Chapter 25 Lecture 24 General Nervousness

In the previous lecture, I said a lot of things that were not easy to understand. Now I can leave this topic for a while and listen to your opinions. I know you are not satisfied.You would have thought that the Introduction to Psychoanalysis was quite different from what I have described.What you expect is not a theory, but an example from life; you may want to tell me that the story about the two children upstairs and downstairs may be used to explain the cause of mental illness. Unfortunately, this is my invention, not Practical examples.Or you will also tell me that when I first describe the two symptoms, we hope that this is not imaginary, but explain their course and relation to the patient's life, the meaning of the symptoms does become a little clearer, you have hoped that I Go on like this.I have not, however, given you many long and difficult theories, which are never complete and always have to be supplemented; I have discussed many concepts that have not been introduced to you before; I have abandoned narrative It is difficult for you to understand how many of these academic terms have the same meaning, and the interchange is just for the sake of pleasing to the ear.I also raised many non-marginal concepts, such as the principle of pleasure, the principle of reality, and the inheritance of species development, etc., before I explained them, I threw them into the sky.

I'm going to talk about neuroses, why don't I start with neurotics, which you all know and are interested in, or the characteristics of neurotics, such as incomprehensible reactions to people, and their excitability, unreliability, and ability to get anything done. inability.Why not start with the simple everyday explanations of neuroticism, and work your way up to the incomprehensible extreme manifestations? Of course, I cannot deny all these things, nor can I say that it is your fault.I am not so proud of my power of presentation as to imagine that every defect has a special purpose.I originally thought that it might be beneficial to you to change the method. To be honest, this is indeed my original intention.Often, however, a man cannot carry out a rational plan; often the material itself suddenly intervenes with facts which make him unconsciously change his original intention.Although the material is very familiar, it cannot be stated exactly as the author intends; often the words have been said, but why we say this way and not that way makes us puzzled afterwards.

There may be a reason for this: my thesis, Introduction to Psychoanalysis, does not include this passage dealing with neuroses.Because the introduction to psychoanalysis includes the study of faults and dreams; as for the theory of neuroses, it is already the main treatise of psychoanalysis.I do not think that I can expound any of the material contained in the theory of neuroses in such a short time. I can only give a brief account, so that you can understand the meaning of the symptoms in a suitable context, and all the external and internal aspects of their formation. conditions and mechanisms.This is what I have to do; that is the point to which psychoanalysis can now contribute.I therefore had to say a lot about the libido and its development and ego-development, and after the first few lectures you will have an overview of the main principles of psychoanalysis and of the concepts of the unconscious and the resistance to repression.In the following lecture you will know at what point the work of psychoanalysis finds its organic cohesion.I have also made it clear that all our results have been obtained from the study of a single group of neuroses, the transference neuroses; .Although you may not have acquired a very thorough understanding and detailed knowledge, I always hope that you have some idea of ​​the method of psychoanalytic work, the problems that must be solved, and the results that must be described.

You wish me to begin my lecture on neuroses by describing the behavior of the neurotic, how he suffers, how he manages to resist, and how he manages to adapt.This is indeed an interesting subject, both worthy of study and not difficult to address; yet we have many reasons for not proceeding with it.The danger is that the unconscious will thus be neglected, the libido will be underestimated, and events will be judged from the patient's ego's point of view.The unreliability and partiality of the patient's ego is notorious.The ego always denies the existence of the subconscious and keeps it repressed; so how can we trust the ego's faithfulness in relation to the subconscious?And what is most repressed is the negated sexual demands; so it is most obvious that the scope and meaning of these demands must not be understood from the point of view of the ego.Once we know the nature of the repression, we will not allow the ego, the victor, to be the judge of the balance.We need to be wary of what our ego tells us and not be fooled.If the evidence is given by itself, it seems to be the active force from the beginning to the end, so the symptoms also seem to be due to its desire and will; we know that it is largely passive, and this is a fact that it tries to conceal. .But it is not often able to maintain this hypocritical situation - in the symptoms of obsessional neurosis, it has to admit that it has encountered some forces that it must strive to resist.

