Chapter 19 Lecture 18 Trauma Perseverance——Subconsciousness

I said last time that we shall take as the starting point of further investigation the knowledge we have acquired, not the doubts we have aroused.However, the two conclusions based on the previous analysis of the two examples, although interesting, have not yet been discussed. - We feel that the patients in these two examples are "attached" to a certain point in their past, and they don't know how to get rid of it, so that they are detached from the present and the future.They seem to be withdrawing from the world by taking advantage of illness; it is no different from the monks and nuns who retired to the monastery to spend the last days of their lives.In the case of the first patient, the long-broken marriage had virtually unlimited influence on her life.Her symptoms enable her to maintain her relationship with her husband; in her symptoms we seem to hear voices defending him, forgiving him, praising him, and pitying him.Although she was young at that time and could still attract other men, she used all kinds of reasons, real or false, to keep her faithfulness to him.So she doesn't see strangers, doesn't make up, and it's hard to stand up when she sits; and she doesn't sign or give gifts, lest her belongings fall into the hands of others.

In the case of the second patient, the young girl's sexual love for her father before puberty was now at its height.She also knew that she could not marry others if she was ill. We can speculate that she was ill because she could not marry and she was often attached to her father. We cannot help asking: how or why a person adopts this idiosyncratic and unhelpful attitude towards life, if it is a general feature of the neurosis and not a peculiarity of these two patients.Indeed, this is a general and important feature of all neuroses.The hysterical patient whom Breuer first examined was persistent when she nursed her father when he was seriously ill.She has recovered, but since then she has always felt unable to cope with life, because she could not handle the duties of a woman.We learn from analysis that each patient's symptoms and results are sufficient to fixate himself on a certain period of his past life.In most cases, this past period is often the earliest stage in life history, such as childhood or even as early as breastfeeding.

The closest analogy to this behavior of neurotic patients can be taken as an example of the recent epidemic in Europe during the war called "traumatic neuroses".Naturally, this disorder also occurred before the war, for example after a train wreck or other terrible life-threatening experiences.Traumatic neuroses are fundamentally different from the naturally occurring neuroses which we analyze and treat; nor can we explain them from the point of view of other neuroses, for reasons which I will tell you later.However, it should be emphasized that this disease also has one point that is completely similar to other kinds of neurosis.In the case of traumatic neuroses, it is clear that the attachment to the moment of the trauma is at the root of the disease.These patients frequently recall in their dreams the situation from which their trauma arose; and in those cases of hysteria which can be analyzed, it seems that the hysterical attacks consist of a complete recall of this situation.These patients did not seem to be adequately coping with the situation before and still do not seem to be doing the job.We have to pay special attention to this level, because it enables us to understand the so-called "economic" conception of the spiritual process. The word "traumatic" really means nothing more than this economy.We call an experience which, for a very short period of time, subjects the mind to a stimulus of the highest degree, so that no adaptation can be sought in the normal way, and which permanently disturbs the distribution of the mind's effective capacities. for trauma.

Because of this analogy, we also call the experience of neurotic attachment "traumatic."We have thus provided a simple condition for neurosis; that is, the inability of a person to cope with a strong emotional experience results in a neurosis, so that the causes of neurosis are roughly analogous to those of trauma.In fact, the first formula that Breuer and I worked out between 1893 and 1895 for the purpose of reducing the new facts we observed to a theory was very consistent with this view.Even the first case of the young woman who separated from her husband does not contradict this statement; because she could not "regret" the marriage in name only, and therefore remained attached to her traumatic situation.In the second case, however, of a young girl who was attached to her father, the deficiency of this formula was immediately seen.First, the little girl's adoration of her father is such a common experience that it usually diminishes with age, so that the use of the word "traumatic" loses its meaning here; According to my experience, the obsession with this first sexual love seemed harmless at that time, and it was only after a few years that it manifested itself as a symptom of obsessive-compulsive neurosis.The causes of neuroses are therefore very complex and varied; but we feel that the "traumatic" view need not be dismissed as false, since it might otherwise serve as an aid to explanation.

Therefore, we have to give up the way out we just adopted.Since this path is no longer feasible at this time, we must study further before we can find a satisfactory way out.But before leaving the question of the "attachment to trauma," we should note that this phenomenon is found everywhere outside of neuroses; every neurosis contains such an attachment, but not every attachment leads to neurosis, or Both are combined with neurosis, or both occur during neurosis.Sadness, for example, can be seen as a good example or prototype of an emotional obsession with something in the past and, like neurosis, is completely out of touch with the present and the future.However, the difference between grief and neurosis is also understood by ordinary people.On the other hand, there are neuroses which may be called morbid grief.

