health and only leads to hysteria if there is a psychical incompatibility or an accumulation of excitation.

II

 Obsessional Neurosis

Obsessional neurosis occurs in persons with a disposition to neurosis but who lack the aptitude for conversion. In these cases, the affect, detached from the incompatible idea, instead of converting into somatic innervation, attaches itself to other ideas which are not incompatible. There is a ‘false connection’ between the freed affect and this other ideas, which turn into obsessional ideas.

Freud notes that in all cases he analysed the source of the affect (which is now in a false connection) was the subject’s sexual life. While Freud does not exclude the possibility that the source could be elsewhere, he never came across any other origin. He notes, further, that it is easy to see that it is precisely sexual life which provides the most copious occasions for the emergence of incompatible ideas.

Often it is the patients themselves who confirm this: a patient might say ‘Something very disagreeable happened to me once and I tried very hard to put it away. I succeeded but then I got this other thing’.[12]

As a rule, however, patients deny the sexual origin of their symptoms: ‘It can’t come from that. I didn’t think at all much about that. For a moment I was frightened, but I turned my mind away from it and I haven’t been troubled by it since’. Freud states that this is evidence that the obsession represents a substitute or surrogate for the incompatible idea and has taken its place in consciousness.

But how does the patient’s effort of will which succeeds in repressing an unacceptable sexual idea give rise to an obsessional one? First of all, these processes occur without consciousness. These processes are not of a psychical nature at all, Freud says, but they are physical processes whose psychical consequences present themselves as if what is expressed by the terms ‘separation of the idea from its affect’ and ‘false connection’ of the latter had really taken place.

In some cases an incompatible sexual idea and an obsessional idea are present simultaneously, and not one after the other. It would not be correct to call them sexual obsessional ideas, because obsessional ideas lack any justification, whereas in these instances the incompatible sexual ideas are fully justified. What is going on here is that there is a ‘perpetual defence against ideas that are continually coming up afresh’.

The affect which attaches to the non-distressing obsessional idea seems to be dislodged or transposed (i.e. displaced). So, if in hysteria there is conversion of the affect, in obsessions there is displacement of the affect.

And which ideas can the subject make use of to provide a secondary connection for the liberated affect? Firstly, any idea which is able, from its nature, to be united with an affect of the quality in question; secondly, an idea which has certain relations to the incompatible idea such that it could serve as a surrogate for it. For example, the affect of liberated anxiety will seize upon common primary phobias about animals, thunderstorms, darkness etc. or upon things which are unmistakably associated with what is sexual such as micturition, defaecation.[13]

Freud then makes the point that the ego gains much less advantage from choosing transposition (i.e. displacement) of affect as a defence than the hysterical conversion of psychical excitation into somatic innervation.[14]

The paper then gives the examples of three women who suffered from different obsessional and phobic symptoms: a girl who developed obsessional self-reproaches as a result of over-indulging in masturbation; a sexually hyperaesthetic girl was so frightened by the sexual sensation which accompanied her erotic reverie, and which ended with a slight need to urinate, that she developed a dread of being overcome by the need to urinate and of being unable to avoid wetting herself; and a young married woman who suffered from an impulse to throw herself out of the window and a fear of stabbing her child because she lost confidence in herself and regarded herself as a depraved person, capable of anything, on account of the poverty of her marriage, in which intercourse seldom occurred, and who as a result of this would develop erotic ideas at the sight of a man.

III

 Hallucinatory Confusion

In the last section of this essay Freud explains that a much more energetic and successful kind of defence occurs in hallucinatory confusion. Whereas in hysteria and obsessions and phobias the ego defends itself against the incompatible idea by separating it from its affect, leading to a weakened and isolated idea, but which remains in consciousness, sometimes the ego rejects the incompatible idea together with its affect, and behaves as if the idea had never occurred to the ego at all. When this occurs, the subject is in a psychosis, a ‘hallucinatory confusion’.

A few examples are given: a girl who believed a man would ask for her hand is so disappointed when he does not that she passes into a state of hallucinatory confusion, believing that he has in fact come to ask her hand; A mother who rocks a piece of wood thinking that it is her dead baby; a jilted bride who waits for years for her bridegroom arrayed in her wedding-dress.

Freud notes that the content of the hallucinatory psychosis consists precisely in the accentuation of the idea which was threatened by the precipitating cause of the onset of the illness. The ego has fended off the incompatible idea through a flight into psychosis. The process, once again, eludes the subject’s self-perception, as it eludes psychologico-clinical analysis. According to Freud, this process must be regarded as the expression of a pathological disposition to a fairly high degree.

The process proceeds as follows: ‘the ego breaks away from the incompatible idea; but the latter is inseparably connected with a piece of reality, so that, in so far as the ego achieves this result, it, too, has detached itself wholly or in part from reality.’[15]

Concluding Comment

While this essay still owes a lot to the influence of Charcot and Breuer, Freud’s own views begin to emerge: the theory of defence; the important part played by sexuality; indirect references are made to the ‘unconscious’; and the fundamental theory of cathexis and its displaceability.

Albert Llussà i Torra*