Introduction to Psychoanalysis

Chapter 46 General Nervousness (2)
If you are doctors and you have experience with mentally ill patients, you can no longer expect that those who complain the most about their pain will be the most receptive to your help. In fact, the opposite is true.At any rate, you will easily see that everything that increases the benefit of the disease is sufficient to increase the resistance caused by the repression, and makes the treatment more difficult.There is another kind of benefit derived from disease that does not follow the symptoms, but occurs after they appear.If the psychic organization of the disease persists for too long, it may acquire a quality independent of substance; it has a function similar to that of instinct; it will combine with the forces of psychic life, and even opposing forces are not excluded, Thus a provisional arrangement is constructed; it almost never relinquishes any useful and profitable opportunity for self-expression, and thus acquires a new force for the consolidation of its position—the second faculties.Now, instead of taking examples from patients, we take the following facts from ordinary life: a worker with a strong working ability is injured and disabled by an accident at work.He could no longer work, but he also received regular and modest compensation for this, and learned to use his disability to beg for a living.Though his new life is inferior, it is sustained by the rottenness of his old one; and if his deformity were cured, you deprived him of the means of subsistence, and it would be too late for him to return to his old employment. A doubt.If mental illness also comes with such benefits, it can be juxtaposed with the first benefit, and it is called the "second benefit" obtained due to the disease.

I advise you not to underestimate the practical importance of these disease-related benefits, and to underestimate their theoretical significance.In addition to the specialness we have admitted before, this factor often reminds me of an example of animal intelligence given by Orlander: an Arabian riding a camel on a narrow mountain road in the mountains, suddenly in the Turning the corner he saw a lion pounce on him.As a result, he fell into a desperate situation with a deep valley on one side and a cliff on the other, and could only sit and wait for death.But that was not the case with the camel. It jumped down the valley with the Arabs, and the lion next to it could only stare blankly.In fact, the help that mental illness can give patients is roughly equivalent to this; the resolution of conflicts through the formation of symptoms is, after all, only a spontaneous process that is not enough to meet the needs of life, and once the patient accepts this decision, he must give up other life. And it is a higher talent for human beings.If there are more choices in this fashion, the more noble way is to fight fate head-on and make a fair fight.

I don't start my research with ordinary nervousness. What is my motivation?I will elaborate on this point.You might think that starting with this would make it difficult to prove that psychosis has a sexual origin, but you would be wrong.In transference psychosis the sexual origin must be explained before the symptoms can be seen; in the case of "reality psychosis" in its general form the sexual origin is an obvious fact. I learned this fact more than 20 years ago, when I began to wonder why, when examining psychiatric patients, everything about sexual life is not taken into account?And I also caused dissatisfaction among patients because of my research on this matter. However, my efforts soon achieved results, and I came to a point of view from the research: if the sex life is normal, psychosis will not attack, of course I mean actual psychosis .Although this conclusion seriously ignores individual differences, and also lacks an accurate concept of the word "normal"; but roughly speaking, this conclusion still has considerable value so far.At that time I was able to discover a special connection between a nervousness and a wounded sexual state; if I were still working with similar material I could still repeat these relationships, and I often found that a person who If he is completely satisfied with an incomplete sexual gratification such as masturbation, he will suffer from a real psychosis; if he chooses another incomplete sexual way of life, this psychosis will immediately mutate into other types .Therefore, we can infer changes in the way of his sexual life based on the patient's symptoms.I hold on to this concept until the patient proves it and stops lying.However, at that time they will definitely seek treatment from a doctor who is not interested in sex.

How did I not know then that the causes of mental illness need not always be sexual; some people are traumatized by sexual gratification, but others are traumatized by loss of property or recent intense physical trauma.These different interpretations became apparent later on, and I gained a better understanding of the relation of the ego to the libido; and our understanding of it becomes more complete if we investigate the matter more deeply.A person becomes ill only when the ego is unable to deal with the libido.The stronger the ego, the easier it is to deal with the libido; no matter what the reason, every time the power of the ego is weakened, the libido will increase its demands, which can lead to the occurrence of psychosis.Another point is that there are other, more profound relations between the ego and the libido, which we shall leave for a later discussion.The most important thing to note is that, in either case, and whatever the circumstances that lead to the illness, the energy that sustains the psychotic symptoms is supplied by the libido, which becomes dysfunctional.

I should now tell you that there is an absolute difference in symptoms between actual psychoses and psychoses; what we have said before has been mostly concerned with the first category of transfer psychoses, that is, psychoses.Both actual and psychogenic psychoses are libidinal in origin; that is, the symptoms are perversions of the libidinal function, substitutes for libidinal gratification.But the symptoms of actual psychosis, such as feeling headaches, pain, stimulation of some organs and weakening or disappearance of some physiological functions, have no meaning in the mind.This is true even of hysterias, which are not only mostly bodily, but are purely material processes; their occurrence has nothing to do with complex psychic functions as we know them.Thus, the symptoms of psychosis which would previously have been thought to be irrelevant to the mind, are in fact only the symptoms of actual psychoses which are really irrelevant to the mind.But how exactly do they become expressions of libido?Isn't libido just a function of psychic activity?It's actually easy to answer this question.Let us now return to the first objection to psychoanalysis: the objector holds that psychoanalysis seeks to explain the symptoms of psychosis purely in terms of psychology, and since there is no psychological explanation for any of the symptoms, we are almost hopeless.These critics, however, forget that the sexual function is not merely psychological, any more than it is purely physical.Sexual influences are both physical and psychological.We have seen that psychotic symptoms are the psychological result of disturbances in the physiological functions, so we need not be surprised if we say that actual psychosis is the direct physical expression of sexual disturbances.

