Selected papers on hysteria and other psychoneurosesFreud, Sigmund
Science
Selected papers on hysteria and other psychoneuroses
Freud, Sigmund
Hysteria; Neuroses; Psychoanalysis
How I overcame the first difficulty, and what it taught me, I will show
later. I will first state what position I have taken in my daily
practice towards the second problem. It is very difficult to examine a
case of neurosis before it has been subjected to a thorough analysis,
such as would result only through the application of Breuer’s method.
But before we have such a thorough knowledge we are obliged to decide
upon the diagnosis and kind of treatment. Hence the only thing remaining
for me was to select such cases for the cathartic method which could,
for the time being, be diagnosed as hysteria, and which showed some or
many stigmata, or the characteristic symptoms of hysteria. Yet it
sometimes happened that in spite of the diagnosis of hysteria the
therapeutic results were very poor, and even the analysis revealed
nothing of importance. At other times I attempted to treat cases which
no one took for hysteria by Breuer’s method, and I found that I could
influence them, and even cure them. Such, for example, was my experience
with obsessions, the real obsessions of Westphal’s type, cases which did
not show a single feature of hysteria. Thus the psychic mechanism
revealed in the “Preliminary Communication” could not be pathognomonic
of hysteria. Nor could I for the sake of this mechanism throw so many
neuroses into the same pot with hysteria. From all the investigated
doubts I finally seized upon a plan to treat all the other neuroses in
question just like hysteria, to investigate the etiology and the form of
psychic mechanisms, and to leave the diagnosis of hysteria to be
dependent upon the result of this investigation.
It thus happened that, proceeding from Breuer’s methods, I occupied
myself mostly with the etiology and the mechanism of the neuroses. After
a relatively brief period I was fortunate in obtaining useful results. I
then became cognizant of the fact that if we may speak of a reason for
the acquirement of neuroses the etiology must be sought for in the
sexual moments. This agrees with the fact that, generally speaking,
various sexual moments may also produce various pictures of neurotic
disease. Similarly we now venture to employ the etiology for the
characteristics of the neuroses, and build up a sharp line of
demarcation between the morbid pictures of the neuroses. If the
etiological characters constantly agreed with the clinical ones, this
was justified.
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