¹
An ‘end of the world’ based
upon other motives is to be found at the climax of the ecstasy of
love (cf. Wagner’s
Tristan und Isolde
); in this case
it is not the ego but the single love-object which absorbs all the
cathexes directed upon the external world.
²
Cf. Abraham (1908) and Jung (1907).
Abraham’s short paper contains almost all the essential views
put forward in the present study of the case of
Schreber.
³
He has perhaps withdrawn from it not only
his libidinal cathexis, but his interest in general - that is, the
cathexes that proceed from his ego as well. This question is
discussed below.
4
[Woe! Woe!
Thou
hast it destroyed,
The
beautiful world,
With
powerful fist!
In
ruins 'tis hurled,
By the
blow of a demigod shattered!
. . . . .
Mightier
For
the children of men,
More
splendid
Build
it again,
In
thine own bosom build it anew!]
Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia
2438
In the meantime, however, it is a
source of some satisfaction to find that our newly acquired
knowledge involves us in a number of further discussions.
(1) Our first reflection will
tell us that it cannot be the case that this detachment of the
libido occurs exclusively in paranoia; nor can it be that, where it
occurs elsewhere, it has such disastrous consequences. It is quite
possible that a detachment of the libido is the essential and
regular mechanism of every repression. We can have no positive
knowledge on that point until the other disorders that are based
upon repression have been similarly examined. But it is certain
that in normal mental life (and not only in periods of mourning) we
are constantly detaching our libido in this way from people or from
other objects without falling ill. When Faust freed himself from
the world by uttering his curses, the result was not a paranoia or
any other neurosis but simply a certain general frame of mind. The
detachment of the libido, therefore, cannot in itself be the
pathogenic factor in paranoia; there must be some special
characteristic which distinguishes a paranoic detachment of the
libido from other kinds. It is not difficult to suggest what that
characteristic may be. What use is made of the libido after it has
been set free by the process of detachment? A normal person will at
once begin looking about for a substitute for the lost attachment;
and until that substitute has been found the liberated libido will
be kept in suspension within his mind, and will there give rise to
tensions and colour his mood. In hysteria the liberated libido
becomes transformed into somatic innervations or into anxiety. But
in paranoia the clinical evidence goes to show that the libido,
after it has been withdrawn from the object, is put to a special
use. It will be remembered that the majority of cases of paranoia
exhibit traces of megalomania, and that megalomania can by itself
constitute a paranoia. From this it may be concluded that in
paranoia the liberated libido becomes attached to the ego, and is
used for the aggrandizement of the ego. A return is thus made to
the stage of narcissism (known to us from the development of the
libido), in which a person’s only sexual object is his own
ego. On the basis of this clinical evidence we can suppose that
paranoics have brought along with them a
fixation at the stage
of narcissism
, and we can assert that the length of
the step
back from sublimated homosexuality to narcissism
is a measure
of the amount of
regression
characteristic of paranoia.
Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia
2439
(2) An equally plausible
objection can be based upon Schreber’s case history, as well
as upon many others. For it can be urged that the delusions of
persecution (which were directed against Flechsig ) unquestionably
made their appearance at an earlier date than the phantasy of the
end of the world; so that what is supposed to have been a return of
the repressed actually preceded the repression itself - and this is
patent nonsense. In order to meet this objection we must leave the
high ground of generalization and descend to the detailed
consideration of actual circumstances, which are undoubtedly very
much more complicated. We must admit the possibility that a
detachment of the libido such as we are discussing might just as
easily be a partial one, a drawing back from some single complex,
as a general one. A partial detachment should be by far the
commoner of the two, and should precede a general one, since to
begin with it is only for a partial detachment that the influences
of life provide a motive. The process may then stop at the stage of
a partial detachment or it may spread to a general one, which will
loudly proclaim its presence in the symptoms of megalomania. Thus
the detachment of the libido from the figure of Flechsig may
nevertheless have been what was primary in the case of Schreber; it
was immediately followed by the appearance of the delusion, which
brought back the libido on to Flechsig again (though with a
negative sign to mark the fact that repression had taken place) and
thus annulled the work of repression. And now the battle of
repression broke out anew, but this time with more powerful
weapons. In proportion as the object of contention became the most
important thing in the external world, trying on the one hand to
draw the whole of the libido on to itself, and on the other hand
mobilizing all the resistances against itself, so the struggle
raging around this single object became more and more comparable to
a general engagement; till at length a victory for the forces of
repression found expression in a conviction that the world had come
to an end and that the self alone survived. If we review the
ingenious constructions which were raised by Schreber’s
delusion in the domain of religion - the hierarchy of God, the
proved souls, the fore-courts of Heaven, the lower and the upper
God - we can gauge in retrospect the wealth of sublimations which
were brought down in ruin by the catastrophe of the general
detachment of his libido.
Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia
2440
(3) A third consideration which
arises from the views that have been developed in these pages is as
follows. Are we to suppose that a general detachment of the libido
from the external world would be an effective enough agent to
account for the ‘end of the world’? Or would not the
ego-cathexes which still remained in existence have been sufficient
to maintain
rapport
with the external world? To meet this
difficulty we should either have to assume that what we call
libidinal cathexis (that is, interest emanating from erotic
sources) coincides with interest in general, or we should have to
consider the possibility that a very widespread disturbance in the
distribution of libido may bring about a corresponding disturbance
in the ego-cathexes. But these are problems which we are still
quite helpless and incompetent to solve. It would be otherwise if
we could start out from some well-grounded theory of instincts; but
in fact we have nothing of the kind at our disposal. We regard
instinct as being the concept on the frontier-line between the
somatic and the mental, and see in it the psychical representative
of organic forces. Further, we accept the popular distinction
between ego-instincts and a sexual instinct; for such a distinction
seems to agree with the biological conception that the individual
has a double orientation, aiming on the one hand at
self-preservation and on the other at the preservation of the
species. But beyond this are only hypotheses, which we have taken
up - and are quite ready to drop again - in order to help us to
find our bearings in the chaos of the obscurer processes of the
mind. What we expect from psycho-analytic investigations of
pathological mental processes is precisely that they shall drive us
to some conclusions on questions connected with the theory of
instincts. These investigations, however, are in their infancy and
are only being carried out by isolated workers, so that the hopes
we place in them must still remain unfulfilled. We can no more
dismiss the possibility that disturbances of the libido may react
upon the ego-cathexes than we can overlook the converse possibility
- namely, that a secondary or induced disturbance of the libidinal
processes may result from abnormal changes in the ego. Indeed, it
is probable that processes of this kind constitute the distinctive
characteristic of psychoses. How much of all this may apply to
paranoia it is impossible at present to say. There is one
consideration, however, on which I should like to lay stress. It
cannot be asserted that a paranoic, even at the height of the
repression, withdraws his interest from the external world
completely - as must be considered to occur in certain other kinds
of hallucinatory psychosis (such a Meynert’s amentia). The
paranoic perceives the external world and takes into account any
alterations that may happen in it, and the effect it makes upon him
stimulates him to invent explanatory theories (such as
Schreber’s ‘cursorily improvised men’). It
therefore appears to me far more probable that the paranoic’s
altered relation to the world is to be explained entirely or in the
main by the loss of his libidinal interest.
Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia
2441
(4) It is impossible to avoid
asking, in view of the close connection between the two disorders,
how far this conception of paranoia will affect our conception of
dementia praecox. I am of opinion that Kraepelin was entirely
justified in taking the step of separating off a large part of what
had hitherto been called paranoia and merging it, together with
catatonia and certain other forms of disease, into a new clinical
unit - though ‘dementia praecox’ was a particularly
unhappy name to choose for it. The designation chosen by Bleuler
for the same group of forms - ‘schizophrenia’ - is also
open to the objection that the name appears appropriate only so
long as we forget its literal meaning. For otherwise it prejudices
the issue, since it is based on a characteristic of the disease
which is theoretically postulated - a characteristic, moreover,
which does not belong exclusively to that disease, and which, in
the light of other considerations, cannot be regarded as the
essential one. However, it is not on the whole of very great
importance what names we give to clinical pictures. What seems to
me more essential is that paranoia should be maintained as an
independent clinical type, however frequently the picture it offers
may be complicated by the presence of schizophrenic features. For,
from the standpoint of the libido theory, while it would resemble
dementia praecox in so far as the repression proper would in both
disorders have the same principal feature - detachment of the
libido, together with its regression on to the ego - it would be
distinguished from dementia praecox by having its dispositional
fixation differently located and by having a different mechanism
for the return of the repressed (that is, for the formation of
symptoms). It would seem to me the most convenient plan to give
dementia praecox the name of
paraphrenia
. This term has no
special connotation, and it would serve to indicate a relationship
with paranoia (a name which cannot be changed) and would further
recall hebephrenia, an entity which is now merged in dementia
praecox. It is true that the name has already been proposed for
other purposes; but this need not concern us, since the alternative
applications have not passed into general use.
Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia
2442
Abraham has very convincingly
shown ¹ that the turning away of the libido from the external
world is a particularly clearly-marked feature in dementia praecox.
From this feature we infer that the repression is effected by means
of detachment of the libido. Here once more we may regard the phase
of violent hallucinations as a struggle between repression and an
attempt at recovery by bringing the libido back again on to its
objects. Jung, with extraordinary analytic acumen, has perceived
that the deliria² and motor stereotypes occurring in this
disorder are the residues of former object-cathexes, clung to with
great persistence. This attempt at recovery, which observers
mistake for the disease itself, does not, as in paranoia, make use
of projection, but employs a hallucinatory (hysterical) mechanism.
This is one of the two major respects in which dementia praecox
differs from paranoia; and this difference can be explained
genetically from another direction. The second difference is shown
by the outcome of the disease in those cases where the process has
not remained too restricted. The prognosis is on the whole more
unfavourable than in paranoia. The victory lies with repression and
not, as in the former, with reconstruction. The regression extends
not merely to narcissism (manifesting itself in the shape of
megalomania) but to a complete abandonment of object-love and a
return to infantile auto-erotism. The dispositional fixation must
therefore be situated further back than in paranoia, and must lie
some where at the beginning of the course of development from
auto-erotism to object-love. Moreover, it is not at all likely that
homosexual impulsions, which are so frequently - perhaps invariably
- to be found in paranoia, play an equally important part in the
aetiology of that far more comprehensive disorder, dementia
praecox.