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escaped from his hands. Here was the real psychic traumatism, the
operation of which merely became manifest in the cat. "But in how many
cases," asks Breuer, "is a cat thus reckoned as a completely sufficient
_causa efficiens_?"
In every case that they have investigated Breuer and Freud have found some
similar secret lesion of the psychic sexual sphere. In one case a
governess, whose training has been severely upright, is, in spite of
herself and without any encouragement, led to experience for the father of
the children under her care an affection which she refuses to acknowledge
even to herself; in another, a young woman finds herself falling in love
with her brother-in-law; again, an innocent girl suddenly discovers her
uncle in the act of sexual intercourse with her playmate, and a boy on his
way home from school is subjected to the coarse advances of a sexual
invert. In nearly every case, as Freud eventually found reason to believe,
a primary lesion of the sexual emotions dates from the period of puberty
and frequently of childhood, and in nearly every case the intimately
private nature of the lesion causes it to be carefully hidden from
everyone, and even to be unacknowledged by the subject of it. In the
earlier cases Breuer and Freud found that a slight degree of hypnosis is
necessary to bring the lesion into consciousness, and the accuracy of the
revelations thus obtained has been tested by independent witness. Freud
has, however, long abandoned the induction of any degree of hypnosis; he
simply tries to arrange that the patient shall feel absolutely free to
tell her own story, and so proceeds from the surface downwards, slowly
finding and piecing together such essential fragments of the history as
may be recovered, in the same way he remarks, as the archæologist
excavates below the surface and recovers and puts together the fragments
of an antique statue. Much of the material found, however, has only a
symbolic value requiring interpretation and is sometimes pure fantasy.
Freud now attaches great importance to dreams as symbolically representing
much in the subject's mental history which is otherwise difficult to
reach.[275] The subtle and slender clues which Freud frequently follows in
interpreting dreams cannot fail sometimes to arouse doubt in his readers'
minds, but he certainly seems to have been often successful in thus
reaching latent facts in consciousness. The primary lesion may thus act as
"a foreign body in consciousness." Something is introduced into psychic
life which refuses to merge in the general flow of consciousness. It
cannot be accepted simply as other facts of life are accepted; it cannot
even be talked about, and so submitted to the slow usure by which our
experiences are worn down and gradually transformed. Breuer illustrates
what happens by reference to the sneezing reflex. "When an irritation to
the nasal mucous membrane for some reason fails to liberate this reflex,
a feeling of excitement and tension arises. This excitement, being unable
to stream out along motor channels, now spreads itself over the brain,
inhibiting other activities.... _In the highest spheres of human activity
we may watch the same process_." It is a result of this process that, as
Breuer and Freud found, the mere act of confession may greatly relieve the
hysterical symptoms produced by this psychic mechanism, and in some cases
may wholly and permanently remove them. It is on this fact that they
founded their method of treatment, devised by Breuer and by him termed the
cathartic method, though Freud prefers to call it the "analytic" method.
It is, as Freud points out, the reverse of the hypnotic method of
suggestive treatment; there is the same difference, Freud remarks, between
the two methods as Leonardo da Vinci found for the two technical methods
of art, _per via di porre_ and _per via di levare_; the hypnotic method,
like painting, works by putting in, the cathartic or analytic method, like
sculpture, works by taking out.[276]
It is part of the mechanism of this process, as understood by these
authors, that the physical symptoms of hysteria are constituted, by a
process of conversion, out of the injured emotions, which then sink into
the background or altogether out of consciousness. Thus, they found the
prolonged tension of nursing a near and dear relative to be a very
frequent factor in the production of hysteria. For instance, an originally
rheumatic pain experienced by a daughter when nursing her father becomes
the symbol in memory of her painful psychic excitement, and this perhaps
for several reasons, but chiefly because _its presence in consciousness
almost exactly coincided with that excitement_. In another way, again,
nausea and vomiting may become a symbol through the profound sense of
disgust with which some emotional shock was associated. Then the symbol
begins to have a life of its own, and draws hidden strength from the
emotion with which it is correlated. Breuer and Freud have found by
careful investigation that the pains and physical troubles of hysteria are
far from being capricious, but may be traced in a varying manner to an
origin in some incident, some pain, some action, which was associated with
a moment of acute psychic agony. The process of conversion was an
involuntary escape from an intolerable emotion, comparable to the physical
pain sometimes sought in intense mental grief, and the patient wins some
relief from the tortured emotions, though at the cost of psychic
abnormality, of a more or less divided state of consciousness and of
physical pain, or else anæsthesia. In Charcot's third stage of the
hysterical convulsion, that of "_attitudes passionnelles_," Breuer and
Freud see the hallucinatory reproduction of a recollection which is full
of significance for the origin of the hysterical manifestations.
The final result reached by these workers is clearly stated by each
writer. "The main observation of our predecessors," states Breuer,[277]
"still preserved in the word 'hysteria,' is nearer to the truth than the
more recent view which puts sexuality almost in the last line, with the
object of protecting the patient from moral reproaches. Certainly the
sexual needs of the hysterical are just as individual and as various in
force as those of the healthy. But they suffer from them, and in large
measure, indeed, they suffer precisely through the struggle with them,
through the effort to thrust sexuality aside." "The weightiest fact,"
concludes Freud,[278] "on which we strike in a thorough pursuit of the
analysis is this: From whatever side and from whatever symptoms we start,
we always unfailingly reach the region of the sexual life. Here, first of
all, an etiological condition of hysterical states is revealed.... At the
bottom of every case of hysteria--and reproducible by an analytical effort
after even an interval of long years--may be found one or more facts of
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