If the whole structure of a person's life is fundamentally shaken by a traumatic experience, it is true that he can lose his vitality, lose interest in the present and the future, and become forever addicted to memories; but such unfortunate people do not necessarily become neurotic. .We should therefore not place too much emphasis on this feature as an attribute of neurosis, although it is also common and important. 2 Now please convey the second conclusion which we have drawn from the analysis; we do not need to limit this conclusion.As far as the first patient is concerned, we have already known the tedious compulsions she performed, and the affectionate reminiscences they aroused; This relationship infers the purpose of the compulsive action.But one factor has been completely neglected, and this one deserves our full attention.As the patient continues to move, she is unaware of the relation of her movements to her past experience;Later, under the influence of treatment, I suddenly noticed this relationship and was able to tell it.Even then, she did not understand that the purpose of this gesture was to amend a painful event in her past in order to enhance the worth of her dear husband.It took her a long time and many efforts to understand and admit that this motivation can be the driving force for the realization of the compulsion.

The scene of the morning after the wedding and the patient's tenderness for her husband constitute what we call the "meaning" of the compulsion.But she does not understand both sides of this meaning, she does not understand the Whence and the whither of the movement when she moves.So there is always some psychic process going on in her, and the compulsion is the result of it; she knows the result as usual;Bernheim once experimented with hypnosis, and ordered the hypnotized person to open an umbrella in the bedroom five minutes after waking up, and the hypnotized person did it on time without knowing why; our patients are similar to this.These are what we call unconsciousmental processes that take place in us; and we are ready to abandon speculation as to the existence of unconscious mental processes, if anyone can give a more correct scientific explanation of the matter.If they cannot, we are willing to insist on this supposition; and should it be protested that in science the unconscious is a mere expedient, a figurehead, we shall be obliged to refute the incomprehensibility of his statement.How something unreal can produce something as real and obvious as a compulsion!

As far as the second patient is concerned, basically the same is true.She made a rule that the bolster should not come into contact with the bed frame, but she did not know the cause, meaning, or force of this rule.Regarding this rule, no matter whether she deals with it calmly, or vigorously resists, or resolutely refuses to implement it; but it is invalid rather than impossible.It was in vain that she tried to inquire into the reason.These symptoms, ideas and impulses of obsessive-compulsive neurosis, since no one knows their origin, and are able to resist the irresistible resistance of normal psychic life, they seem to come from another world even to the patients themselves. A powerful ghost, or a ghost mixed in the vortex of the world.Among these symptoms we clearly see a special area of ​​psychic activity isolated from the rest.In other words, these symptoms may well be evidence of the unconscious; it is for this reason that clinical psychiatry, which recognizes only the psychology of consciousness, has nothing to do with them, and can only call them symptoms of a specific degeneration.The obsessions and impulses themselves are the same as the execution of the compulsions, and neither is subconscious.For if they do not invade consciousness, they are unlikely to cause symptoms.But the preceding psychic processes discovered by analysis and the chains discovered by interpretation are indeed unconscious, at least until the patient understands their course through analytical investigation.

Consider also the following points: 1. The individual symptoms of the various neuroses suffice to confirm all the facts of these two examples; Subconscious psychic processes, but under all favorable conditions these processes can become conscious again.So you can see that psychoanalysis is useless without the subconscious part of the mind, and we are used to dealing with the subconscious as something real.Perhaps you must also admit that those who know only the term unconscious, but who have never analyzed, or interpreted dreams, or inquired into the meaning and purpose of neurotic symptoms, are hardly qualified to speak on this subject.I would like to repeat this to call your attention; as psychoanalysis can discover the meaning of neurotic symptoms, there is undeniable evidence for the existence of unconscious psychic processes—or, at least, we seem to have to assume it.

But there is another layer.We are better informed by Breuer's second discovery - which is his own contribution and which I consider to be more important than the first - in relation to the unconscious and neurotic symptoms.It turns out that not only is the meaning of symptoms always unconscious; there is also a relationship of substitution between symptoms and unconsciousness; and the existence of symptoms is only the result of this unconscious activity.About this layer, you will soon understand.I share with Breuer the following proposition: that is, whenever we encounter a symptom, we can conclude that there is some unconscious activity in the patient's mind that contains the meaning of the symptom.Conversely, this meaning must first be unconscious before the symptom can occur.Symptoms do not arise from conscious processes; as soon as unconscious processes become conscious, symptoms must disappear.From this you will immediately know that this is the way out of psychiatric therapy, a way of eliminating symptoms.Breuer used this method to restore health to his patients, or to remove the shackles of symptoms; he discovered a method by which the patients brought into consciousness the subconscious processes which contained the meaning of the symptoms, and the symptoms disappeared.

