Symptom Formation and the Secondary Defense of the Ego

We will study the symptom formation and the secondary combat of the ego against the symptom but we have frankly made no fortunate selection among the phobias. The fear which dominates in the picture of this affection appears to us now as a complication which veils the subject matter. There are neuroses in abundance in which no fear is shown. The genuine conversion hysteria is of this sort, and its severest symptoms are found with no admixture of fear. This fact must warn us that we must not adhere too closely to the relations between fear and symptom formation. Otherwise conversion hysteria stands so close to the phobias that I have held myself justified in grouping the latter with "fear hysterias." But no one has as yet been able to give the condition which differentiates between them or whether a case assumes the form of a conversion hysteria or a phobia. Nor has any one explored the reasons for development of fear in hysteria.

The commonest symptoms of conversion hysteria---a motor paralysis, contracture, involuntary action or discharge, a pain, a hallucination---are either permanently established or intermittent investment processes, the explanation of which prepares new difficulties. One really knows but little of such symptoms. Through analysis one may learn what disturbed course of excitement they replace. Mostly it results that they themselves have a part in these, as if the total energy had been concentrated on a fragment. Pain was present in the situation in which the repression fell; hallucination was at the time a perception; motor palsy was a defense against action which should have been carried out in that situation but was inhibited; contracture is usually a displacement for a muscular innervation intended at the time at another place; the convulsive attack an expression of an affective outbreak which has withdrawn itself from the normal control of the ego. Changeable in a striking manner is the feeling of disinclination which accompanies the appearance of the symptoms. In the permanent symptoms displaced as to motility, as palsies and contractures, this is mostly absent; the ego behaves against these as if non-participating. In the intermittent cases and in symptoms of the sensory sphere, these sensations of pain are as a rule distinct and in the case of pain the symptoms may increase to an excessive degree. It is very difficult in this manifoldness to find the factor which makes such differences possible and which can explain them in unit fashion. Even the battle of the ego against the once formed symptom is but little in evidence in conversion hysteria. Only when the sensitiveness to pain in some region of the body has become a symptom will this be placed in position to play a double rôle. The pain symptom appears just as certainly when this locality is touched from without, as when the pathogenic situation which represents it is associatively activated from within, and the ego grasps precautionary rules in order to hold back the awakening of symptoms through external perception. Whence originates the special opaqueness of symptom formation in conversion hysteria we cannot guess, but it gives us a motive to leave promptly a field so unfertile.

We turn now to compulsion neurosis in the expectation that here we can learn more about symptom formation. The symptoms of compulsion neurosis are in general of two kinds and of opposite tendencies. They are either prohibitions, precautions, expiations---hence negative in nature---or, contrariwise, they are substitute gratifications, very often in symbolic clothing. Of these two groups the negative, defensive, punitive, is the older and with the duration of the disease the gratifications which mock at all defense take the upper hand. It is a triumph of symptom formation when it succeeds in fusing the prohibition with gratification; so that the originally defensive command or prohibition obtains the significance of a gratification; whereby often very artificial methods of combination are claimed. In this performance an inclination to synthesis shows itself which we have already conceded to the ego. In extreme cases the patient effects that most of his symptoms have acquired the exact opposite of their original significance, a testimony of the power of ambivalence, which, we know not why, plays so great a rôle in compulsive neuroses. In the crudest cases the symptom is two stage---that is, upon the action which executes a certain instruction there follows immediately a second, which abolishes the first or makes it regressive if it does not dare to carry out the opposite.

Two impressions are at once derived from this fugacious survey of compulsive symptoms. The first, which is maintained in constant warfare against the repressed which applies itself more and more to the disfavor of the repressing forces, and the second, that the ego and super-ego play a specially large part in the symptom formation.

