Mourning And Melancholia
(1917e)
My Contact With Josef
Popper-Lynkeus (1932c)
My Views On The Part
Played By Sexuality In The Aetiology Of The Neuroses
(1906a)
New Introductory
Lectures On Psycho-Analysis (1933a)
Notes Upon A Case Of
Obsessional Neurosis (1909d)
Observations And
Examples From Analytic Practice (1913h)
Observations On
Transference-Love (1915a)
Obsessive Actions And
Religious Practices (1907b)
On Beginning The
Treatment (1913c)
On Narcissism: An
Introduction (1914c)
On The History Of The
Psycho-Analytic Movement (1914d)
On The Occasion Of The
Opening Of The Hebrew University (1925c)
On
The Psychical Mechanism Of Hysterical Phenomena
(1893a)
On The Sexual Theories
Of Children (1908c)
On The Teaching Of
Psycho-Analysis In Universities (1919j)
On The Universal
Tendency To Debasement In The Sphere Of Love
(1912d)
On Transformations Of
Instinct As Exemplified In Anal Erotism
(1917c)
Preface To
Aichhorn's Wayward Youth (1925f)
Preface To Bourke's
Scatalogic Rites Of All Nations (1913k)
Preface To Freud's
Shorter Writings 1893-1906 (1906b)
Preface To Hermann
Nunberg's General Theory Of The Neuroses On A Psycho-Analytic
Basis (1932b)
Preface To J. J.
Putnam's Addresses On Psycho-Analysis
(1921a)
Preface To Marie
Bonaparte's The Life And Works Of Edgar Allan Poe
(1933d)
Preface To Max
Eitingon's Report On The Berlin Psycho-Analytic Policlinic
(1923g)
Preface To Maxim
Steiner's The Psychical Disorders Of Male Potency
(1913e)
Preface To Raymond De
Saussure's The Psycho-Analytic Method
(1922e)
Preface To Reik's
Ritual: Psycho-Analytic Studies (1919g)
Preface To Richard
Sterba's Dictionary Of Psycho-Analysis
(1936b)
Preface To Sandor
Ferenczi's Psycho-Analysis: Essays In The Field Of
Psycho-Analysis (1910b)
Preface To Ten Years Of
The Berlin Psycho-Analytic Institute (1930b)
Preface To Wilhelm
Stekel's Nervous Anxiety-States And Their Treatment
(1908f)
Prefatory Note To A
Paper By E. Pickworth Farrow (1926c)
Prospectus For Schriften
Zur Angewandten Seelenkunde (1907e)
Psychical (Or Mental)
Treatment (1890a)
Psycho-Analysis And
Telepathy (1941d [1921])
Psycho-Analysis And The
Establishment Of The Facts In Legal Proceedings
(1906c)
Psycho-Analytic Notes On
An Autobiographical Account Of A Case Of Paranoia
(1911c)
Psychopathic Characters
On The Stage (1942a [1905])
Recommendations To
Physicians Practising Psycho-Analysis (1912e)
Remarks On The Theory
And Practice Of Dream-Interpretation (1923c)
Remembering, Repeating
And Working-Through (1914g)
Review Of Wilhelm
Neutra's Letters To Neurotic Women
(1910m)
Sexuality In The
Aetiology Of The Neuroses (1898a)
Some Additional Notes On
Dream-Interpretation As A Whole (1925i)
Some Character-Types Met
With In Psycho-Analytic Work (1916d)
Some Dreams Of
Descartes' (1929b)
Some Elementary Lessons
In Psycho-Analysis (1940b [1938])
Some General Remarks On
Hysterical Attacks (1909a)
Some Neurotic Mechanisms
In Jealousy. Paranoia And Homosexuality
(1922b)
Some Psychical
Consequences Of The Anatomical Distinction Between The Sexes
(1925j)
Some Reflections On
Schoolboy Psychology (1914f)
Splitting Of The Ego In
The Process Of Defence (1940e [1938])
The Acquisition And
Control Of Fire (1932a)
The Antithetical Meaning
Of Primal Words (1910e)
The Claims Of
Psycho-Analysis To Scientific Interest
(1913j)
The Disposition To
Obsessional Neurosis (1913i)
The Dissolution Of The
Oedipus Complex (1924d)
The Dynamics Of
Transference (1912b)
The Economic Problem Of
Masochism (1924c)
The Expert Opinion In
The Halsmann Case (1931d)
The Future Of An
Illusion (1927c)
The Future Prospects Of
Psycho-Analytic Therapy (1910d)
The Handling Of
Dream-Interpretation In Psycho-Analysis
(1911e)
The Infantile Genital
Organization (1923e)
The Interpretation Of
Dreams (1900a)
The Loss Of Reality In
Neurosis And Psychosis (1924e)
The Moses Of
Michelangelo (1914b)
The Neuro-Psychoses Of
Defence (1894a)
The Occurrence In Dreams
Of Material From Fairy Tales (1913d)
The Psychical Mechanism
Of Forgetfulness (1898b)
The Psycho-Analytic View