Clinical medicine provides us with a useful clue, recognized by many different researchers, to advance our understanding of actual psychosis.The details of the symptoms of these diseases, and the common features exhibited by the systems and functions of the body, are clearly similar to the chronic intoxication or sudden release of toxins of a different nature, such as the symptoms produced after drunkenness and abstinence from alcohol.These two conditions can be compared with those of the Brazilian multimorbidity, which is also the result of poisoning, but the toxins are the result of disturbances in the metabolism of the body and not from outside the body.From these comparative results, I think we must regard psychosis as the result of disturbed sexual metabolism, but the reason for the disturbance is that the sex is too poisonous, which cannot be handled by the patient himself or the mental state is no longer sufficient. He was allowed to properly dispose of these toxins.Such hypotheses about the nature of sexuality were already admitted in ancient times, for example, that love is called "intoxication" and can be caused by alcohol, and this view removes the dynamic of love more or less outside the body.Now it is time to remember the concept of the "erogenous zone" and think of the various organs capable of producing sexual excitement.In addition, the question of sexual metabolism or sexual chemistry is still blank. We know nothing about these things and cannot deduce whether sexual substances are divided into male and female. Stimulating motivation will do.The edifice of psychoanalysis we have erected is really only a superstructure, and sooner or later an organic foundation has to be built for it, about which we know nothing.

Psychoanalysis becomes a science characterized by its methods, not by its objects of study.These methods can be applied to the study of cultural history, religion, mythology, and the symptoms of psychosis without losing their essential nature.The purpose and achievement of psychoanalysis is to discover the subconscious in the mind.The symptoms of actual psychosis are not a problem for psychoanalysis, because they may be caused by direct poisons; psychoanalysis cannot do any analysis of them, and this work can only be left to biology and medicine.By now you should understand better why my material is arranged the way it is.If I begin with an introduction to psychiatry, it is natural to deal with the simple knowledge of actual psychoses, and it would be justified to proceed step by step with more complex psychoses arising from disturbances of the libido.At that time I was obliged to collect all kinds of knowledge about actual psychoses, which became the introduction to psychoanalysis as the most important technical method of understanding these symptoms.Our subject, however, is an introduction to psychoanalysis; therefore I consider it more important to explain to you the ideas of psychoanalysis than to teach you something about psychosis; Naturally, mental illness should not be placed first.I still think that this arrangement of mine is in your best interest, that the knowledge of psychoanalysis deserves the attention of educated men, and that the theory of psychiatry is but a chapter of medicine.

Still, you'd be quite right to want me to focus more on reality psychosis.Realistic psychosis and psychogenic psychosis are closely related clinically, and we need to pay more attention to them.What I want to tell you is that there are three simple forms of actual psychosis: one is neurasthenia, the other is anxiety psychosis, and the third is melancholia.Of course, such a classification can not help but be suspicious. Although these terms are very common, the meaning of these terms is difficult to determine.Some medical scientists think that it is impossible to classify the various worlds represented by psychosis, so they oppose the classification of all clinical diseases, and do not even recognize the difference between actual psychosis and psychological psychosis; I think they go too far, they are a little unreasonable up.The three forms of psychosis mentioned above sometimes occur alone, but in most cases they are mixed and have the color of psychological psychosis.Therefore, we cannot for this reason give up the distinction between them.We should understand the difference between minerals and ores in mineralogy: minerals can be classified, no doubt partly because they are crystals, unlike others, ores are mixtures of minerals, and this mixture has corresponding conditions. , rather than relying solely on chance.Our limited knowledge of the development of the theory of psychosis is certainly not comparable to that of the ore; but if we can identify the clinical elements, these elements should be advanced like the ore, and it is the correct method of investigation.

There is also a relationship between actual psychosis and psychopsychosis which is notable and makes an important contribution to the knowledge of the formation of the latter's symptoms; the symptoms of actual psychosis are often the core or initial stage of psychopsychotic symptoms.This relation is evident between neurasthenia and transformational hysteria in the metastatic psychosis, between anxiety psychosis and anxiety hysteria; Psychosis, that is, between delusional psychosis (including early dementia and paranoia).We now discuss the headache or backache in hysteria as an example, and it turns out that this pain makes use of condensation and diversion to satisfy libidinal fantasies or substitutes for memory; Pain is a direct symptom of sexual toxins, without fanciful elements, that is, it is also a physical manifestation of sexual excitement.We would be reluctant to assert that hysterical symptoms have such a nucleus, but it is certainly a fact that all bodily effects of sexual excitement, whether normal or pathological, are especially apt to serve for the formation of hysterical symptoms.They are like grains of sand, used by oysters as raw materials for making mother-of-pearl.All brief manifestations of sexual excitement during coitus can be used as the most suitable and convenient raw material for producing psycho-psychotic symptoms.

In addition, there is a journey that is equally interesting in diagnosis as in treatment.Some persons, though predisposed to psychosis, do not in most cases develop psychosis, yet why should any disease in their bodies, perhaps mere general inflammation or injury, be often enough to cause it; To be used as a tool for those subconscious fantasies that are trying to make a difference.In such cases, the physician will first try the remedy and then switch to another, or remove the organic basis on which the symptom rests, regardless of the presence or absence of psychotic tendencies; The mental illness is treated and the physical stimuli are ignored.Two remedies sometimes work one way, sometimes the other; and in this mixed syndrome there is really no so-called general principle to follow.

(End of this chapter)