Clinical Papers and Essays on Psychoanalysis

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This is the second volume of the works of Karl Abraham, whose Selected Papers on Psycho-Analysis is one of the most widely read and highly valued classics on the subject. The first part of this book contains short clinical papers on a wide range of subjects, including The Psychogenesis of Agoraphobia in Childhood, The Role of Grandparents in the Psychology of Neurosis, The Emotional Relationships of Little Girls towards their Parents, early Infantile Thinking, and others.

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2 The Significance of Intermarriage between Close Relatives in the Psychology of the Neuroses (1909)

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IT has long been assumed that marriage between near relatives is harmful to the offspring of such a union. Medical literature, as well as popular belief, attributes a variety of nervous and mental disorders to parental consanguinity. There can be no doubt that in many families inbreeding and mental or nervous disorders go together. It does not necessarily follow, however, that the inbreeding and the disorders are cause and effect. The question is rather whether the incidence of intermarriages in certain families is not due to a specific cause, whether such neuropathic families are not compelled to intermarry by a peculiar tendency prevailing among their members. If we regard intermarriage as a psychopathological phenomenon, we observe that it cannot be viewed apart from a series of other psychological phenomena to which it is fundamentally related.

I do not claim that the views on the psychology of intermarriage put forward here are of general validity. Such marriages between relatives may, of course, like any other marriages, be contracted for purely practical reasons. In other cases, external reasons such as being cut off from general social life may prevent mixing with people outside the family. Moreover the tendency towards inbreeding may vary among different peoples and at different social levels. In cases, however, where relatives are led to marry solely by reason of individual desire I would infer that the capacity for transferring love on to persons outside the family is deficient, attachment to members within the family being at the same time excessive.

 

3 Observations of the Cult of the Mother and its Syrnbolism in Individual and Folk Psychology (1911)

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WE know from the analysis of dreams and of neuroses that the mother’s body is often represented by certain recurrent symbols. Two representations are most frequently met with: one is the lonely house in a garden or in a wood where one feels one has lived in former times. The other is a secret room with a narrow portal in which one would like to take refuge from danger. I will mention a few examples, but for the sake of brevity will omit the full analytical material for my interpretation. These psychological phenomena are, incidentally, familiar to every psycho-analyst.

(1) A. reports a very vivid phantasy, recurring since childhood. He imagines a magnificent house situated in a large, tropical garden. At the same time he has the feeling that he lived there as a little boy.

(2) B., who suffers from severe anxiety states, withdraws in his daydreams to a secret hiding place. Deep in the forest and underground lies a recess known only to himself. His greatest wish is to live there alone with his phantasies.

 

4 On the Determining Power of Names (1911)

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IN his paper on ‘The Implications of Names’1 Stekel has drawn attention to hidden relations between names and occupations as well as between names and neuroses. As the author proves by an abundance of examples, the bearer of a particular name often feels that he has a duty to it; in other cases a name may arouse certain psychological reactions such as obstinacy, pride and shame. The question advanced by Stekel certainly deserves our attention. I will here attempt a contribution towards its clarification.

From experience with my neurotic patients I can confirm Stekel’s observation. By way of illustration I may mention that in two cases of obsessional neurosis I found a correspondence between the meaning of the patient’s name and the content of his obsessional ideas, and that I am now treating a homosexual whose name fully corresponds to his feminine character traits. I should like to add that in some families a certain character-trait expressed in a particular name is handed down. I know, for instance, a family whose members are especially characterised by their pride, and whose name is in full accordance with their personalities. In such cases an ancestor may have assumed, or have been given, such a name because such a quality was particularly evident. This trait would be handed down even without the support of the name. The latter, however, imposes a duty on the descendants to make a particular display of their special characteristic.

 

5 Should Patients Write Down Their Dreams? (1913)

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IN a short paper entitled ‘The Handling of Dream Interpretation in Psycho-analysis’1 Freud briefly considered the question whether or not it was of advantage to let patients write down their dreams immediately on waking. He came to the conclusion that such a procedure was superfluous. ‘Even if the text of a dream is thus laboriously preserved instead of being swallowed by oblivion one is soon convinced that the patient gains nothing by it. No associations are evoked by the text, and the result is the same as if the dream had not been preserved.’2

My own experience fully confirms this view. The question, however, seems to me to be of considerable interest to the psychoanalyst who makes daily use of dream-interpretation. For this reason I will mention some instances from my own practice. These arose with precisely those patients who had already been told of the futility of immediately writing down their dreams.