A man who ignores these warnings and is willing to be deceived by the face value of his ego will obviously do well; psychoanalysis focuses on the subconscious, and he can cope with the protests of his sex life and the passivity of the ego. avoided.Adler says that nervousness is the cause, not the effect, of neurosis, and he agrees; but he cannot explain a single detail in the formation of a dream or symptom. You ask me: Is it possible to give importance to the part played by the ego in the formation of neuroses and symptoms without absolutely neglecting the other factors discovered by psychoanalysis?My answer is: that is certainly possible, sooner or later; but the research that psychoanalysis is currently doing should not start from this end point.We can naturally make a point in advance to include this study.There is a neurosis called the narcissistic neuroses, and the ego and the narcissistic neuroses are more deeply related than any other neuroses we have studied.An analytical study of these neuroses will allow us to estimate correctly and reliably the place occupied by the ego in them.

But there is also a relationship between the ego and the neurosis which is obvious from the outset.This relationship seems to be common to all neuroses, but it is particularly marked in the traumatic neuroses, a neurosis so little understood.You must know that the same factor is present in the cause and mechanism of all kinds of neuroses; it is only that in one neurosis this factor plays an important role in the formation of symptoms, in another neurosis it is another. One factor dominates.Just like actors in a troupe, each actor plays a particular role—leader, confidant, villain, etc.;The hallucinations that form the symptoms are therefore by no means as pronounced as in hysteria; while the "counterattack" or resistance of the ego is first of all obsessive-compulsive neurosis, the paranoia's delusions are characterized by the mechanism of so-called embellishment in dreams.

In traumatic neuroses, especially those arising from war, egoistic motives and efforts at self-defense and self-interest make a special impression on us; After it is formed, it depends on them to maintain.The purpose of this tendency is to protect the ego from the dangers of inducing disease; it is unwilling to restore health unless the danger is no longer likely to strike again, or if the danger is rewarded in a considerable way. The ego is similarly interested in the origin and continuation of all other neuroses; we have said that the symptoms are on the one hand satisfied by the ego's tendency to repress, and are therefore also protected by the ego.Moreover, it is also a very convenient way to solve mental conflicts by the formation of symptoms, which is most in line with the spirit of the principle of pleasure; because symptoms can save the self from mental pain.In fact, as far as certain neuroses are concerned, even doctors have to admit that using neuroses to resolve conflicts is the most harmless and socially acceptable method.Are you not surprised that a physician sometimes admits that he also sympathizes with the disease he is treating?In fact, a person does not need to regard health as the most important thing in all kinds of life situations; he also knows that there are other kinds of pain in the world besides neurotic pain, and a person can also be healthy according to his needs. His own health was sacrificed; and he knew that one man's affliction of this kind would often save many others from other distresses.Therefore, although we may say that every mental patient has escaped into the disease, we have to admit that there are many cases where there are good reasons for this flight, and the doctor knows this situation and has to acquiesce.

However, we can continue the discussion regardless of these special cases.Roughly speaking, since the ego has escaped into neurosis, it "benefits from the illness" inwardly; under certain circumstances, it can also have a specific external benefit, which is actually of some value.Let me give you the most common example.For example, if a woman is violently abused by her husband, if she is prone to neurosis, she will often escape into the disease at this time.If she is too cowardly or old-fashioned to console her by cheating on her, if she is not strong enough to openly resist external attacks and divorce her husband, and if she has no ability to live independently and no hope of finding a better husband, Finally, if she remains strongly sexually attached to the domineering man, she has no other way but to escape into the disease.Disease is her tool against her husband, it can be used for self-defense or revenge.Although she did not dare to complain about her marriage, she could openly complain about her illnesses; the doctor was her good friend; her husband who had been extremely violent now had to forgive her, spend money for her, and allow her to leave the family and relax his oppression a little.If this external "accidental" benefit from the disease is very significant, and in fact there is no comparable substitute, then you will not easily have the hope of receiving a therapeutic effect.