The compulsive neurosis is probably the most interesting and most gratifying object of analytical investigation although as yet it is an unconquered problem. If we will penetrate deeply into its nature we must confess that uncertain assumptions and unproved surmises cannot yet be dispensed with. The exit situation of the compulsive neurosis is probably no other than that of hysteria, the necessary defense against the libidinous claims of the Oedipus complex. In every compulsive neurosis we seem to find a lower stratum of precociously formed hysterical symptoms. Then, however, the further formation is decidedly altered by a constitutional factor. The genital organization of the libido shows itself as weakly and too little resistant. When the ego begins its defensive striving its first result is that the genital organization (phallic phase) regresses wholly or in part to an earlier sadistic-anal stage. This fact of regression remains a determinant of all that follows. One may draw yet another possibility into consideration. Perhaps the regression is not the consequence of a constitutional but a time factor. Hence it is not endowed with power because the genital organization of the libido is weak, but because the effort of the ego is premature, set in during the bloom of the sadistic phase. I do not trust myself to make a final decision upon this point, but analytical observation is not favorable to this supposition. Rather does it show that in the turn to compulsive neurosis the phallic stage has already been reached. The time of life for the outbreak of this neurosis is also later than for hysteria (the second childhood period after the termination of the latent period) and in a case of very late development of this affection which I could cite, it was clearly shown that a real depreciation of the hitherto intact genital life created the condition for the regression and the origin of the compulsive neurosis.[3]

The metapsychologic explanation of the regression is to be sought in a mixture of impulses, in the separation of an erotic component which appeared at the onset of the genital phase in the destructive investments of the sadistic phase.

The conquest of the regression signifies the first result of the ego in the defensive fight against the libido claims. We distinguish here the general tendency of the defense from the repression, which is only one of the defensive mechanisms. Perhaps still more clearly than in normal and hysterical cases one recognizes in the compulsive neurosis the castration complex as the motive of defense. We now find ourselves at the beginning of the latency period, which is characterized by the fall of the Oedipus complex, the creation or consolidation of the super-ego, and the erection of an ethical and esthetic shrine in the ego. These processes in compulsive neuroses go over the normal measure. For the destruction of the Oedipus complex the regressive degradation of the libido is added, the super-ego is especially rigid and unamiable, and the ego develops in obedience to the super-ego reaction pictures of conscience, sympathy and purity. With inexorable and not always successful rigidity, the temptation to the continuation of early infantile onanism is tabooed; it now leans upon regressive sadistic-anal ideas but represents the unconquered portion of the phallic organization. There is here an internal contradiction, so that in the very interest of preservation of manhood (castration fear) every activity of manhood is hindered but even this contradiction is only exaggerated in the compulsive neurosis and adheres already to the normal mode of removing the Oedipus complex. As every excess carries in itself the germ to a self-uplift, this holds good also in compulsion neuroses since the very repressed onanism forces itself in the form of compulsive actions to an ever-increasing approximation to gratification.

The reaction formations in the ego of the compulsive neurotic, which we recognize as exaggerations of the normal character, we may class as a new mechanism of defense along with repression and regression. In hysteria it seems to be absent or far weaker. Retrospectively, we gain the presumption that it is distinguished as a defense process of hysteria. It seems that it limits itself to suppression as the ego turns away from the unpleasant prompting, leaving it to its course in the unconscious and takes no further part in its fate. This cannot be entirely or exclusively correct, for we know the case where the hysterical symptom simultaneously signified the fulfilment of a demand for punishment from the super-ego; but it may describe a general character of the behavior of the ego in hysteria.

One may simply receive it as a fact that in the compulsive neuroses so strict a super-ego is formed that the fundamental trait of this affection is libido regression; and one may seek to associate it with the character of the super-ego. In fact the super-ego which springs from the It cannot withdraw itself from the regression and mixture of impulses which proceeds from the latter. It would not be surprising if it were not on its own part harder, more punitive and less amiable than when the development is normal.