Case 1. A patient had a very elaborate and eventful dream associated with strong emotion. On waking he drowsily reached for his writing materials which, contrary to the physi cian’s instructions, he had put at his bedside. Next morning he brought me two large pages covered with notes. It at once became obvious, however, that what he had written was entirely illegible. The desire to rescue the dream from oblivion is in this case obviously countered by the opposite striving towards repression. The result is a compromise in that the dream is written down, but the writing is illegible, disclosing nothing.

 

6 A Screen Memory Concerning a Childhood Event of Apparently Aetiological Significance (1913)

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THE following communication is taken from a case which, for external reasons, I was able to observe for a very short period only and which therefore could not be properly analysed. The analysis of the patient’s screen-memory is therefore of a fragmentary character; in the few available sessions it was not possible to analyse all his associations. In some instances I had to draw the inferences for myself—though to the experienced eye they were perfectly obvious. Wherever I have made such interpolations, I shall expressly say so.

The patient, a man of forty-seven, had suffered since his youth from an obsession. He had to look at and examine all objects in the most painstaking manner and especially had to make their back fully accessible to his view. Once he had carefully scrutinised an object he had further to ruminate over its origin and make. From his childhood onwards there also existed a compulsion to pray and to brood upon religious questions. These obsessive symptoms were of such intensity that the patient became endlessly involved with each object. He could no longer follow his profession and finally could not even leave the house as every object in the street held his attention for long periods. His wife had to go everywhere with him and had to drag him along to prevent his stopping whenever his attention was arrested; otherwise he would stay for an indefinite period, meditating and talking to himself. His behaviour on the occasion of his first interview with me illustrates this.

 

7 On the Psychogenesis of Agoraphobia in Childhood (1913)

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NEUROTICS who are afraid of walking in the street without being accompanied by a particular person usually suffer from a second phobia also: the fear of being alone indoors. The unconscious of such patients does not permit them to be away from those on whom their libido is fixated. Any attempt by the sufferer to defy the prohibitions set up by his unconscious is visited by an anxiety state.

A five-year-old boy afflicted with both these phobias recently produced quite spontaneously, that is to say without being questioned by the doctor, a confirmation of this psychoanalytical observation. What he said is so amazingly appropriate and succinct that I should like to quote it here and to add a few words of comment.

So severe was his anxiety that the boy could not be induced to leave his parents’ home to go by himself to visit relatives living next door, although he had not even to cross the road to do so. He also became frightened if his mother went out, even when his nurse stayed with him. Recently he reached the point where he actually refused to go out with his nurse.

 

8 Some Remarks on the Role of Grandparents in the Psychology of Neuroses (1913)

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IN my work as a psycho-analyst I have always been struck by the fact that some neurotic and psychotic patients would always return to speaking of their grandfather or grandmother. Yet in no single case of this kind had the grandparents exercised a decisive influence upon the course of the patient’s life. However much these cases differed from one another, their analysis invariably led to one uniform conclusion: the special emphasis given to the grandfather or grandmother was always rooted in a violent rejection of the father or mother.

The deeper causes of this singular manifestation, like many other characteristics of the neurotic, become comprehensible to us if compared with the behaviour of children. Two examples from the life of a normal or only slightly abnormal boy may serve to illustrate this.

This boy indulges in the typical day-dream of being the prince of an imaginary kingdom. He ascribes to the king of this realm just those qualities which he most respects in his own father. Later he endows this king with a father, thereby himself acquiring a grandfather, to whom he attributes the power of creating things by his command, that is to say, divine omnipotence. The result is clear: the father who in the eyes of the small child had been omnipotent, is in turn subjected to a higher power which he, too, must respect. In this way the omnipotence previously ascribed to his father is challenged. It should be noted that the boy knew neither of his grandfathers and therefore he had created the grandfather-figure in his phantasy-kingdom mainly from his own imagination.

