Symptom Formation

The main features of symptom formation have long been studied and have been expressed, it is to be hoped, in an impregnable manner. The symptom is a sign and substitute of a suppressed impulse-gratification, the result of a repressive process. The repression proceeds from the ego, which, perchance in the service of the super-ego, will not coöperate in an instinct investment incited by the It. The ego through the repression makes it possible for the idea, which was the carrier of the unamiable striving, to become shut off from consciousness. Analysis often demonstrates that it remains as an unconscious formation. Thus far it is clear, but presently the unsolved difficulties begin.

Our previous descriptions of the process in repression have emphasized the result of the shutting off from consciousness, but in other respects we have left matters open to doubt. The question arises, what is the fate of the impulse activated in the It which aims at gratification? The answer is an indirect one and runs as follows: through the process of repression the anticipated desire for gratification is changed to pain. One would then confront the problem of how pain could be the result of the instinct gratification. We hope to explain the situation by the definite statement that the intentional course of the stimulus in the It fails to take place because of repression, while the ego succeeds in inhibiting or diverting the same. Then the riddle unfolds of affect-transformation by repression. We have, however, confessed to the ego that it can express so far reaching an influence on the processes in the It and we should learn to understand in what way this astounding unfolding of power becomes possible.

I believe that this influence belongs to the ego as a result of its intimate associations with the perceptive system, which indeed constitutes its very nature and is the basis of its differentiation from the It. The function of this system, which we have called the perceptive-conscious, is bound up with the phenomenon of consciousness; it receives excitations not only from without but also from within and by means of pleasure-pain sensations which it attains therefrom it attempts to direct all of the courses of the psychic happenings in accordance with the pleasure principle. We imagine the ego as good as powerless against the It, but when it strives against an instinctive process in the It, it needs only to give the signal of pain in order to attain its objective through the almost omnipotent factor of the pleasure principle. When we contemplate this situation by itself for the moment we may illustrate it by an example from another sphere of activity. A certain clique resists a measure which meets with the inclinations of the mass of the people. This minority then usurps the press, manipulates through it the sovereign "public opinion" and pushes matters in such a way that the planned measure does not go through.

Other questions now arise. Where does the energy originate which brings about the pain signal? Here an idea shows us the way the defence of an unwished for process within may follow the pattern of a defence against an external irritant, where the ego takes the same path against internal as it does against external danger. If the danger is from without, the organized being takes flight and then first of all withdraws from the perception of danger; later it is recognized that a more efficacious means is to effectuate such muscular actions that the perception of danger becomes impossible, even when it is not denied; in other words, to withdraw from the region of danger. One such effort at flight is equivalent to repression. The ego withdraws the (preconscious) investment from the instinct representation to be repressed and applies it for the disengagement of displeasure (anxiety). The problem of how anxiety arises from repression may be no simple one and in any case one has the right to hold fast to the idea that the ego is the chief place of anxiety and to reject the earlier notion that the investment energy of fixation of the repressed incitation becomes automatically changed to anxiety. If I formerly so expressed myself I was giving it a phenomenological and not a metapsychological presentation.

From what has been said a new question comes up. How is it economically possible that a mere withdrawal and conducting off---as in the retreat of a preconscious ego-investment---could engender disinclination or fear, which according to our presuppositions can result only from enhanced investment? My reply is that this causation is not to be explained economically. Anxiety is not newly engendered in repression but is reproduced as an affective state after a present memory picture. With a further inquiry as to the origin of this anxiety---as of affects in general---we abandon the undisputed psychological territory and enter the borderland of physiology. Affective states are incorporated into the soul life as precipitates of archaic traumatic experiences and are awakened in like situations as memory symbols. I mean that I am not in error in making them equivalent to the late and isolated hysterical attacks, and to be regarded as their normal prototypes. In mankind and the creatures related to him the act of parturition appears to be the first individual anxiety experienced to give the characteristic traits of the expression of an anxiety affect. We are not, however, to overestimate this connection and in its recognition are not to overlook the fact that an affect symbol is a biological necessity for a situation of peril and at all events must be obtained. I also hold that it is unjustified to assume that in every outbreak of anxiety something occurs in the soul life which reproduces the birth situation. It is not at all certain whether the hysterical attacks which are originally such traumatic reproductions maintain this character permanently.

