Freud, “The Aetiology of Hysteria” (1896) (Part I)
Freud distinguishes two procedures for approaching hysteria and identifying its causes. The “method of anamnestic investigation” (191) credits the views of the patients, and those of the patient’s acquaintances, regarding the hysteria’s origin. “[W]e question the patient or those about him in order to find out to what harmful influences they themselves attribute his having fallen ill and developed these neurotic symptoms” (191). These attributions are doubtful, however, often reflecting the patient’s various blind spots — scientific ignorance, logical blundering, and psychological defense — and contradicted, further, by evidence yielded by the “second method of arriving at the aetiology of hysteria” (191). This second approach, which Freud likens to those of the dermatologist (191) and forensic physician (192), disregards the patient’s own conjectures about the hysteria, at least to a point, in favor of directly “penetrating from the symptoms to a knowledge of their causes” (192).
Now, I have softened this contrast slightly — ‘at least to a point’ — since the patient’s testimony concerning the illness remains indispensable in the second approach: namely, in the form of his or her memories and associations. Indeed, the process of eliciting this testimony evidently constitutes the better part of “Breuer’s method,” as it is now named. The therapist “lead[s] the patient’s attention back from his symptom to the scene in which and through which that symptom arose” (193), hence demands the patient’s cooperative “reproduction of the traumatic scene” (193). Nevertheless, compared to “the older method of anamnestic enquiry” (192), the new one has little use for the patient’s self-attributions, while his or her “symptoms” themselves are elevated in importance.
With the patient’s assistance, then, the analyst deciphers these symptoms for their “meanings.” In Freud’s words, the second method, but not the first, “induce[s] the symptoms of a hysteria to make themselves heard” (192) and, following this inducement, the symptoms appear as “witnesses to the history of the origin of the illness” (192). Thus the second method — symptom decipherment — rests on the premise that “symptoms of hysteria…are determined by certain experiences of the patient’s which have operated in a traumatic fashion and which are being reproduced in his psychical life in the form of mnemic symbols” (192-3). In this way, analysis uncovered the “efficient causes of hysteria” (193) — its aetiology — in certain “traumatically operative scenes” (193).
Freud now allows that, while the new “method” is fundamentally sound, “the difficult technique of this therapeutic procedure” (193) is not easily implemented. This hedge is repeated several times. Freud cautions the reader that “general doubt about the reliability of the psycho-analytic method can be appraised and removed only when a complete presentation of its technique and results is available” (204) — so implying that such a complete presentation is as yet impossible. And in the article’s concluding paragraph, while welcoming “the attention you give to the procedure I have employed,” Freud reminds us again that the “procedure is new and difficult to handle” (220).
In particular, “the path from the symptoms of hysteria to its aetiology” is, as a rule, “laborious” (193). The path is laborious, not only because of the sophistication and subtlety demanded of the analyst by the method, but because of the “material” itself. In general, the analysis unfolds sequentially, in stages that cannot be abridged or accelerated. The initial “stage” is especially apt to discourage, since it confronts the analyst with unexpected and perplexing data. Why is this?
Freud’s methodological premise, recall, is that the hysterical symptom (say, vomiting, or leg paralysis) expresses (symbolically) an unconscious memory of some traumatic scene. Yet the first “scene” reproduced by the patient frequently lacks the desiderata of a traumatic experience:
“Tracing a hysterical symptom back to a traumatic scene assists our understanding only if the scene satisfies two conditions; if it possesses the relevant suitability to serve as a determinant and if it recognizably possesses the necessary traumatic force” (193)
In other words, to adequately explain a symptom, a “scene” — whose unconscious memory is preserved in and as that symptom — must satisfy qualitative and quantitative criteria. Qualitatively, the ostensibly traumatic event must be of the correct type, or “suitable.” In Freud’s example, a symptom expressing disgust, like vomiting, must be indexed to the memory of an experience meriting disgust — and not, say, “fright” (193-4). Quantitively, the recollected experience must surpass some threshold of affective intensity, a magnitude of “traumatic force.” Otherwise this affect, too, will fail to account for the emergence and persistence of a “symptom” in lieu of its original “discharge.”
Yet Freud tells us that the first “trauma” that surfaces in analysis, to which the patient associatively links the symptom, typically lacks these characteristics: the recollected scene is either qualitatively unsuitable, or quantitively negligible, or both, and so cannot explain the symptom. How, then, does Freud reconcile (a) the theory that symptoms express memories of trauma with (b) the observation that these symptoms appear to originate in emphatically non-traumatic, or unsuitably traumatic experiences? In fact, the patient’s reproduction of such explanatorily “insufficient” scenes neither seems to comport with the theory of hysteria nor delivers any real relief — it “fail[s] to secure any therapeutic gain; the patient retains his symptoms unaltered” (195).
Freud continues, however, that the perceived discrepancy between theory and evidence, as well as the therapeutic disappointment, are both overcome by pressing on with the analysis. The problem is not the theory of hysteria or the associative-recollective method predicated upon it; rather, the analyst and patient have arrived at a premature result. The first “scene” uncovered in analysis, while perhaps the proximate cause or catalyst for the symptom, is neither its “origin” nor underlying explanation. To discover these, says Freud — that is, to find a scene that in the patient’s life does satisfy the traumatic desiderata of suitability and force — one must look further into the past:
“If the memory which we have uncovered does not answer our expectations, it may be that we ought to pursue the same path a little further; perhaps behind the first traumatic scene there may be concealed the memory of a second, which satisfies our requirements better and whose reproduction has a greater therapeutic effect” (195)
The first scene, then, is as a rule not the “final” one — hence fully illuminating and therapeutic — but “behind it there must be hidden a more significant, earlier, experience; and we direct his attention by the same technique to the associative thread which connects the two memories” (195-6). By applying the recollective-associative method in this consistent, thoroughgoing way, analysis arrives, first, at memories dating to puberty of uniformly sexual scenes that are by appearance more likely to warrant a traumatic reaction. Yet because these pubescent scenes also frequently fail to satisfy the Freud’s stated traumatic “desiderata,” analysis continues on to a second cluster of unconscious memories — this time, of infantile sexual scenes. So emerges the notorious “thesis” of the article:
“I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood but which can be reproduced through the work of psycho-analysis in spite of the intervening decades” (203)
Earlier in the article, and in preparation for this thesis, Freud had introduced a “conclusion” reached through “analytic work along these chains of memory” (197). This conclusion seems to anticipate the psychoanalytic doctrine of ‘retroactive trauma’:
“We have learned that no hysterical symptom can arise from a real experience alone, but that in every case the memory of earlier experiences awakened in association to it plays a part in causing the symptom” (197)
In summary, the claim is that “hysterical symptoms can only arise with the co-operation of memories” (197), and that, “even in such instances” where a trauma that is suitable and forceful is located, nevertheless “there exists a chain of operative memories which stretches far back behind the first traumatic scene” (197).