Chapter 18 Lecture 17 The Significance of Symptoms

In the previous lecture, I said that clinical psychiatry does not ask about the form or content of individual symptoms; as for psychoanalysis, it takes this as a starting point, thinking that the symptoms themselves have their own meanings and are related to the patient's life experience. There is considerable relationship. Between 1880 and 1882, Breuer studied and cured a case of hysteria. Since then, the disease has attracted a lot of attention. He was the first to discover the meaning of neurotic symptoms.The same result was obtained by Jeanet in France; in fact Jeanet published it earlier than Breuer, who did not take his observations into account until ten years later, during the period of my collaboration with him, 1893-1895. The results are published in the world.Whoever discovers first is not of much importance. You know that each discovery has to be done more than once, and it cannot be completed at one time, and success does not have to be directly proportional to labor.For example, America was not named after Columbus.Before Breuer and Jeannet, the famous psychiatrist Lloyd Wright said that the delusions of madmen, if we can interpret them, are not without meaning.I confess that I have always attached great importance to Jeannet's explanations of the symptoms of neuroses, which he regarded as expressions of the "idees inconscientes" which occupied the patient's mind.But later Jeanne's attitude was very cautious, as if he thought that the word "subconscious mind" was just a noun, an expedient noun, without a definite meaning.I have since been unable to understand Jeannet's teachings; but I believe he lost his greatness for no reason.

The symptoms of neurosis, like errors and dreams, each has its own meaning, and like errors and dreams, both have a considerable relationship with the inner life of the patient.This is an important point, which I would like to illustrate with a few examples.I can only say that although it has not been proved that all kinds of neuroses are like this, anyone can believe it if they only make some observations.But for some reason I shall not take the example from hysteria, but from another very peculiar neurosis, whose origin is close to hysteria.I must say a few prefaces about this disease.The obsessional neurosis, the obsessive neurosis, is not as common as hysteria, or we can say, it is not so noisy, it is often hidden and is the patient's mind, almost no physical manifestations, only mental symptoms.Psychoanalysis was originally based on the study of obsessive-compulsive neuroses and hysteria, both of which our therapy has been effective in treating.But as far as obsessional neurosis is concerned, mental feelings do not leap into physical expression, so they are easier to understand through psychoanalytic research than hysteria; It is more significant than hysteria.

The form of obsessive-compulsive neurosis is as follows: the patient is filled with really uninteresting thoughts, feels peculiar impulses, and is compelled to perform uninteresting but necessary actions.The thoughts or obsessions may in themselves be meaningless, merely tedious to the patient; But he couldn't resist.He seems to be facing the question of life and death, thinking hard and unable to control himself.The impulses he felt in him seemed equally childish and meaningless; they were terrible things, such as the temptation to commit a felony, and the patient not only rejected them as out of place, but avoided them with terror. , prevent their realization by various preventive methods.In fact, he never once realized these impulses; and not once did prevention and getting rid of them fail to win the final victory.All he really does is absolutely harmless chores—what we call obsessions—rehearsals of routine movements, rehearsals that result in ordinary necessary actions—going to bed, washing, dressing , walks, etc. - all become extremely difficult and onerous work.Those morbid ideas, impulses and actions are not mixed in the same proportion as obsessive-compulsive neurosis; roughly speaking, one or the other of these expressions always occupies a more important position; the name of the disease is derived from this; But the features common to all forms are still evident.

It was clearly a case of madness.I think psychiatrists, in spite of their wildest fantasies, cannot invent such a disease.If we didn't see this phenomenon with our own eyes every day, we wouldn't believe it.Do not think that in the treatment of such a patient, you can advise him to try to get rid of these absurd ideas, not to perform these boring actions and replace them with reasonable actions. That is what he wants, because he is not ignorant of his situation , I don't disagree with your opinion on his obsessive-compulsive disorder, and this opinion, he himself will put forward.But he just felt that he couldn't help it; the movements he made in a compulsive situation seemed to have a kind of force behind him, which could not be resisted by the power of abnormal spiritual life.There is only one way out of helplessness—he can only exchange and replace; he can replace the original absurd idea with a milder idea.He can replace the original one with another preventive method, he can perform another action in place of the original red tape.All in all, he can switch from one to the other, but he can't completely cancel it.This alternation of symptoms, including a radical change in their original form, is one of the main features of the disease; what is more noticeable in this disease is the presence of all opposite values ​​or polarities in the psychic life, according to translation: That is to say, opposite concepts such as strength, lightness and darkness seem to be differentiated more significantly.In addition to being compelled by positivity and negativity, intellectual skepticism also develops, and even gradually develops to be full of doubts about things that are usually taken to be true.All these are enough to make the patient more and more hesitant, lose energy, and reduce freedom; although obsessive-compulsive neurotic patients are full of energy, good judgment, and generally have superhuman intelligence.He is usually virtuous, often afraid of doing wrong, and generally innocent.You can imagine that in the confusion of such contradictory characters and morbid expressions, it is indeed a difficult and difficult work to pursue the cause of his illness.Our present purpose is merely to explain some of the symptoms of the disease.