 

9 On Neurotic Exogamy: A Contribution to the Similarities in the Psychic Life of Neurotics and of Primitive Man (1913)

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UNTIL recent times the only special significance attached to marriages between close relatives was that they were regarded as genetically unsound. In an earlier paper1 I have pointed out that marriages between relatives must be considered to be essentially psychopathological phenomena. Starting from the sexual deviations of neurotic patients made known to us by psycho-analytical investigation I reached the conclusion that many such neurotics failed to transfer their libido on to persons outside their family. They failed because even after puberty their libido remains incestuously fixated. For the neurotic, who must avoid not only the object of his original incestuous wishes, but also women outside his family, marriage to a kinswoman constitutes a compromise.

In the paper mentioned above I have shown that in order to appreciate correctly the psychological significance of the tendency towards inbreeding, this phenomenon must be ranged with certain other manifestations. At one end of the scale we find true incest. This is far less rare in psychopathic families than has been hitherto supposed. At the other extreme is complete and permanent avoidance of all heterosexual relationships.

 

10 A Contribution Towards the Understanding of the Suggestive Effect of Medicine in the Neuroses (1914)

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ONE of my patients tells me that people meeting him for the first time often communicate their most intimate secrets to him. With emotion he said: ‘A man once told me that he was not going to marry, because he was disappointed by every girl after he had once had intercourse with her.’

It struck me as significant that he should mention just this example. The next associations were as follows: ‘My anxiety sometimes lessens if I see a pretty girl in the tram who attracts me sexually, even though she is a complete stranger to me… . Is it possible, doctor, for sexual feelings to drive out anxiety?’ After I had commented on this, he continued: ‘If I am frightened, I always get most help from medicine which I have only carried in my pocket and have never taken. Once I have taken a medicine, I am always disappointed.’

We now understand why the patient had chosen this particular example. In it he identified himself with that marriage-shy acquaintance. He himself had never ‘taken’ a girl. He is completely fixated to his mother through his anxiety; only near this woman, untouchable to him, is he free from anxiety.

 

11 Some Illustrations on the Emotional Relationship of Little Girls Towards Their Parents (1917)

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A MOTHER, in telling me about her four-year-old daughter, whom we will call Elsie, said that she showed particular love and tenderness for her father. Recently she had particularly liked to play at being father’s wife. When the mother asked her why she wanted to be her father’s wife she replied that she would ‘like to know what it was like’, and added that she could then at last find out ‘what coffee tastes like’. ‘I asked her’, the mother continued, ‘what is to happen to me, and she had her answer ready: “You will just be our child”.’

‘On one occasion’, the mother continued, ‘Elsie related to her elder sister a story she had herself made up. It began: “Once upon a time there was a dwarf who had seven little dwarfs. Their mother had died a long time ago”. When I asked why the mother had died the child explained: “Oh, she was already over a hundred and very poorly”. Some months ago at the zoo, Elsie stopped in front of a cage in which there was a wild sow with a large litter. Elsie exclaimed with the greatest delight: “Look, there is a father pig with his children!” I explained that it was the mother, but she insisted, “No, the father”. When I assured her once more that it was the mother she asked: “But where is the father?” Only when I said that he had probably just gone a little walk did her face brighten again.

 

12 Some Remarks on Ferenczi's Paper on Sunday Neuroses (1919)

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TEMPORARY exacerbations of nervous disorders in connection with Sundays, feast-days and holidays have often come to my attention. The remarks which follow on the aetiology of such fluctuations are intended not to contradict Ferenczi’s thesis, but to supplement it in one particular direction.

A large number of people are only able to ward off the outbreak of severe neurotic symptoms by working at high pressure. There is in these people, as a result of too severe a repression of instincts, a constant danger of the conversion of accumulated excitation into neurotic symptoms. By their strenuous efforts in their profession, in study, or in some other round of activity, they divert their attention from their libidinal demands. They develop the habit of working to an extent which is far beyond the requirements of any real necessity. Work in ever-increasing dosage becomes as indispensible to them as the habitual drug to the morphine addict. If at some time such neuropaths develop a neurotic illness, doctors and laymen alike are quick to produce an apparently plausible aetiology. ‘Overwork’, they say. In some of these cases, however, work does not succeed in keeping the pressure of libidinal forces always at bay. Eventually these forces break through by way of conversion. In other cases, with which we are particularly concerned here, neurotic symptoms of greater or less acuteness and severity break out when, for external reasons, work is interrupted. The psychic equilibrium so strenuously maintained by constant work will be overthrown in the course of a Sunday or a holiday or a longer period of inactivity. Such patients feel better again as soon as they resume work.

