It was reprinted not only in the present book, but also in the first of Freud's collected volumes of his shorter works, Sammlung kleiner Schriften zur Neurosenlehre The following footnote was appended to this latter reprint: 'Also printed as an introduction to Studies on Hysteria, , in which Josef Breuer and I further developed the views expressed here and illustrated them by case histories.
It is of course obvious that in cases of 'traumatic' hysteria what provokes the symptoms is the accident. The causal connection is equally evident in hysterical attacks when it is possible to gather from the patient's utterances that in each attack he is hallucinating the same event which provoked the first one. The situation is more obscure in the case of other phenomena. Our experiences have shown us, however, that the most various symptoms, which are ostensibly spontaneous and, as one might say, idiopathic products of hysteria, are just as strictly related to the pre- cipitating trauma as the phenomena to which we have just alluded and which exhibit the connection quite clearly.
The symptoms which we have been able to trace back to precipitating factors of this sort include neuralgias and anaesthesias of very various kinds, many of which had persisted for years, contractures and par- alyses, hysterical attacks and epileptoid convulsions, which every observer regarded as true epilepsy, petit mat and disorders in the nature of tic, chronic vomiting and anorexia, carried to the pitch of rejection of all nourishment, various forms of dis- turbance of vision, constantly recurrent visual hallucinations, etc.
The disproportion between the many years' duration of the hysterical symptom and the single occurrence which pro- voked it is what we are accustomed invariably to find in traumatic neuroses. Quite frequently it is some event in child- hood that sets up a more or less severe symptom which persists during the years that follow. The connection is often so clear that it is quite evident how it was that the precipitating event produced this particular phenomenon rather than any other. In that case the symptom has quite obviously been determined by the precipitating cause.
We may take as a very commonplace instance a painful emotion arising during a meal but suppressed at the time, and then producing nausea and vomiting which persists for months in the form of hysterical vomiting. A girl, watching beside a sick-bed in a torment of anxiety, fell into a twilight state and had a terrifying hallucination, while her right arm, which was hanging over the back of her chair, went to sleep; from this there developed a paresis of the same arm accompanied by contracture and anaesthesia.
When subsequently a severe and highly complicated hysteria developed, she could only speak, write and understand English, while her native language remained unintelligible to her for eighteen months. Precisely on account of her intention she made a 'clacking' noise with her tongue. An instance of hysterical counter- will'. This noise was repeated on a subsequent occasion on which she wished to keep perfectly still; and from it there developed a tic which, in the form of a clacking with the tongue, occurred over a period of many years whenever she felt excited.
At the instant at which the joint gave way with a crack, he felt a violent pain in his own hip-joint, which persisted for nearly a year. Further instances could be quoted. In other cases the connection is not so simple. It consists only in what might be called a 'symbolic' relation between the precipitating cause and the pathological phenomenon a rela- tion such as healthy people form in dreams.
For instance, a neuralgia may follow upon mental pain or vomiting upon a feeling of moral disgust. We have studied patients who used to make the most copious use of this sort of symbolization. It is precisely the typical hysterical symptoms which fall into this class, such as hemi-anaesthesia, contraction of the field of vision, epileptiform convulsions, and so on.
An explanation of our views on this group must be reserved for a fuller discussion of the subject. Observations such as these seem to us to establish an analogy between the patho genesis of common hysteria and that of traumatic neuroses, and to justify an extension of the concept of traumatic hysteria.
In traumatic neuroses the operative cause of the illness is not the trifling 1 [This patient is the subject of the first case history; see below, p- 2! In an analogous manner, our investigations reveal, for many, if not for most, hysterical symptoms, precipitating causes which can only be described as psychical traumas.
Any experience which calls up distressing affects such as those of fright, anxiety, shame or physical pain may operate as a trauma of this kind; and whether it in fact does so depends naturally enough on the susceptibility of the person affected as well as on another condition which will be mentioned later. In the case of common hysteria it not infrequently happens that, in- stead of a single, major trauma, we find a number of partial traumas forming a group of provoking causes.
These have only been able to exercise a traumatic effect by summation and they belong together in so far as they are in part components of a single story of suffering. There are other cases in which an apparently trivial circumstance combines with the actually operative event or occurs at a time of peculiar susceptibility to stimulation and in this way attains the dignity of a trauma which it would not otherwise have possessed but which thence- forward persists.
But the causal relation between the determining psychical trauma and the hysterical phenomenon is not of a kind imply- ing that the trauma merely acts like an agent provocateur in releasing the symptom, which thereafter leads an independent existence. We must presume rather that the psychical trauma or more precisely the memory of the trauma acts like a foreign body which long after its entry must continue to be regarded as an agent that is still at work; and we find the evidence for this in a highly remarkable phenomenon which at the same time lends an important practical interest to our findings.
For we found, to our great surprise at first, that each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying affect, and when the patient had described that event in the greatest possible detail and had put the affect into words.
Recollection without affect almost invariably, produces no result.
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The psychical process which originally took place must be repeated as vividly as possible; it must be brought back to its status nascendi and then given verbal utterance. Failures of function, such as paralyses and anaesthesias, vanish in the same way, though, of course, with- out the temporary intensification being discernible. This, how- ever, is not so.