You have listened to the discussion in the preceding paragraph and perhaps wondered what contribution modern psychiatry has to obsessive-compulsive neuroses; it is but a meager contribution.Psychiatry only gives appropriate names to various compulsions; nothing else can be said.It is only said that patients suffering from these symptoms are "degenerate" and "degenerate".This does not satisfy us; it is only a judgment of value, or even a pejorative, never an explanation.I think we can easily conclude that the results of degeneration naturally produce various strange states.We believed that patients with this symptom must be different from the average person; but are they really more "degenerate" than other neurotics, hysterics, or insane people?This adjective is obviously too flimsy.If you know that men and women who have geniuses and supernatural powers can also show this symptom, you can't help but wonder whether this adjective is appropriate after all.Due to the prudence of the great men themselves and the inaccuracy of their biographers, it is generally not easy for us to know their true nature. However, some of them are also crazy about the truth. For example, Zola sees Taurus, "Emile Zola", Studies in Medical Psychology, Paris, 1896, and we also know that he suffered from many queer compulsive habits throughout his life.

Psychiatry calls these patients "degeneres super-ieurs" and is done.It appears from the results of psychoanalysis, however, that these special obsessive-compulsive symptoms, like all other symptoms of the disease in non-regressive patients, can be permanently eliminated.I myself have often achieved this result. I will illustrate the analysis of the obsessive-compulsive syndrome by taking only two cases; the first is an old one, but I have not found a better one, and the second is a recent one.Since this description must be both clear and detailed, we will only limit ourselves to these two examples.

A woman in her late thirties who suffers from very severe obsessive-compulsive disorder, I might have cured her, had my work not been spoiled by a sudden change of fate--this layer may be able to tell you later.Several times a day, among other actions, she would perform the following strange compulsive action.She often ran from her room into the adjacent room, stood by a table in the middle of the room, rang the bell to call the maid, or asked her to do a trifle, or left without doing anything, and then ran back to her room. Room.This phenomenon is not dangerous, but it is still enough to arouse our curiosity.As for the reason, it is simply stated by the patient without the help of the analyst.I can never guess the meaning of this compulsion, and I can never explain it.I have asked the patient many times why she has this action, or what its significance is, and she always says she doesn't know.But one day, after I had persuaded her not to be suspicious of a certain behavior, she suddenly understood the meaning of compulsion, because she recounted the process of this compulsion.Ten years ago, she married a man much older than her.On the night of the wedding, she knew that this man lacked sexual ability.That night, he ran into her room from his own room many times, trying to try his skills, but in the end he failed.The next morning, he said angrily: "This is too much contempt for the maid who makes the bed." So he picked up a bottle of red ink and poured it on the bed sheet, but not where the spots should be. superior.At first I could not see what relation this recollection had to the compulsion just discussed; for I could see no resemblance between the two situations except a servant woman and the act of running from one room to another.Later, the patient led me into the adjacent room, and I saw a large red spot on the tablecloth.She also explained that she was standing by the table so that the servant girl could see the red spot when she came in.The connection between the compulsion and the scene of the wedding night is therefore beyond doubt, although we still need to make further inquiries on the matter.

First, we can know that the patient has substituted herself for her husband; running from one room to another, she is acting out his actions.To preserve the similarity, let's also assume that she represents the bed and sheets by table and tablecloth.This seems far-fetched; but we have studies of dream-symbolism to support it.The table often represents the bed in dreams; the combination of "bed and table" means marriage, so the bed can represent the table, and the table can also represent the bed. All these are enough to prove that the compulsion is meaningful; it may be regarded as a repeated rehearsal of an important situation, but we need not stop at this similarity; if we examine the relationship between the two situations more carefully, it may be more inferred that The purpose of its compulsive action.This action obviously centered on calling the servant woman to come.The patient showed the red spot to the servant, just in response to the sentence that her husband said, "This is too contemptible to the servant!"As she repeated her husband's actions, her husband was not despised by the servants, for the red spot had appeared in its proper place.So she not only rehearses the old scenes, but also extends them and modifies them so that the scenes have no faults that can be criticized.In addition, there is another layer, which is to correct the situation that caused the tragedy of that night and the necessary situation for red ink, that is, the lack of sexual ability of the husband.This compulsive action seems to say: "No, he did not lose face in front of the servant woman, he is not impotent." As in a dream, in the current compulsive action, she fulfilled her desire to restore her husband Credibility after pouring red ink.

