Chapter XVI: Part 16

Now I must point out to you the decisive difference between the symptoms of the _actual neuroses_ and those of the _psychoneuroses_, with the first group of which (the transference neuroses) we have hitherto been so much occupied. In both the actual neuroses and the psychoneuroses the symptoms proceed from the Libido; that is, they are abnormal ways of using it, substitutes for satisfaction of it. But the symptoms of an actual neurosis—headache, sensation of pain, an irritable condition of some organ, the weakening or inhibition of some function—have no ‘meaning,’ no signification in the mind. Not merely are they manifested principally in the body, as also happens, for instance with hysterical symptoms, but they are in themselves purely and simply physical processes; they arise without any of the complicated mental mechanisms we have been learning about. They really are, therefore, what psychoneurotic symptoms were for so long held to be. But then, how can they be expressions of the Libido which we have come to know as a force at work in the mind? Now, really, the answer to that is very simple. Let me resurrect one of the very first objections ever made against psycho-analysis. It was said that the theories were an attempt to account for neurotic symptoms by psychology alone and that the outlook was consequently hopeless, since no illness could ever be accounted for by psychological theories. These critics were pleased to forget that the sexual function is not a purely mental thing, any more than it is merely a physical thing. It affects bodily life as well as mental life. Having learnt that the symptoms of the psychoneuroses express the mental consequences of some disturbance in this function, we shall not be surprised to find that the actual neuroses represent the direct somatic consequences of sexual disturbances.

Clinical medicine gives us a useful hint (recognized by many different investigators) towards comprehension of the actual neuroses. In the details of their symptomatology, and also in the peculiarity by which all the bodily systems and functions are affected together, they exhibit an unmistakable similarity with pathological conditions resulting from the chronic effect or the sudden removal of foreign toxins—i.e. with states of intoxication or of abstinence. The two groups of affections are brought still closer together by comparison with conditions like Basedow’s disease[49] that have also been found to result from poisoning, not, however, from poisons derived externally, but from such as arise in the internal metabolism. In my opinion these analogies necessitate our regarding the neuroses as the effects of disturbances in the sexual metabolism, due either to more of these sexual toxins being produced than the person can dispose of, or else to internal and even mental conditions which interfere with the proper disposal of these substances. Assumptions of this kind about the nature of sexual desire have found acceptance in the mind of the people since the beginning of time; love is called an “intoxication,” it can be induced by “potions”—in these ideas the agency at work is to some extent projected on to the outer world. We find occasion at this point to remember the erotogenic zones, and to reflect upon the proposition that sexual excitation may arise in the most various organs. Beyond this the subject of ‘sexual metabolism’ or the ‘chemistry of sexuality’ is an empty chapter: we know nothing about it, and cannot even determine whether to assume two kinds of sexual substances, to be called ‘male’ and ‘female,’ or to content ourselves with _one_ sexual toxin as the agent of all the stimuli effected by the Libido. The edifice of psycho-analytic doctrine which we have erected is in reality but a superstructure, which will have to be set on its organic foundation at some time or other; but this foundation is still unknown to us.

As a science psycho-analysis is characterized by the methods with which it works, not by the subject-matter with which it deals. These methods can be applied without violating their essential nature to the history of civilization, to the science of religion, and to mythology as well as to the study of the neuroses. Psycho-Analysis aims at and achieves nothing more than the discovery of the unconscious in mental life. The problems of the actual neuroses, in which the symptoms probably arise through direct toxic injury, offer no point of attack for psycho-analysis; it can supply little towards elucidation of them and must leave this task to biological and medical research. Now perhaps you understand better why I chose this arrangement of my material. If I had intended an _Introduction to the Study of the Neuroses_ it would undoubtedly have been correct to begin with the simple forms of (actual) neuroses and proceed from them to the more complicated psychical disorders resulting from disturbances of the Libido. I should have had to collect from various quarters what we know or think we know about the former, and about the latter psycho-analysis would have been introduced as the most important technical means of obtaining insight into these conditions. An _Introduction to Psycho-Analysis_ was what I had undertaken and announced, however; I thought it more important to give you an idea of psycho-analysis than to teach you something about the neuroses; and therefore the actual neuroses which yield nothing towards the study of psycho-analysis could not suitably be put in the foreground. I think too that my choice was the wiser for you, since the radical axioms and far-reaching connections of psycho-analysis make it worthy of every educated person’s interest; the theory of the neuroses, however, is a chapter of medicine like any other.