 

13 Two Mistakes of a Hebephrenic Patient (1921)

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A YOUNG girl suffered from an insidious type of hebephrenia. She was suspicious and negativistic, showing various signs of the onset of delusion-formation, but so far she had not developed any delusional system. Her suspicions were directed in particular towards the possibility that others might defraud her or steal from her.

One day the patient told me, in great excitement, that a 50 mark note was missing from a suitcase in her room. She would not hear of any explanation other than that somebody living in the same boarding-house had stolen it from her. During a careful search, in which she was helped by another person, she found her money. She herself had put away the note in such a way that it could easily be overlooked. She had put it inside a folded sheet of writing paper which she had then put with the other sheets.

A short time later there was a new upheaval. The patient had lost 150 marks. She said that she had searched high and low for them, but without success. The next day it was discovered that the missing money was in fact no longer in her possession because she had spent it.

 

14 Psycho-analysis and the War Neuroses ( 1921)

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DURING the war academic neurology has come more and more to regard the aetiology of the traumatic neuroses from the psychological point of view. Despite the rapprochement referred to by Ferenczi, however, there are two respects in which it continues to differ from our way of thinking. It takes account almost exclusively of the reaction of the ego-drives to the trauma, and it confines itself to the obvious manifestations of the neurosis. The object of this paper is to emphasise the importance of the unconscious and of sexuality in addition to the recognised factors.

When, before the war, psycho-analysis proclaimed the sexual aetiology of the neuroses, the case of traumatic neuroses was said to disprove this theory. Some people still maintain that the origin of the war neuroses refutes our theories. Shock, the fear of repeated exposure to situations of danger, the wish for a pension, and a predisposition the nature of which was far from clear, were held to be adequate causes of this illness. The great number of neuroses which broke out during the war were thought to demonstrate the unimportance of the sexual aetiology.

 

15 The Rescue and Murder of the Father in Neurotic Phantasy-Formations (1922)

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WE are familiar with and well understand the wishful ideas of neurotics which take the form of rescue phantasies, since Freud in 1910 interpreted their unconscious meaning and showed that they derive from the parent complex.1 In these phantasies the neurotic saves sometimes his father, sometimes his mother, from mortal peril. The phantasies of mother-rescue arise for the most part from the tender feelings of the son, but according to Freud’s analysis, alongside the desire to rescue they contain the wish to give the mother a child. Later these phantasies were specially studied by Rank.2 Rank3 and also Harnik4 have helped us to understand why phantasies of mother-rescue appear in poetical works.

With regard to phantasies of rescuing the father, Freud has pointed out that here the son’s impulses of defiance find their chief expression. He has further indicated the general form usually taken by such phantasies. The son generally saves from mortal danger a substitute of the father, such as a king or some other exalted personage. Elsewhere 5 Freud cites an example of a typical phantasy of father-rescue, but without giving a detailed analysis. I have often encountered the same phantasy in my patients, and I assume that it is also familiar to other analysts. I should here like to make a detailed examination of its unconscious content, and particularly of its symbolism, and to show that it is not enough merely to discover for oneself in such a neurotic product a manifestation of infantile defiance already recognised by Freud. A deeper analysis seems to me to be necessary. It also provides, as I shall show in this paper, valuable clues to the understanding of the patient’s unconscious. Finally it gives us insight into the deeper layers of related phantasy-formations which we shall draw upon for comparison.