All the other facts about the patient suffice for the above explanation of her obscure compulsions.She had been separated from her husband for a long time, and at that time was making up her mind to legally divorce him.Yet her heart was always attached to him; she forced herself to be true to him.She then withdraws to avoid being seduced by others and, in fantasy, forgives and idealizes him.The most secret purpose of her illness was to protect him from malicious slander, to justify her separation from him, and to live comfortably without her.So we analyze a harmless compulsion and immediately discover the main cause of the attack, and at the same time deduce the characteristics of obsessional neuroses in general.I would very much like you to study this case more, for all the unforeseen circumstances of obsessive-compulsive neurosis are gathered here.The interpretation of its symptoms is discovered by the patient in a split second, without the guidance or intervention of the analyst, and its interpretation does not take place in events that have been forgotten in childhood, but originates in events that the patient clearly remembers in adulthood.All the attacks on our symptomatic explanations which critics have so often thrown at us, therefore, are no longer tenable.Such good examples are indeed not easy to come across.

One more thing!Does it not surprise you that this innocuous compulsion directly touches upon the most secret affairs of the patient?There is almost nothing a woman wants to tell anyone more than her wedding night; is it by chance that we now know the secrets of her sex life and that it has no special significance at all?Or you could say that I have chosen this example on purpose to justify myself.Let us not jump to this conclusion; note the second example for the moment.This second example is quite different in nature from the first, but is an ordinary example, a preparatory ritual before going to bed.

