A Definition of Inhibition and Symptom
Our usage of speech permits us, in the description of pathological phenomena, to differentiate between symptoms and inhibitions, but not much value is attributed to this distinction. If cases of illness did not come to us of whom we must say that they show only inhibitions and no symptoms, and if we did not know how they came about, we should hardly be interested in discriminating between inhibition and symptom.
These two do not flourish on the same soil. Inhibition has a special relationship to function and does not necessarily indicate something pathological, for one may call the restrictions of a function inhibition of the same. Symptoms, on the other hand, signify indications of disease processes. So also may inhibition be a symptom of disease. The usage of language, then, is such that it speaks of inhibition where there is an unusual variation of the same or a new performance. In many cases it is left to one's discretion to emphasize the positive or negative side of a pathological process, and designate the result as a symptom or an inhibition. This, in all truth, is not interesting and the question with which we begin this thesis is shown to bear little fruit.
As inhibition is evidently so intimately connected with function, one may arrive at the idea of studying the different ego functions, in respect to which forms of disturbance of the same are expressed in the individual neurotic functions. For this comparative study we choose: the sexual function, eating, locomotion and occupation.
(a) The sexual function is subject to very manifold disturbances, the majority of which show the character of simple inhibitions. These may be comprehended under the head of psychic impotence. The status of normal sexual function presupposes a very complicated course, and disturbance may come about in every part. The principal stations for inhibition in men are: the turning aside of the libido at the beginning of the process (psychic frigidity); the absence of physical preparation (erection); the shortening of the act (precocious ejaculation---which may equally be described as a positive symptom); the holding back of the same (lack of ejaculation); and the absence of the psychic effect (pleasure in the orgasm). Other disturbances result from the association of the function with special conditions of perverse or fetichistic nature.
One cannot long escape the recognition of a relationship between inhibition and _angst_.[1] Many inhibitions are palpably a renunciation of function because in the exercise of the latter fear is developed. Direct fear of the sexual function is frequent in women. We associate it with hysteria, and also with the defensive symptom of nausea, which set in originally as a supplementary reaction to the passively experienced sexual act and appear later at the mental image of the same. A great number of compulsive behaviors are also shown as precautions and assurance against sexual experience and are therefore of phobic nature.
One does not get far in the comprehension of these matters and at most one remarks only that very different procedures are applied in the disturbance of the functions: (1) The mere absence of libido, which seems the soonest to manifest itself, which we call a pure inhibition. (2) The impairment in the execution of the function. (3) The aggravation of the same by special conditions and the modification by deviation to other objectives. (4) The prevention by safety measures. (5) The interruption through development of fear so far as its addition cannot be hindered, and finally (6), a supplementary one which protests against the disturbance and would make what has happened undone if the function could be carried out.
(b) The most common disturbance of the nutritive function is anorexia through withdrawal of the libido. Also aggravation of the appetite is often seen---a compulsion to eat motivated by fear of starving has been but little studied. As a hysterical refusal of food is the symptom of vomiting, refusal of food through fear belongs to psychotic states (delusion of poisoning).
(c) Locomotion is inhibited in many neurotic conditions through disinclination to walk and weakness on walking, while hysterical inhibition is manifested by motor palsy of the locomotor apparatus or else by some special abolition of function like abasia. Especially characteristic are difficulties of locomotion through the interposition of definite conditions, through the non-fulfilment of which fear arises (phobias).
(d) Inhibition of one's occupational activities, which comes so often to treatment as an isolated symptom, shows diminished desire for work or poor execution or reaction phenomena, as exhaustion (vertigo, vomiting) when continuation of the occupation is forced. Hysteria forces the cessation of labor through engendering organ and functional paralyses, the existence of which cannot be conjoined with execution. The compulsive neuroses disturb work through continuous diversion and through loss of time in the interpolated delays and repetitions.
We could extend this survey over other functions but could not expect to attain more thereby. We have not gone beyond the surface phenomena. Hence we resolve to take a view which makes the conception of an inhibition no longer very enigmatical. Inhibition is the expression of a functional limitation of the ego, which can come about from very different causes.
Many of the mechanisms of this renunciation of function and a general tendency to the same are well known to us. It is easy to recognize this tendency in the specialized inhibitions. If piano playing, writing and even walking are subject to neurotic inhibitions, analysis shows us the reason for the same in an over-strong erotisation of the organs involved---the fingers and the feet. We have gained the view in general that the ego function of an organ is injured if its erogeneity, its sexual significance, increases. It then behaves---if one dare make a scurrilous comparison---like a cook who will no longer work at the fireside because the man of the house enters into love relations with her. If writing which consists in letting ink flow from a tube on a piece of white paper, has assumed the symbolic significance of coitus; or when walking has become a symbolic substitute for stamping on Mother Earth, then both writing and walking will be prohibitive because it is as if one would carry out some forbidden sexual transaction. The ego renounces this function proper to it in order not to be compelled to undertake a new repression, in order to avoid a conflict with the It.
Other inhibitions follow obviously in the service of self-punishment---frequently in connection with professional activities. The ego dare not do certain things because it will use them in a manner disapproved of by the more strict super-ego. In turn the ego renounces these functions in order not to engage in a conflict with the super-ego.
The general inhibitions of the ego follow another and simple mechanism. When the ego is claimed by a psychic task of particular difficulty,---through an affliction, a grand affect-suppression, through the necessity of holding down a constantly increasing sexual fancy,---it is so deprived of disposable energy that it must retrench its supply in many directions like a speculator who has tied up his money in his enterprises. An instructive example of such an intensive general inhibition of brief duration was observed by me in a compulsive patient who fell into a paralyzing weariness of one or several days' duration on occasions which should obviously have led to an outbreak of rage. Beginning here there must be found a way to the comprehension of general inhibition through which the depressive states and the most severe of these, melancholy, characterize themselves.
In conclusion, one may say of the inhibitions that they are restrictions of the ego functions either from prudence or impoverishment of energy. It is easy to recognize now wherein _inhibition_ differs from _symptom_; for _symptom_ can be nothing more than a process within or connected with the ego.