I have objected to the idea that neurosis is self-inflicted and self-created; you will now think that what I have just told you about the "benefits of the disease" is no less than a justification for it.However, I would like to ask you to stay calm for a while.This may mean only the following: namely, that the ego welcomes the neurosis which it cannot avoid no matter what, and if there is any use for neurosis, the ego makes the best of it.This is only one side of the problem.If neurosis is beneficial, the ego would of course like to live with it, but we have to take into account that there are also disadvantages among the benefits.Roughly speaking, the ego clearly suffers from the acceptance of neurosis.It can solve the contradiction, but unfortunately the price is too high; the pain that comes with the symptom is roughly the same as the pain of the contradiction before the symptom, and may be greater; the ego hopes to avoid the pain caused by the symptom, but does not want to Giving up the benefits of illness; that's exactly what it can't do.From this it appears that the ego is really unwilling to be actively concerned with this problem from beginning to end, as it originally thought.This is one thing we are to remember well.

If you are physicians and have a lot of experience with neurotics, you can no longer expect that those who complain most of their ailments will be most receptive to your aid--in fact often the opposite is true.In any case, it is easy to see that everything that increases the benefit of the disease tends to strengthen the resistance caused by the repression, and thus increases the difficulty of the treatment.There is also a kind of sickness benefit, which does not accompany the symptoms, but arises after they have occurred.A psychic organization like a disease, if it persists for a long time, acquires the character of an independent entity; it has a function similar to that of the instinct of self-preservation; Combining forces, even radically opposite ones, seldom relinquish useful and profitable opportunities for repeated self-expression, and thus acquire a second faculty to strengthen their position.Now we don't need to draw an example from a disease, but take an example from our daily life as follows: A worker who can do work is disabled due to an accidental injury at work.He can no longer work, but receives regular small payments for it, and learns to use his disability to beg for life.His new life, humbler as it is, is sustained by the destruction of the old one; and if you cure him of his cripple, you deprive him of the means of subsistence, for will he now be able to do his former work again? , is already a question.If neurosis also has this incidental benefit, we can put it side by side with the first benefit and name it the second benefit obtained by the disease.