A well-grown, intelligent woman of nineteen years of age, the only child of her parents, superior in education and intellect, of a very lively disposition, who has in recent years been suddenly and unexplainably insane .She was often angry, especially with her mother; she was depressed, suspicious and hesitant, and later claimed that she could no longer walk alone through squares and streets.We don't want to go into details about her complicated symptoms, but from her symptoms, at least two diagnoses can be made: agoraphobia and obsessive-compulsive neuropathy; now just pay attention to the various preparatory rituals of this girl before going to bed. caused great concern to her parents.Roughly speaking, normal people have a ritual before going to bed, or, at least, certain conditions are required, otherwise they cannot fall asleep; this process from waking up to falling asleep often forms a certain pattern, and it is performed once every night as usual .However, the conditions of sleep required by a healthy person can be rationally explained, and if external circumstances necessitate a change in the ritual, he can quickly adapt.As for the morbid rites, which are invariable, often require great sacrifices to maintain their frivolous rites; superficially, also under the pretense of sound motives, differing from the normal only in that they seem too cautious in their practice.But if we look more closely, we can see that there is no sufficient reason for this excuse, and all the customs of his ceremony cannot be covered by the reasons given, and some of them directly contradict the reasons.In order to sleep, the patient declared that she needed a quiet environment at night, and that all noise must be excluded.So she did two things: she stopped the big clock in the house, and moved all the other small clocks out of the house, even the small watch on the bedside table.All the flower pots and vases were carefully placed on the writing table so that they would not fall and break at night, so as not to disturb her slumber.She also knows that these precautionary reasons for quietness are difficult to hold: even if the small watch is placed on the bedside table, the ticking sound will not be heard; and we all know that the regular ticking sound of the clock will never disturb sleep. The opposite can lead to sleep.She also admits that the fear that the pots and vases will not break even if they are left in place at night is a misgiving.As for some other actions in the ceremony, they are not in line with the motive of seeking tranquility; for example, insisting that the door between one's own bedroom and the parents' bedroom is ajar. In order to achieve this goal, all kinds of obstacles are placed. She seemed to summon the source of the voice again; however, the most important rituals were all related to the bed.The bolster at the head of the bed must not touch the wooden bed frame.The bolster had to be stacked across the bolster in a diamond shape; she then placed her head exactly on top of the diamond.Before covering the eiderdown quilt, she must shake the duck feathers to make the feathers fall; but she must also flatten the eiderdown to redistribute the duck feathers. I shall omit the various other details of the ceremony; for they neither furnish us with new material, nor would they lead us too far from the subject.But do not think that these little things are going well.Every time she does something, she is always worried about not doing it well; she must try and try, and act and act; Let worried parents sleep peacefully. The analysis of these pathologies is not as simple as in the previous case.I had to offer a little opinion on the explanation, and she either vehemently denied it or laughed and doubted it.But after initially rejecting my explanation, she then considered the possibilities it suggested, noted the associations it aroused, recalled possible relations, and finally accepted them voluntarily.After accepting it, she began to gradually reduce those forced movements, and she had abandoned all the rituals before the treatment was over.But I must also tell you that analytical work, as we do at present, never concentrates on a single symptom continuously until its meaning is fully understood.For we often have to leave the subject under study and bring it up on the other hand.The explanation of the symptoms which I am now about to tell you, therefore, is really a synthesis of many results which, because of the interruption of the research in other respects, are often not obtained until weeks or months have elapsed. The patient came to know that the clocks were moved outside at night because they were symbols of the female genitals.We know that clocks and watches may have various other symbols besides this, and the reason why they have the meaning of female genitalia is that they also have periodic movements and regular intervals.Women often boast that menstruation is as regular as a clock.The patient was most afraid that the ticking sound of the clock would disturb her lucid dreams.The ticking of a clock can be compared to the excitement of the clitoris during sexual arousal.This feeling did wake her up several times from her dreams; she was afraid of the erection of her penis, so she turned all the clocks away every night.Pots and vases, like all containers, are symbols of female genitalia.So it does make sense to prevent them from falling below overnight.We know that the custom of breaking a vase or basin at betrothal times was widespread; each present took a fragment as a token of disowning the bride, a custom which may have arose with monogamy.The patient also recalls this part of the ritual, several associations.When she was a child, she once slipped and fell while holding a glass or porcelain bottle, cut her finger and bled profusely.When she was growing up, she knew about sexual intercourse and other things, and she was afraid that she would be suspected of being a virgin on her wedding night or because she did not bleed.She is afraid that the vase will break, which means she wants to get rid of the whole complex about chastity and first coitus bleeding, that is, she wants to get rid of the anxiety about whether she will bleed.These concerns have nothing to do with preventing sound. One day, she thought about the central idea of ​​the ceremony, and suddenly realized why she didn't let the bolster touch the back of the bed.She said that from her point of view, the long pillow often looked like a woman, while the straight back of the bed looked like a man.Thus, as if by a magical rite, she separates man from woman; that is to say, separates father from mother, so that no copulation can take place.Years before the ceremony, she had used a more direct method to achieve this purpose.She feigned cowardice, or took advantage of her tendency to panic, to keep the door between her bedroom and her parents' bedroom open.This method is still one of the existing rituals; thus, she can eavesdrop on the actions of her parents; this has caused her to lose sleep for months.She was not satisfied with bothering her parents like this, and she sometimes slept between her father and mother at that time.So the "long pillow" and the "back of the bed" are really blocked and separated.Later, she grew too big to sleep comfortably with her parents, so she deliberately pretended to be timid and asked her mother to switch with her so that she could sleep with her father.This matter was indeed the starting point of fantasy, and what the result was is clearly visible in the ceremony. If the long pillow represents a woman, then she shakes the eiderdown quilt to lower and bulge the feathers, which does have a meaning.What does it mean?It means pregnancy; but she also does not want her mother to be free of pregnancy; because she has been afraid for several years that the result of her parents' intercourse will give birth to another child and make herself an opponent.Conversely, if the long pillow means the mother, then the small pillow can only represent the daughter.Why is the small pillow placed obliquely on top of the big pillow to form a rhombus, and her