Introduction to Psychoanalysis

Chapter 31 Significance of Symptoms (1)
Gentlemen, in the last lecture I said that clinical psychiatry is not concerned with the form and content of individual symptoms; that these are the starting point for psychoanalysis, which regards symptoms as meaningful in themselves and connected with the patient's life. Experience is closely related.From 1880 to 1882, Breuer studied and cured a case of hysterical psychosis. Since then, people have been very enthusiastic about this disease. It was also at this time that he first discovered the neurological symptoms of psychosis.Jeanne of France also found the same result.In fact Jeanne's work was published before Breuer's, and it took ten years, during the period of my collaboration with him, before he published his observations to the world.Of course, it doesn't make much sense to investigate who made the discovery first. You know, a discovery cannot be completed at one time, and success is not directly proportional to credit.For example, the New World of America does not bear the name of Columbus.The famous psychiatrist Lloyd Wright, who lived before Breuer and Jeanne, also said that the delusions of madmen are not all meaningless if we conduct research and analysis.I confess my preference for Jeannet's explanation of the neurotic symptoms, which he regards as the expression of "unconscious ideas" that occupy the patient's mind.Jeannet, however, was extremely cautious, as if he felt that "subconscious" was only a term of convenience, with no definite meaning at all.Since then I have never heard of Jeannet's teachings, but I believe he has lost his greatness for no reason.

Psychotic symptoms, like mistakes and dreams, have their own meaning and are closely related to the mental life of the patient, just like mistakes and dreams.This is very important and I will illustrate with a few examples.I have not yet been able to prove that this is not true of any kind of mental illness; but anyone who observes seriously may believe it.For several reasons, however, I shall not take the example of hysteria, but of another rather peculiar psychosis, which is very close in origin to hysteria.Regarding this kind of mental illness, I have a few words to explain first. It is called "obsessive-compulsive psychosis". It is not as common as hysteria. We can also say that it is not so hysterical. There are almost no physical manifestations, only mental symptoms.Psychoanalysis was originally based on obsessive-compulsive psychosis and hysteria, and our treatment method is very effective in the treatment of these two psychosis.With regard to obsessive-compulsive psychosis, the psychic sensations do not present themselves as physical symptoms, it is easier than hysteria to be fully understood for psycho-analytic reasons; more prominent.

The symptoms of obsessive-compulsive psychosis are as follows: the patient lacks interest in everything in his heart, feels a special excitement but is forced to do things that are not fun but must be done.Maybe those thoughts and obsessions have no meaning in themselves, but can only make the patient feel boring or stupid; but in any case, the patient can't help but use such ideas as the starting point of focusing his thoughts. Although he doesn't want to, he can't resist, just like Facing life and death, like life and death, I have been worrying and thinking, unable to control myself.The impulse felt in the heart is also childish and meaningless; these thoughts are very terrible, such as the excitement of committing a felony. its achieved.In fact, it is true that the impulsive idea never came true, and the avoidance and precautions won all the victories in the end.What he does is absolutely harmless chores, what we call compulsive behaviors, repetitions of everyday actions, reenactments of adaptations, so that the ordinary normal behaviors, namely, sleeping, washing, dressing, walking, etc., But it turned into something extremely difficult and complicated.Such morbid thoughts, excitements, and actions do not mix in equal proportions to form an obsessive-compulsive psychosis; generally one or the other of their manifestations takes precedence, and the name of the disorder also Thus determined; yet the commonality possessed by all common forms is still evident.

Clearly, the disorder was insane.I do not think that even the wildest fantasies of psychiatric scholars could have concocted such a disorder.If we didn't experience these situations every day, we wouldn't believe them.You must not think that the treatment of these patients can persuade him to try his best to get rid of those absurd thoughts, and not to substitute some meaningless actions for normal behavior, which is exactly what he wants.It's not that he doesn't understand where he's at, and he agrees with your point of view on this obsessive-compulsive disorder, or they can make the same point themselves.However, he felt that he couldn't help himself, and there seemed to be a strong force forcing him to do such a behavior, which was beyond the control of the normal mental state.Therefore, he can only exchange and replace, which is the only way to replace the original absurd idea with a more relaxed one.He may also replace the original one with a preventive measure, and replace the original red tape with other actions.In short, he can change from one to the other, but he cannot completely eliminate these symptoms.All such transference of symptoms is a characteristic of obsessive-compulsive psychosis, including substantial changes from the original form.What is even more noteworthy about this disease is the marked differentiation of all relative values, or extreme values, of the mental life of the patient.In addition to being compelled by positivity and passivity, intellectual doubts arise, and what is more, they gradually expand to doubts about the most real things.All of these can make patients fall into a situation of hesitation, decadence, depression, and self-restraint; although most patients with obsessive-compulsive psychosis are energetic, sharp in thinking, and their intelligence is better than normal people.Generally speaking, they abide by moral principles, often worry about doing the wrong thing, and are often right.You should be able to see how hard it is to work through this maze of contradictory character traits and pathological manifestations to find the source of the disease.Now, our purpose is only to explain some of the symptoms of this disease.