I would advise you not to underestimate the practical importance of benefit from illness, but also not to overemphasize its theoretical implications.This factor, apart from the special cases already admitted, often reminds us of an example given by Oberlander in Fliegende Blatter to illustrate animal intelligence.An Arab rode a camel on a narrow road in the mountains.When he turned a corner, he suddenly saw a lion in front of him about to pounce on him.He had no way to escape now, there was a deep valley on one side and a cliff on the other; it was impossible to retreat or escape; he had to bow his head and wait for death.Not so with camels.It leaped and jumped down the ravine together with the rider—the lion had no choice but to stare aside.Probably no better relief can be offered by neurosis to the patient; perhaps because the resolution of contradictions by symptom formation is after all an automatic process, not adequate for the demands of life, and the patient has to give up his highest talent.If there is still a choice at this time, the more honorable way is to go up and fight a fair fight with fate. I don't start with general nervousness. What is the motive?I will also explain this level.You may think that it will be more difficult to prove that neurosis has a sexual origin from this point; in fact, you are wrong.In the case of transference neuroses, the symptoms must be explained before their sexual origin is seen; in the general form of what we call actual neuroses actual neuroses, the sexual origin is a strikingly obvious fact. .I knew this fact more than twenty years ago, when I began to wonder why everything about sex life was not taken into consideration when examining neurotic patients.I gradually caused dissatisfaction among my patients by studying the matter, but after a while my efforts led me to the conclusion that if the sex life was normal there would be no neurosis--I mean actual neurosis.On the one hand, this conclusion ignores individual differences, and on the other hand, the word "normal" still lacks a fixed meaning; but generally speaking, this conclusion still has considerable value today.I was then able to establish a special relationship between a certain nervousness and a certain wounded sexual state; if I still had similar material to study, I could of course repeat these relationships.I have often noticed that if a person is satisfied with an incomplete sexual gratification, such as masturbation, he suffers from a certain kind of actual neurosis; into another way.Therefore, I can infer the change of the patient's sexual life style from the change of the patient's condition.I will hold on to this conclusion until it is proven that the patient is no longer lying.But they will have to go to doctors who are not interested in sex. Nor did I not know then that the cause of neurosis need not always be sexual; some people do suffer from a compromised sexual situation;The explanation of these changes will naturally become clear later, when the relationship between the ego and the libido will be deeply understood; and the deeper we study this problem, the more fully we will understand it.A person is neurotic only when the ego cannot handle the libido.The stronger the ego, the easier it is to deal with the libido; every weakening of the ego's capacity, for whatever reason, increases the demands on the libido and makes neurosis possible.In addition, there are other close relations between the ego and the libido, but these relations are not yet discussed, so we will not discuss them for the time being.The most important thing to note is that, in any case, and regardless of the circumstances of onset, the energy on which the neurotic symptoms depend is supplied by the libido, so that the libido becomes dysfunctional. . Now I should tell you that there is an absolute difference between the symptoms of actual neuroses and those of psycho-neuroses; and what we have said before mostly concerned the first group of psycho-neuroses, the transference neuroses.The symptoms of both practical neuroses and psychoneuroses originate in the libido; that is to say, the symptoms are perverted uses of the libido, that is, substitutes for libido-satisfaction.But the symptoms of actual neurosis—such as headaches, painful sensations, disturbed conditions in certain organs, weakening or cessation of certain functions—have no "meaning" in the mind.Not only are they mostly bodily manifested, as are the symptoms of hysteria, but they are purely material processes; they occur without reference to the complex psychic mechanisms we know.So I used to think that the symptoms of psychosis had nothing to do with psychology; now the symptoms of neurosis really have nothing to do with psychology.But how can they be expressions of the libido?Is not the libido also a faculty acting in the mind?In fact, the answer to this question is very simple.Let us now restate the first objection to psychoanalysis as follows.Opponents think that our theory is an attempt to explain the symptoms of neuroses solely in terms of psychology, and since no disease has ever been explained by a psychological theory, our hopes are very slim.But these critics forget that the sexual function is not purely psychological any more than it is merely physical.Its influence extends both to the life of the body and to the life of the mind.Now that we know that the symptoms of psychoneurosis are the psychological result of disturbances in the sexual functions, we should not be surprised to hear that actual neuroses are the direct organic result of sexual disturbances. Clinical medicine gives us a useful hint, recognized by many different researchers, by which to understand actual neurosis.As far as the details of their symptoms are concerned and the characteristics jointly exhibited by the systems and functions of the body, there is obviously a mutual relationship between them and the morbidity that occurs after the chronic intoxication or sudden elimination of heterogeneous toxins, that is, the state of drunkenness or abstinence from alcohol. similar point.These two morbidities can be compared with Basedow's disease, exophthalmic goitre, which is a common disease in Brazil, because this disease is also the result of poisoning, but the toxin does not come from the outside, but from the metabolism in the body.I think that from these comparisons