Of Psychogenic Disturbance Of Vision (1910i)
The Psychogenesis Of A
Case Of Homosexuality In A Woman (1920a)
The Psychopathology Of
Everyday Life (1901b)
The Question Of Lay
Analysis (1926e)
The Resistances To
Psycho-Analysis (1925e)
The Sexual Enlightenment
Of Children (An Open Letter To Dr. M. Furst)
(1907c)
The Significance Of
Sequences Of Vowels (1911d)
The Subtleties Of A
Faulty Action (1935b)
The Theme Of The Three
Caskets (1913f)
Thoughts For The Times
On War And Death (1915b)
Three Essays On The
Theory Of Sexuality (1905d)
To Thomas Mann On His
Sixtieth Birthday (1935c)
Two Encyclopaedia
Articles (1923a)
Two Instances Of
Pathogenic Phantasies Revealed By The Patients Themselves
(1910j)
Two Lies Told By
Children (1913g)
Types Of Onset Of
Neurosis (1912c)
1
STUDIES ON HYSTERIA
(1893-1895)
2
Intentionally left blank
Studies On Hysteria
3
PREFACE TO THE FIRST EDITION
In 1893 we published a ‘Preliminary
Communication’¹ on a new method of examining and
treating hysterical phenomena. To this we added as concisely as
possible the theoretical conclusions at which we had arrived. We
are here reprinting this ‘Preliminary Communication’ to
serve as the thesis which it is our purpose to illustrate and
prove.
We have appended to it a series
of case histories, the selection of which could not unfortunately
be determined on purely scientific grounds. Our experience is
derived from private practice in an educated and literate social
class, and the subject matter with which we deal often touches upon
our patients’ most intimate lives and histories. It would be
a grave breach of confidence to publish material of this kind, with
the risk of the patients being recognized and their acquaintances
becoming informed of facts which were confided only to the
physician. It has therefore been impossible for us to make use of
some of the most instructive and convincing of our observations.
This of course applies especially to all those cases in which
sexual and marital relations play an important aetiological part.
Thus it comes about that we are only able to produce very
incomplete evidence in favour of our view that sexuality seems to
play a principal part in the pathogenesis of hysteria as a source
of psychical traumas and as a motive for ‘defence’ -
that is, for repressing ideas from consciousness. It is precisely
observations of a markedly sexual nature that we have been obliged
to leave unpublished.
The case histories are followed
by a number of theoretical reflections, and in a final chapter on
therapeutics the technique of the ‘cathartic method’ is
propounded, just as it has grown up under the hands of the
neurologist.
If at some points divergent and
indeed contradictory opinions are expressed, this is not to be
regarded as evidence of any fluctuation in our views. It arises
from the natural and justifiable differences between the opinions
of two observers who are agreed upon the facts and their basic
reading of them, but who are not invariably at one in their
interpretations and conjectures.
J. BREUER
,
S. FREUD
April
1895
¹
'On the Psychical Mechanism of
Hysterical Phenomena’,
Neurologisches Centralblatt
,
1893, Nos. 1 and 2.
Studies On Hysteria
4
PREFACE TO THE SECOND EDITION
The interest which, to an ever-increasing
degree, is being directed to psycho-analysis seems now to be
extending to these
Studies on Hysteria
. The publisher
desires to bring out a new edition of the book, which is at present
out of print. It appears now in a reprint, without any alterations,
though the opinions and methods which were put forward in the first
edition have since undergone far-reaching and profound
developments. So far as I personally am concerned, I have since
that time had no active dealings with the subject; I have had no
part in its important development and I could add nothing fresh to
what was written in 1895. So I have been able to do no more than
express a wish that my two contributions to the volume should be
reprinted without alteration.