Elsewhere I have deduced that most repressions with which we have to do therapeutically are cases of after-repression, which presuppose the existence of archaic repressions exerting their attractive influence on a newer situation. Of this background and forestage of repression too little is known. One comes easily into the danger of overestimating the rôle of the super-ego in repression.

At present we are unable to judge whether the appearance of the super-ego creates the border between primeval repression and late repression. The first---very intensive---outbursts of anxiety do at any rate follow upon the differentiation of the super-ego. It is plausible throughout that quantitative factors, such as the excessive strength of the excitation and the breach in the stimulus protection, are the first occasions of the primary repression.

Mention of protection from excitation reminds us like a catchword that repressions appear in two different situations---first, when an unpleasant instinctive stimulus is awakened by an external perception, and second, when the latter occurs from internal provocation. We will return later to this difference. Stimulus protection is afforded only against external irritation, not from internal instinctive demands.

As long as we study the attempt at flight of the ego we remain far from symptom formation. The symptom arises from the instinct stimulus which is encroached on by the repression. When the ego attains its objective, through the pain signal, of keeping under the instinct stimulus, we learn nothing as to how this is brought about. We only learn from cases which are to be termed more or less unsuccessful repressions.

In general, then, it is so presented that despite the repression the instinct stimulus has found a substitute, but this is strongly blighted, displaced and inhibited. It is no longer recognizable as a satisfaction. When it consummated, no feeling of pleasure accompanies it. For this reason the consummation has assumed the character of a compulsion. But in this lowering of the course of satisfaction to the symptom, the repression shows its power in another respect. The substitution process is withheld from removal by the motor actions and even when this is unsuccessful it must exhaust itself in the alteration of its own body and cannot encroach on the outer world; it is forbidden it to transform itself into activity. We understand that in suppression the ego works under the influence of external reality and on that account shuts off the result of the process of substitution from this reality.

The ego dominates the access to consciousness as also the transition to action against the external world; in repression its power is employed in both directions. The instinct object is adapted to sense one side, and the impulse prompting to the other side of its expression of force. It is now permissible to ask how this recognition of the power of the ego coincides with the description outlined of the position of the same ego in my study "The Ego and the It." We have therein depicted the dependence of the ego on the It and the super-ego and unmasked its weakness and readiness to anxiety toward both and its superiority, which has been built up laboriously. This judgment has since found a strong echo in psychoanalytic literature. Numerous voices emphasize urgently the weakness of the ego against the It, of the rational against the demoniacal in us, and are ready to make this proposition into a foundation for a psychoanalytic view of the universe. Should not the insight into the mode of action of repression be the very thing to hold the analyst back from so extreme a partisan designation?

I am not at all for the fabrication of world contemplations. One may leave such to philosophers who by their own confession cannot make life's journey practicable without such a Baedeker, which gives information about all things. Let us humbly take upon ourselves the contumely with which the philosophers look down upon us from the standpoint of their indigence. Since we, too, cannot deny our narcistic pride, we will seek our comfort in the venture that all of these life pilots soon age, that it is just our shortsighted restricted work in miniature which makes necessary their new editions, and that even the most modern of these Baedekers are essays to replace old catechism, so convenient and complete. We know exactly how little light science has hitherto diffused over the riddle of this world; all the noise of the philosophers can change nothing, only a patient continuation of the work which subordinates everything to one demand for certainty, can effect slowly the transformation. If the wanderer sings in the dark, he denies his anxiety but this does not make him see more clearly.