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The first case of this kind that came under observation dates back to the year , that is to say to the 'pro-suggestion' era. A highly complicated case of hysteria was analysed in this way, and the symptoms, which sprang from separate causes, were separately removed. This observation was made possible by spontaneous auto-hypnoses on the part of the patient, and came as a great surprise to the observer. Hysterics suffer mainly from reminiscences. II remet le sujet dans 1'etat ou le mal s'est manifeste et combat par la parole le meme mal, rnais renaissant.
He puts the subject back into the state in which his trouble first appeared and uses words to combat that trouble, as it now makes a fresh emergence. In Janet's interesting study on mental automatism , there is an account of the cure of a hysterical girl by a method analogous to ours. The following considerations may perhaps make this a little more intelligible. The fading of a memory or the losing of its affect depends on various factors. The most important of these is whether there has been an energetic reaction to the event that provokes an affect. By 'reaction' we here understand the whole class of voluntary and involuntary reflexes from tears to acts of revenge in which, as experience shows us, the affects are discharged.
If this reaction takes place to a sufficient amount a large part of the affect disappears as a result.
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If the reaction is suppressed, the affect remains attached to the memory. An injury that has been repaid, even if only in words, is recollected quite differently from one that has had to be accepted. Lan- guage recognizes this distinction, too, in its mental and physical consequences; it very characteristically describes an injury that has been suffered in silence as 'a mortification' [ Krdnkung' 9 lit.
The injured person's reaction to the trauma only exercises a completely 'cathartic' effect if it is an adequate reaction as, for instance, revenge. But language serves as a substitute for action; by its help, an affect can be 'abreacted' almost as effectively. If there is no such reaction, whether in deeds or words, or in the mildest cases in tears, any recollection of the event retains its affective tone to begin with.
We have found the nearest approach to what we have to say on the theoretical and therapeutic sides of the question in some remarks, published from time to time, by Benedikt.
These we shall deal with elsewhere. Freud had used the term 'abreaction' previously June 28, , in a letter to Fliess referring to the present paper Freud, , Letter 9.
A memory of such a trauma, even if it has not been abreacted, enters the great complex of associations, it comes alongside other experiences, which may contradict it, and is subjected to rectification by other ideas. After an accident, for instance, the memory of the danger and the mitigated repetition of the fright becomes associated with the memory of what happened afterwards rescue and the consciousness of present safety. Again, a person's memory of a humiliation is corrected by his putting the facts right, by considering his own worth, etc. In this way a normal person is able to bring about the disappearance of the accompanying affect through the process of association.
Our observations have shown, on the other hand, that the memories which have become the determinants of hysterical phenomena persist for a long time with astonishing freshness and with the whole of their affective colouring. We must, how- ever, mention another remarkable fact, which we shall later be able to turn to account, namely, that these memories, unlike other memories of their past lives, are not at the patients' dis- posal.
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Not until they have been questioned under hypnosis do these memories emerge with the undiminished vividness of a recent event. Thus, for six whole months, one of our patients reproduced under hypnosis with hallucinatory vividness everything that had excited her on the same day of the previous year during an attack of acute hysteria.
A diary kept by her mother with- out her knowledge proved the completeness of the reproduction [p. Moreover, certain memories of aetiological importance which dated back 10 I. This can only be explained on the view that these memories constitute an exception in their relation to all the wearing-away processes which we have discussed above. In the first group are those cases in which the patients have not reacted to a psychical trauma because the nature of the trauma excluded a reaction, as in the case of the apparently irreparable loss of a loved person or because social circumstances made a reaction impossible or because it was a question of things which the patient wished to forget, and therefore inten- tionally repressed x from his conscious thought and inhibited and suppressed.
Freud's own first published use of the word was in the second section of his first paper on anxiety neurosis ; and it occurs several times in his later con- tributions to the present volume e. At this period 'repres- sion' was used as an equivalent to 'defence' "Abwehr" , as is shown, for instance, in the joint Preface to the First Edition p.
The word 'defence' does not occur in the 'Preliminary Communication', however. It first appeared in Section I of Freud's first paper on 'The Neuro- Psychoses of Defence' , and, like 'repression' is freely used by him in the later parts of the Studies e. Breuer uses both terms in his theoretical chapter e. On some of its earlier appearances the term 'repressed' is accompanied as here by the adverb 'intentionally' 'absichtlich' or by 'deliberately' 'willkiirtich''.
This is expanded by Freud in one place , where he states that the act of repression is 'introduced by an effort of will, for which the motive can be assigned'. Thus the word 'intentionally 1 merely indicates the existence of a motive and carries no implication of conscious intention. Indeed, a little later, at the beginning of his second paper on 'The Neuro-Psychoses of Defence' , Freud explicitly describes the psychical mechanism of defence as 'unconscious'. Some remarks on the origin of the concept of repression will be found in the Editor's Introduction, p.
The second group of conditions are determined, not by the content of the memories but by the psychical states in which the patient received the experiences in question.
For we find, under hypnosis, among the causes of hysterical symptoms ideas which are not in themselves significant, but whose persistence is due to the fact that they originated during the prevalence of severely paralysing affects, such as fright, or during positively abnormal psychical states, such as the semi-hypnotic twilight state of day-dreaming, auto-hypnoses, and so on. In such cases it is the nature of the states which makes a reaction to the event impossible.