This discovery by Breuer was not the result of reasoning, but was due to the cooperation of the patient before this fortunate observation could be made.Do not force yourself to compare this with what you already know; you should admit that it is basically a new fact, which explains many others.I shall therefore extend the matter as follows. The formation of symptoms is actually the substitution of other things in the subconscious.Some psychic processes, under normal conditions, have to wait until the patient becomes aware of them consciously.If this does not develop; or if these processes are suddenly blocked and become unconscious, symptoms follow.The symptom is thus a substitute; if we can reset the process by psychotherapy, we shall have accomplished the task of eliminating the symptom. Breuer's discoveries remain the basis of psychoanalytic therapy.From the results of later research it can be shown that the symptoms disappear when the unconscious process becomes conscious, although this will be carried out with unexpected difficulties.Our work in therapy is to transform something unconscious into something conscious; our work is not complete until this change has taken place. A few more digressions now, or you will infer that the effects of this treatment were accomplished too easily.According to what we have come to, neuroses result from ignorance of the psychic processes which one should know.This is very similar to Socrates' famous saying that crimes are caused by ignorance.During analysis, an experienced analyst can easily know what the patient's subconscious emotions are.Therefore, it should not be too difficult to treat. You only need to tell him this knowledge and relieve his ignorance.The unconscious meaning of the symptoms is at least on the one hand easy to treat in this way, although on the other hand—that is, the relationship between the past experience of the patient's life and the symptoms—is not easy to infer from it; All the experience, had to wait for the patient to remember before telling him.But speaking of this level, there are many times when one can seek falsehoods.We may ask the patient's relatives and friends about his past life; they often know what caused his trauma; or we can tell what the patient does not know because these things happened in the patient's childhood.Now if these two methods are combined, the source of the patient's ignorance may not be difficult to eliminate in a short time. If only that would be great!But things went beyond our initial expectations.This knowing is different from that knowing.There are different kinds of cognition, and they are by no means of equal value psychologically.Moliere said it well "Ily a fagots et fagots" [everyone is different].The doctor's knowledge is different from the patient's knowledge and does not have the same effect.It is ineffective for a doctor to tell a patient what he knows.That may not be accurate enough.We may say that this method is indeed not sufficient to make the symptoms disappear; but it has another effect, which enables the analysis to proceed, the first result of which is often a firm denial.The patient already knows what was unknown before—the meaning of the symptoms—but what he knows is still very limited.Therefore, we know that there is more than one kind of ignorance.We need a deep understanding of psychological problems to know these ignorant distinctions.However, the saying "knowing the meaning of the symptoms can make the symptoms disappear" is still true.The necessary condition is that this knowledge must be based on a change in the patient's heart, and this change in heart can only be achieved by the psychiatric treatment for this purpose.We thus encounter many problems here, which can soon be regarded as the dynamics of symptom formation. Here I have to stop talking, and I want to ask you, don't you think what I said is too deep and messy?Have I often said a passage and then restricted it; caused a train of thought, and let it fall; so that you are bewildered?If that's the case, then I'm very sorry.But I am very unwilling to sacrifice truth to simplicity, I would rather make you fully aware of the complexity and difficulty of this subject, and believe what I tell you, if you cannot take it for a while, it will not hinder you.I know that every listener and reader can arrange the facts heard and read to suit his own mind, shorten and shorten, simplify and extract what he wants to remember.Roughly speaking, this sentence is good: that is, the more you listen to at the beginning, the richer you will get in the end.Therefore, I hope that although my words are very complicated, you have understood the main points of what I have said about the unconscious, the meaning of symptoms, and the relationship between the two.You may also understand that our subsequent efforts will be directed in two directions: 1. to know how people get sick and how to adopt a neurotic attitude towards life: this is a clinical problem; symptoms; this is still a psychodynamic problem, and the two problems must have a point of contact. I do not want to discuss further today; but since the end of get out of class is not yet in, I would like to draw your attention to another feature of the above two analyzes; that is, the memory gaps or amnesias, the importance of which again will not be fully understood until later a little.You already know that psychoanalytic treatment can be summed up in the following formula: that is, all pathogens that belong to the unconscious must enter the conscious.Now this formula can be substituted for another: that is, all the patient's amnesia must be replenished, in other words, we must try to eliminate his amnesia; you may not be surprised to hear this.In fact, the meaning of this