BREUER
As regards my share of the book,
too, the only possible decision has been that the text of the first
edition shall be reprinted without alteration. The developments and
changes in my views during the course of thirteen years of work
have been too far-reaching for it to be possible to attach them to
my earlier exposition without entirely destroying its essential
character. Nor have I any reason for wishing to eliminate this
evidence of my initial views. Even to-day I regard them not as
errors but as valuable first approximations to knowledge which
could only be fully acquired after long and continuous efforts. The
attentive reader will be able to detect in the present book the
germs of all that has since been added to the theory of catharsis:
for instance, the part played by psychosexual factors and
infantilism, the importance of dreams and of unconscious symbolism.
And I can give no better advice to any one interested in the
development of catharsis into psycho-analysis than to begin with
Studies on Hysteria
and thus follow the path which I myself
have trodden.
FREUD
VIENNA
,
July
1908
Studies On Hysteria
5
I
PRELIMINARY COMMUNICATION
(1893)
(BREUER AND FREUD)
Studies On Hysteria
6
I
ON THE PSYCHICAL MECHANISM OF HYSTERICAL PHENOMENA:
PRELIMINARY COMMUNICATION (1893)
(BREUER AND FREUD)
I
A chance observation has led us, over a number
of years, to investigate a great variety of different forms and
symptoms of hysteria, with a view to discovering their
precipitating cause - the event which provoked the first
occurrence, often many years earlier, of the phenomenon in
question. In the great majority of cases it is not possible to
establish the point of origin by a simple interrogation of the
patient, however thoroughly it may be carried out. This is in part
because what is in question is often some experience which the
patient dislikes discussing; but principally because he is
genuinely unable to recollect it and often has no suspicion of the
causal connection between the precipitating event and the
pathological phenomenon. As a rule it is necessary to hypnotize the
patient and to arouse his memories under hypnosis of the time at
which the symptom made its first appearance; when this has been
done, it becomes possible to demonstrate the connection in the
clearest and most convincing fashion.
This method of examination has in
a large number of cases produced results which seem to be of value
alike from a theoretical and a practical point of view.
Studies On Hysteria
7
They are valuable theoretically
because they have taught us that external events determine the
pathology of hysteria to an extent far greater than is known and
recognized. 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 precipitating 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 paralyses, hysterical
attacks and epileptic convulsions, which every observer regarded as
true epilepsy,
petit mal
and disorders in the nature of
tic
, chronic vomiting and anorexia, carried to the pitch of
rejection of all nourishment, various forms of disturbance of
vision, constantly recurrent visual hallucinations, etc. The
disproportion between the many years’ duration of the
hysterical symptom and the single occurrence which provoked it is
what we are accustomed invariably to find in traumatic neuroses.
Quite frequently it is some event in childhood 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 the 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 the chair, went to sleep; from this there
developed a paresis of the same arm accompanied by contracture and
anaesthesia. She tried to pray but could find no words; a length
she succeeded in repeating a children’s prayer in English.
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. - The mother of a very sick child, which had at
last fallen asleep, concentrated her whole will-power on keeping
still so as not to waken it. 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. - A highly intelligent man
was present while his brother had an ankylosed hip-joint extended
under an anaesthetic. 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.
Studies On Hysteria
8
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 relation 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. In still other cases it is not possible to
understand at first sight how they can be determined in the manner
we have suggested. 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 pathogenesis of
common hysteria and that of the 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
physical injury but the affect of fright - the psychical trauma. 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, instead 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
thenceforward persists.
Studies On Hysteria
9
But the causal relation between the determining psychical trauma
and the hysterical phenomenon is not of a kind implying 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. 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. Where what we are dealing with are phenomena
involving stimuli (spasms, neuralgias and hallucinations) these
re-appear once again with the fullest intensity and then vanish for
ever. Failures of function, such as paralyses and anaesthesias,
vanish in the same way, though, of course, without the temporary
intensification being discernible.¹