During the period of latency the defense of the attempt at onanism seems to be treated as the chief task. This combat generates a series of symptoms which recur in typical fashion in the most dissimilar kinds of people and bear in general the character of a ceremonial. It is to be much lamented that these have not yet been collected and systematically analyzed; as the earliest performances of the neurosis they would shed light over the mechanism here involved in symptom formation. They already show the traits which will appear so fatally in the later severe affection; the disposal of the behaviors which later will be carried out as if automatically---going to sleep, washing, dressing, walking, the tendency to repetition and waste of time. Why this happens so is still not at all intelligible but the sublimation of anal erotic components plays a distinct rôle thereby.

Puberty makes a decisive section in the development of a compulsion neurosis. The genital organization broken up in childhood now sets in with great energy. We know, moreover, that the sexual development of childhood also prescribes the direction in the beginning of the puberty years. Hence on the one hand the aggressive promptings of the early period are again awakened, on the other hand there is a more or less large share of new libidinous stirrings---in bad cases the whole of them---which strike out paths prescribed by regression, and appear as aggressive and destructive purposes. As a result of this disguise of the erotic strivings and the strong reaction-formations in the ego, the warfare against sexuality is carried further under the ethical flag. The ego, amazed, strives against cruel and violent demands sent up by the It into the consciousness and has no inkling that it is fighting erotic wishes, among them such that otherwise would escape its own criticism. The over strict super-ego persists the more energetically in the repression of sexuality which has assumed---to it---such repulsive forms. Thus the conflict in compulsive neurosis becomes intensified in two directions---the defender is intolerant and the defended has become unendurable; both through the influence of one factor, libido regression.

One could find a contradiction against many of our presuppositions in the fact that the unpleasant compulsive idea is conscious. But there is no doubt that previously it has gone through the process of repression. In the majority the actual text of the aggressive instinct is not known to the ego. A large block of analytic labor is required to make it conscious. What gets through to consciousness is in most cases only a disguised substitute, either of a blurred, dreamy vagueness or is made unrecognizable through an absurd disguise. If the repression has not gnawed at the content of the aggressive prompting it has certainly removed the concomitant affect character. So the aggression does not appear to the ego as an impulse but, as the patient says, as a bare thought content that should leave one cold. The noteworthy fact is, however, that this is not the case.

The affect spared by the perception of the compulsive thought comes especially to view at another place. The super-ego behaves as if no suppression had taken place, as if the aggressive prompting were known to it in its proper text and with full affect character; and it treats the ego on a basis of this presupposition. The ego, which knows itself to be blameless, must feel a sense of guilt and bear a responsibility which it knows not how to explain. The riddle herewith given to us is, however, not so great as it at first seems. The behavior of the super-ego is intelligible throughout, the contradiction in the ego shows us only that it has, by means of repression, closed itself against the It while it remains accessible to the influence of the super-ego.[4] The further question, why the ego does not seek to withdraw from the tormenting criticism of the super-ego, disposes of the fact that this really does happen in a large series of cases. There are compulsive neuroses entirely without sense of guilt; as far as we understand, the ego has spared itself the perception of the same through a new series of symptoms, expiations and restrictions to self-punishment. These symptoms signify, however, simultaneous gratifications of masochistic promptings which have likewise drawn strength through regression.

The manifold phenomena of compulsive neurosis are so great that even by much effort we have failed to give a coherent synthesis of all their variations. We have striven to make prominent the typical relations, always with the concern to survey irregularities of no less importance.

I have already described the general tendency of symptom formation in compulsive neuroses. It is to procure more room for substitute-gratifications at the expense of renunciation. The same symptoms which indicate the original limitations of the ego assume later---thanks to the indication of the ego to synthesis---those of gratification, and it is obvious that the last significance gradually becomes the more practicable. An extremely restricted ego which has shown that its gratifications are sought in the symptoms becomes the result of these processes, which approaches more and more the complete failure of the initial defensive striving. The displacement of the relations of the energy in favor of gratification can lead to the dreaded end of paralysis of will on the part of the ego, which for each decision finds almost as strong an impulse on one side as on the other. The hyper-acute conflict between the it and the super-ego which dominates the affection at the beginning and after may so spread itself that none of the arrangements of the ego, incapable of communication, can avoid being drawn into this conflict.