statement is the same; that is, we must admit that there is an important relationship between the development of symptoms and amnesia.But if you consider the first patient previously analysed, you will find this amnesiac notion difficult to prove; for the situation which aroused the compulsion was not yet forgotten, but clearly remembered; factors have not been forgotten.In the second case, the memory of the girl who performed the forced rite is the same, though less clearly.Her behaviors in the past few years, such as insisting on opening the door between her parents and her own bedroom, so that her mother would no longer sleep on her father's bed, etc., she has never forgotten, and clearly remembers, but she just felt uneasy.Of particular note is the case of the first patient, who, although she practiced her compulsion numerous times, never once felt that it resembled the situation after the wedding night; that is, when she was asked to directly explore her compulsion When the movement originated, she never remembered it.Similarly, as far as the girl in the second case is concerned, not only is her ceremony rehearsed every night as usual, but also the circumstances from which her ceremony is produced are no different.Neither had real amnesia or amnesia; but the cues that should have been there to elicit memories had been clipped.This disturbance of memory is sufficient to produce obsessional neuroses; as for hysteria, it is different.Hysteria is often characterized by extensive amnesia.Roughly speaking, the analysis of every single symptom of hysteria gives rise to the thread of a whole of past impressions which, so to speak, are truly forgotten until they are remembered.On the one hand, this thread goes back to the earliest childhood, so hysterical amnesia seems to have a consistent relationship with infantile amnesia, and it is due to infantile amnesia that we do not understand the earliest impressions of psychic life.On the other hand, it surprises us that all the recent experience of the patient is also easily forgotten, and especially the triggers that caused or aggravated the disease, at least partly if not completely forgotten.Those important details are either completely forgotten or replaced by illusions.Roughly speaking, those recollections of recent experiences always manage to escape the analyst's attention, leaving a noticeable gap in the patient's whole experience; emerge. These impairments of the faculties of memory have already been said to be characteristic of hysteria, and sometimes the symptomatic states, the hysterical attacks, have occurred without leaving recallable traces.Since obsessive-compulsive neuroses are different from this, we may presume that these phenomena of forgetting are part of the psychic nature of hysteria and not a general feature of neuroses in general.The importance of this distinction may be diminished by the discussion below.The meaning of a symptom is a mixture of two factors; its whence and its tendency or cause, its whether or why, in other words, 1 the impression and experience from which the symptom occurred, and 2 the purpose the symptom intends to achieve.The source of the symptoms can be analyzed as various impressions. These impressions come from the outside world. They must have been conscious at the beginning, but they may become subconscious due to being forgotten.As for the cause or tendency of the symptom, it is often an inner process, which may be conscious at first, but may never be conscious, and always stays in the subconscious.It is therefore of little importance, as in hysteria, whether the source of the symptom or the impression on which it is based is also forgotten; as for the tendency of the symptom, it may be unconscious in the first place, and this is enough to make the symptom dependent on the unconscious.This is true both in hysteria and in obsessive-compulsive neuroses. Since we attach so much importance to the subconscious of spiritual life, it is inevitable that human beings will resent psychoanalysis.Don't be surprised by this, thinking that this resistance is due to the difficulty in understanding the subconscious mind, or finding evidence for the existence of the subconscious mind. I believe it has a deeper motive.Human self-esteem has suffered two major blows successively from the hands of science.The first time was knowing that our earth is not the center of the universe, but just a speck in the infinite system of the universe. We attribute this discovery to Copernicus, although Alexander's theory also expressed an approximate view.The second time is that the study of biology has deprived human beings of their unique creation privileges, and reduced them to one of the species in the animal kingdom, but also possessed an indelible animal nature: the achievement of this "revaluation" was achieved in The advocacy of Charles Darwin, Wallace, and their predecessors of our time has also aroused the fiercest resistance of their contemporaries.And yet people's self-esteem takes the third hardest blow from modern psychological research; for it proves to each of us that our "self" is not even in our own rooms.And one has to be complacent about getting even a little information about the subconscious processes of the mind.In fact, it is not only us psychoanalysts who want human beings to observe the heart, let alone start from us; we just insist that this is our duty, and firmly support it with empirical evidence that everyone regards as secret. That's all.This is the main reason why the world generally criticizes psychoanalysis, even disregarding the attitude of scholars and rigorous logic.In addition to this, we have been forced to disturb the peace of the world on the other hand, which you will soon realize.