After hearing the foregoing discussion, you may wish to know what contribution modern psychiatry has made to the study of obsessive-compulsive psychosis; it is woefully meager!Psychiatry has only given comparable names to various compulsions, and nothing else.Instead, it is said that sufferers of this disorder are "regressive giants."We cannot be satisfied with this, it is definitely not an interpretation, but a judgment of value, even a pejorative.I do not think it is difficult for us to deduce that all sorts of eccentricities have naturally arisen as a result of degeneration.We thought that patients with such disorders must be different from ordinary patients, but are they really more "degenerate" than other mental patients, hysterics or insane people?Clearly, the term "degeneration" is too loose a term.When you realize that this can happen to great men of great talent and achievements, you will doubt whether the word is accurate at all.Because of the prudence of great heroes and the inaccuracy of their biographers, it is generally difficult for us to know their nature, or they are also fanatical seekers of truth, such as Emile Zola, we know that he has many strange compulsions throughout his life. sexual behavior.

In psychiatry, these patients are called "degenerate giants" and you're done.But as far as the results of the psychoanalysis are concerned, this particular compulsion disappears permanently, as do other symptoms in other non-regressive patients.I have often achieved this result myself.

Here I will analyze the obsessive-compulsive syndrome by citing two examples: the first is an old example, because I have not found a better example, and the second is a recent one.Since this account needs to be both clear and detailed, I will only take two examples.

A lady in her thirties was suffering from severe obsessive-compulsive insanity. I could have cured her, but if fate did not change my work, I will describe the matter in detail later.She only does that weird compulsive move a few times throughout the day, and nothing else.She often ran from her room to the next room, stood beside a table, rang the electric bell to call the maid, ordered her to do a little thing, let her go if there was nothing to do, and then went back to her room.This symptom is not dangerous, but it is enough to arouse our curiosity.The cause of the disorder is stated in general terms by the patient without the help of the analyst.I will not speculate on the meaning of this compulsive behavior, nor will I explain it.I asked the patient many times why she did this, or what it meant, and she always answered that she didn't know.And one day, she suddenly understood the meaning of obsessive-compulsive disorder, but after I persuaded her not to worry about some behaviors, she told the story of this compulsive behavior.She married a man much older than her ten years ago, and on their wedding night, she discovered that her husband was impotent.That night, he ran to her room many times to try his own skills, but failed in the end.In the early morning of the next day, he said with shame and anger: "This will inevitably be ridiculed by the bed maid." So he poured a bottle of red ink on the bed sheet, but he didn't make the spots fall in the right place.At first I did not understand how this recollection was connected with the compulsive behavior just discussed; for I thought that the two situations, excluding a maid and running from one room to another, had no other resemblance.Then the patient took me into the next room, and I saw red spots on the tablecloth.She further told that she wanted to stand by the table, so that the maid would be able to see the red glaze as soon as she came in.We therefore no longer doubt the connection of this compulsive behavior to the circumstances of the wedding night, although further inquiries are still warranted.

First, we have learned that the patient herself ran from room to room instead of her husband, whose behavior was being played out by her.Given the need to maintain similarity, we must assume that instead of a bed and sheets she used a table and tablecloth.Although it seems far-fetched here, the research on the symbolism of dreams can provide reference.The table is often used as a representative of the bed in dreams, and "the bed and the table" have the meaning of marriage, so the bed and the table can be substitutes for each other.

In this way the compulsive behavior can be shown to be meaningful; it seems to reproduce some important situations, but we need not stop at this point of resemblance; if we examine the two situations more closely , it may be possible to infer the purpose of this compulsive behavior.Apparently, at the heart of the act was the summoning of the maid.The patient's display of the erythema to the maid happened to correspond to what the husband said: "This must have made the servant laugh too much." Since she reproduced her husband's behavior, if the husband is not to be despised by the servant, the erythema should appear where he is today. occupied position.Therefore, she not only keeps reproducing the old scene, but also extends and modifies it, making sure that the scene is perfect and irreproachable.In addition, she adapted the situation related to the red ink that occurred in the tragedy of that night, that is, the impotence of the husband.This compulsive behavior seems to show: "No, I am not ashamed in front of the maid, the husband is not impotent." As in a dream, the current compulsive behavior fulfills this wish and thereby restores the husband. Credit after pouring red ink.

All the other facts of the patient support our explanation of her elusive compulsions.Now she has been separated from her husband for a long time, and she is determined to find a way to legally divorce her husband.But she was always haunted by him inside, and she forced herself to be loyal to him.Therefore, she withdraws from the group to escape the temptation of others, and she forgives him in fantasy and idealizes him.The deepest purpose of her illness was to save her husband from malicious slander, to justify the separation of husband and wife, and to live comfortably after his loss of her.We analyzed this harmless compulsion, therefore, and at once found the cause of her illness, while at the same time deducing the general features of obsessive-compulsive psychosis.I look forward to your close study of this example, which brings together all the unpredictable situations of obsessive-compulsive psychosis.The interpretation of this symptom, discovered by the patient in a split second, without the guidance or intervention of the analyst, originates not in something forgotten in childhood, but in something clearly remembered by the patient in adulthood.The various attacks on the interpretation of symptoms that critics have so often imposed on us are then no longer problematic.You must understand that we cannot always encounter such good examples.

Another thing, does it not surprise you that such an innocuous act directly touches upon the most intimate affairs of the patient?The last thing a woman wants to be known about is her wedding night, and it is no accident that we are now fully aware of the privacy of her sex life.You may think that I have chosen this example deliberately for the sake of justification.Let's not jump to conclusions for the time being, please pay attention to the second example, which is completely different in nature from the first example, and is the most common preparatory ritual before going to bed.

(End of this chapter)