 

16 Mistakes with an Overcompensating Tendency (1922)

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IT may be said of all the manifold phenomena described by Freud in his Psyckopathology of Everyday Life that they are contrary to the conscious intentions of the person concerned. The tendency running counter to conscious intention, however, takes a different course in various forms of mistakes. It may fall a victim to repression; this happens, for instance, when we forget words, proper names, and so forth. In the example concerning ‘aliquis’ given by Freud, forgetting the word prevented certain painful associations from becoming conscious. Mistakes in speaking or writing produce a different effect; here the tendency that is unacceptable to consciousness asserts itself so as to interfere with the carrying out of the intended action. Mistakes might be divided into two categories according to their effects; namely, those in which the tendency that is rejected by the conscious is stifled, and those in which it achieves partial expression.

For some time past I have in my psycho-analytical work occasionally come across mistakes which seem to belong to a third category, one not mentioned in the Psyckopathology of Everyday Life. I recently met with a frequently recurring example of this kind in a patient, and this provides the subject for the present note.

 

17 An Octogenarian's Mistake (1922)

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IN the Berliner Tageblatt of the 25th March, 1922, there appeared an amusing article by the actor, Ludwig Barnay, who had recently celebrated his eightieth birthday, on the honours he had received both in former and in recent times. He jokingly mentioned that all the tokens of esteem usually bestowed only on the dead had been conferred on him in his lifetime. In one town a monument had been erected to him; in another a commemorative tablet had been placed on the house in which he had lived; in a third a street had been named after him. He then posed the question what honours remained to be conferred on him after his death, and gave the following reply:

‘In any event a funeral, the usual memorial service and an obituary notice in the public press. But the funeral obsequies will have to do without this threefold celebration, since I have directed in my will that my demise shall not take place until after my cremation.’

The mistake which appears in the last sentence shows very clearly the writer’s wish not to. die at all, and gives us a good insight into the deep unconscious conviction of his own indestructibility held by every human being.

 

18 Two Contributions to the Study of Symbols (1923)

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1. Observations on the Symbolic Meaning of the Triad

THE frequent occurrence of the triad in the various products of human phantasy has long been familiar. We know that its symbolical meanings vary. There is the well-known use of the number three as a representation of the male genitalia, and as an allusion to the triad of father, mother, and child. In the dreams of my patients I have several times met with the triad where it has another, less familiar meaning. It is not my intention to consider here any of the numerous possible meanings for the individual of the symbolical significance of numbers; but rather to formulate a generalised interpretation based on common cultural concepts.

There are three orifices of the human body which principally attract the child’s attention. Their attraction is due not only to the fact that they serve for the intake of food and for evacuation, but also because they possess an erotogenic significance of the highest importance. They are the oral, anal and uro-genital orifices. It is apparent that these orifices are represented in dreams by the number three, particularly when the establishment of genital primacy has failed and when the three erotogenic zones are competing for primacy. A neurotic patient of mine, whose dreams very clearly revealed to me the significance of the number three, harboured in her unconscious an abundance of wish-phantasies, partly of an oral-cannibalistic and partly of an anal character.

 

19 Psycho-analytical Views on Some Characteristics of Early Infantile Thinking (1923)

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PSYCHO-ANALYTICAL interest is focussed on the question of the origin of psychic phenomena. In terms of psycho-analysis the problem is this: by what instinctive forces, conscious and unconscious, are these phenomena determined? The analysis of psychological products regularly reveals in them the combined workings of the ‘ego-instincts’ and the ‘sexual instincts’. Psychoanalysis attributes to the latter a far wider significance than that ascribed to them by other schools of thought. It is not necessary for the purpose of this paper to enter upon a discussion as to whether psycho-analysis is right in this respect; the task before us is a more general one.

Psycho-analysis took as its starting-point the investigation of neurotic symptom-formation. But the more thoroughly the psycho-genesis of a symptom was explored the more definitely did the associations of the patients lead back into the past, and ultimately to early childhood. In this way certain necessary hypotheses suggested themselves with reference to the instinctive life, and especially the sexual life, of the child, which were in opposition to the traditional views. These hypotheses were confirmed by direct observation of children, and thus we attained new points of view about the psychology of childhood. Amongst other results we came to know that thinking in early childhood is in a special degree under the influence of the instinctive life. My intention now is to show how certain phenomena of infantile thinking are determined by peculiarities, with which we are familiar, of the instinctive life of the child. As the title of this paper indicates, I do not pretend to give an exhaustive account of the subject; I am conscious of the fragmentary character of my essay.

 

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