we are compelled to regard neurosis as the result of a disturbance of the sexual metabolism, which has been disturbed either by the production of too much sexual toxins which the patient cannot handle, or by the Internal and even psychological conditions do not allow him to deal properly with these substances.This assumption about the nature of sexual desire has long been recognized by people in ancient times; for example, wine can beget love, and love can be called intoxication-these concepts have more or less moved the power of love outside the body.Here we also remember the concept of the erotogenic zone, and recall that various organs are capable of sexual excitation.Beyond that, the question of the metabolism or chemistry of sex is a blank chapter: we know nothing about it, and we cannot say for sure whether there are two sex substances, or assume only one sex. It is enough for the toxins of the libido to be the motives of various stimuli.The psychoanalytic edifice we have erected is really only a superstructure for which sooner or later we have to build an organic foundation; however, we still lack the knowledge of this foundation. What makes psychoanalysis a science is its method, not its subject matter.These methods can be used to study cultural history, religion, mythology, and neurology without losing their essential properties.The purpose and achievement of psychoanalysis is only to discover the subconscious in the mind.The symptoms of actual neuroses may be directly caused by toxin damage, so they are not the subject of psychoanalysis; psychoanalysis, which can explain them nothing, has to transfer the work to biological and medical research.My material so chooses this arrangement, which you will now understand better.If I were to give an introduction to neurology, it would of course be justified to start with the simple forms of the actual neuroses and then go on to describe the more complex psychoses arising from disturbances of the libido.At that time I had to collect knowledge on the former from various sources, so that as far as the latter was concerned, it was convenient to introduce psychoanalysis as the most important technical method of understanding these pathological conditions.But the title I have announced is an introduction to psychoanalysis; I think it is more important to give you psychoanalytic ideas than to teach you some knowledge of neuroses; Put it up front.I also thought that my choice would be more beneficial to you, because the knowledge of psychoanalysis deserves the attention of ordinary educated people, while the theory of neuroses is only a chapter in medicine. But you also have good reasons for wishing me to pay attention to practical neuroses; the close clinical relationship between practical neuroses and psychiatric neuroses is more than sufficient to warrant our attention.I want to tell you that there are three simple forms of actual neurosis: one is neurasthenia, the other is anxiety-neuro-sis, and the third is hypochondria.This categorization is not without doubts; useful as these terms are, their meanings are far more difficult to ascertain.Some medical scientists, who believe that there can be no classification in the chaotic world of neuroses, object to all clinical categories, and even deny the distinction between actual neuroses and psychoneuroses; Not the path to progress.The three forms of neurosis mentioned above are sometimes simple; but more often they are mixed with each other and have the color of psychoneurosis.So we don't have to give up their distinction from each other.You must know that in mineralogy there is a difference between minerals and ores; minerals can be classified one by one, partly because they are often crystals, unlike the environment, and ores are mixtures of minerals, but the mixture is not purely by chance. And there are quite conditions.As far as the theory of neuroses is concerned, our knowledge of their development is too limited to have the equivalent of ore knowledge; yet if we presuppose recognizable clinical elements, which can be compared to individual minerals, , is not necessarily a legitimate research method. There is also a remarkable relation between practical neuroses and psychoneuroses, and an important contribution to the knowledge of the formation of the latter's symptoms; for the symptoms of practical neuroses are often the nucleus and initial stage of those of psychoneurosis.This relation is most evident between neurasthenia and conversion hysteria in the transference neuroses, and between anxiety neuroses and anxiety hysteria; but it is also seen in melancholia and the A neurological disorder, paraphrenia, includes dementia praecox between dementia praecox and paranoia.Let us take hysterical headache or back pain as an example.Analysis shows that this kind of pain is the satisfaction of the phantasy or memory of the libido by means of compression and displacement; but sometimes this pain is not fabricated, but a direct symptom of sexual poison, It is also a physical manifestation of sexual excitement.We do not wish to maintain that all hysterical symptoms have such a core, but it is often true, and all the bodily effects of sexual excitement, whether normal or pathological, are especially adapted to the formation of hysterical symptoms. .They are just like a grain of sand, taken by oysters from which mother-of-pearl is made.All temporary manifestations of sexual excitement during coitus are the most suitable and convenient material for psychoneurotic symptoms. There is another course that is equally interesting in terms of diagnosis and treatment.Some people are prone to neurosis, but most do not develop neurosis, but a morbid organic condition in them-perhaps an inflammation or an injury-is often enough to make the symptoms from there; so in fact Symptoms are immediately adopted as a tool for those subconscious fantasies that are trying to express themselves.In such cases the doctor will first try one remedy, and then another; or he will try to destroy the organic basis on which the symptom rests, regardless of his neurotic tendencies; The neuropathy that has been formed, and ignore the stimulation of the body.The two procedures are sometimes effective in one way, sometimes in the other; and as far as this mixed disease is concerned, there are no so-called general principles to follow.