head happens to be placed in the center of the rhombus?It was not difficult for her to recall that rhombuses were often used in paintings or on walls to represent female genitalia.She then represents the man or the father by herself and the male genital by her head.It can be verified that beheading is a symbol of castration. Do you ask, does a virgin have such terrible thoughts in her heart?That's what I admit; but don't you forget that I didn't create these ideas, I just exposed them.Strange enough is this ritual at bedtime that you cannot deny the parallels which are revealed by interpretation between ritual and phantasy.But I think it is more important that you should remember that this ritual is not the product of a single fantasy, but a mixture of several fantasies, but those fantasies always converge at some point.Remember also that the details of her rituals have both a positive and a negative relation to sexual desire, partly an expression of it, partly a revolt against it. Perhaps the results of the analysis would be more informative if we connected this ritual with other symptoms of the patient.However, this is not our purpose now.All you need to know now is that the patient had an "erotic attachment" to his father when he was a child.This kind of sex had driven her crazy.Perhaps it was for this reason that her feelings for her mother were so bad.There is another layer, which we cannot let go lightly; that is, the analysis of this symptom also involves the patient's sexual life.All this becomes less surprising the more we understand the meaning and purpose of neurotic symptoms. From the two examples cited above, you can already see that the meaning of neurotic symptoms is no different from faults and dreams, and that these symptoms are closely related to the patient's life.But can I hope that you will believe in the value of my words because of the strength of these two examples?Of course that is not right.But can you expect me to continue with examples until you are convinced?That's not true either; since each patient has to go through a long period of treatment, if I were to fully discuss this point on the theory of the neuroses, it would inevitably take me five hours a week and a term to cover.I am therefore compelled to confine myself to these two cases as proof of what I have said; you may refer again to those works on the subject, such as Breuer's classic explanation of the symptoms of his first case, the hysteria, Jung's The outstanding symptoms of the so-called dementia prωcox praecox explained that Jung was only a psychoanalyst at that time and had not yet expected to become a theorist, as well as the various papers published in our journals later.This type of research is very rich.The analysis and explanation of the symptoms of the neuroses have so much attracted the analyst's attention that other problems of the neuroses have been neglected for the time being. Whichever of you has done some serious research on this subject, you will be deeply impressed by the richness of the evidence.But there is also a difficulty.We have seen that the meaning of a symptom lies in its relation to the patient's life.The more individual the formation of the symptoms is, the more clearly we can see where this relationship lies.It is our business, therefore, to find out, for every idle idea and every useless action, the circumstances in which the idea arose and the action required.The compulsion of the patient who ran to the table and rang the bell to summon the maid was the perfect model for this symptom.But quite different symptoms are not uncommon.For example, some typical symptoms are actually common to all cases, and all their individual differences no longer exist, so that it is not easy to find their relationship with the patient's life or the special situation in the past.Let's talk about obsessive-compulsive neurosis, please.The patient who performed various chores at bedtime may be cited as an example, although she also showed many individual features which could be used for a "historical" explanation.All obsessional neurotics, however, propose certain movements, which are constantly and regularly rehearsed.There are many sick people who wash all day long.And those patients whose agoraphobia is no longer recognized as an obsessive-compulsive neurosis but has been classified as an anxiety hysteria exhibit the same pathological features with impatience and monotony.They are afraid of enclosed spaces, wide squares, long straight roads or paths; and they feel protected if they are followed by a companion or a car.But apart from the commonalities of these basic elements, each patient has a particular modality which clearly differs from one another.For example, A is only afraid of narrow paths, B is only afraid of big roads; C only sees few people around, and D only dares to move forward when he sees people around him.The same is true of hysteria. In addition to many characteristics that vary from person to person, there are often many symptoms common to this disease, which seem to be difficult to explain based on the history of each person.However, we must not forget that it is only because of these symptoms that we can use them for the next diagnosis.If we already know that a particular symptom of hysteria arises from a certain experience or set of experiences, e.g. a hysterical emesis originates from a set of foul-smelling impressions, and if we now find that another emesis appears to originate from an entirely different experience, That would be confusing.Hysterical patients always seem to vomit for some unknown reason, and the historical reasons discovered by analysis seem to be just some excuses fabricated by the patient out of inner needs or randomly fabricated to achieve his cover-up purpose. We are therefore forced to the dismal conclusion that, while the individual patterns of neurotic symptoms may be satisfactorily explained from the experience of the patients, our science cannot account for the fact that these cases are all far more common. Nor have I mentioned to you the difficulties which arise in the pursuit of the historical significance of a symptom.I am not going to tell you, because although I do not want to hide from you, I need not, at the beginning of our joint research, daze you with bewilderment or amazement.Although our understanding of symptom explanation has just begun, we want to stick to our existing knowledge and gradually conquer those unknown difficulties.I want to encourage you with the following thought: namely, that it is almost difficult to assume a fundamental difference between this symptom and that.If individual symptoms can be explained by the patient's experience, then the typical symptoms related to a certain experience can also be explained by the common experience of human beings.All the usual features of neuroses, such as the repetitive movements and doubts of obsessive-compulsive neurosis, may be generalized reactions which the patient is compelled to intensify by pathological changes.All in all, we really have no reason to be discouraged; we'll see what else we can discover. A very similar difficulty has been encountered in the theory of dreams, but this difficulty was not dealt with in our previous discussion of dreams.The manifest content of dreams is inherently complex and individual; the results of the analysis of this content have already been described in detail.But there are also some dreams which can be said to be typical, which are common to everyone, and their content is the same, so the analysis is equally difficult.For example, dreams of falling, flying, floating, swimming, being caught, being naked, and other anxiety dreams; these dreams have different interpretations depending on the dreamer, and there is no explanation for why they are common to everyone. .But we notice that even in these dreams their common basic elements are dotted with individual peculiarities.Perhaps the knowledge of dream life gained from the study of other kinds of dreams can serve as an interpretation of these dreams—without twisting them, but by gradually expanding our meaning of these facts.