However, you are justified in expecting that we should take some interest in the actual neuroses; their close clinical connection with the psychoneuroses even necessitates this. I will tell you then that we distinguish three pure forms of actual neurosis: _neurasthenia_, _anxiety-neurosis_ and _hypochondria_. Even this classification has been disputed; the terms are certainly all in use, but their connotation is vague and unsettled. There are some medical men who are opposed to all discrimination in the confusing world of neurotic manifestations, who object to any distinguishing of clinical entities or types of disease, and do not even recognize the difference between actual neuroses and psychoneuroses; in my opinion they go too far, and the direction they have chosen does not lead to progress. The three kinds of neurosis named above are occasionally found in a pure form; more frequently, it is true, they are combined with one another and with a psychoneurotic affection. This fact need not make us abandon the distinctions between them. Think of the difference between the science of minerals and that of ores in mineralogy: the minerals are classified individually, in part no doubt because they are frequently found as crystals, sharply differentiated from their surroundings; the ores consist of mixtures of minerals which have indeed coalesced, not accidentally, but according to the conditions at their formation. In the theory of the neuroses we still understand too little of the process of their development to formulate anything similar to our knowledge of ores; but we are certainly working in the right direction in first isolating from the mass the recognizable clinical elements, which are comparable to the individual minerals.

A noteworthy connection between the symptoms of the actual neuroses and the psychoneuroses adds a valuable contribution to our knowledge of symptom-formation in the latter; the symptom of the actual neurosis is frequently the nucleus and incipient stage of the psychoneurotic symptom. A connection of this kind is most clearly observable between neurasthenia and the transference neurosis known as conversion-hysteria, between the anxiety-neurosis and anxiety-hysteria, but also between hypochondria and forms of a neurosis which we shall deal with later on, namely, paraphrenia (dementia præcox and paranoia). As an example, let us take an hysterical headache or backache. Analysis shows that by means of condensation and displacement it has become a substitutive satisfaction for a whole series of libidinal phantasies or memories; at one time, however, this pain was real, a direct symptom of a sexual toxin, the bodily expression of a sexual excitation. We do not by any means maintain that all hysterical symptoms have a nucleus of this kind, but it remains true that this very often is so, and that all effects (whether normal or pathological) of the libidinal excitation upon the body are specially adapted to serve the purposes of hysterical symptom-formation. They play the part of the grain of sand which the oyster envelopes in mother-of-pearl. The temporary signs of sexual excitation accompanying the sexual act serve the psychoneurosis in the same way, as the most suitable and convenient material for symptom-formation.

There is a similar process of special diagnostic and therapeutic interest. In persons who are disposed to be neurotic without having yet developed a neurosis on a grand scale, some morbid organic condition—perhaps an inflammation, or an injury—very commonly sets the work of symptom-formation in motion; so that the latter process swiftly seizes upon the symptom supplied by reality, and uses it to represent those unconscious phantasies that have only been lying in wait for some means of expression. In such a case the physician will try first one therapy and then the other; will either endeavour to abolish the organic foundation on which the symptom rests, without troubling about the clamorous neurotic elaboration of it; or will attack the neurosis which this opportunity has brought to birth, while leaving on one side the organic stimulus which incited it. Sometimes one and sometimes the other procedure will be found justified by success; no general rules can be prescribed for mixed cases of this kind.

TWENTY-FIFTH LECTURE
ANXIETY

You will certainly have judged the information that I gave you in the last lecture about ordinary nervousness as the most fragmentary and most inadequate of all my accounts. I know that it was; and I expect that nothing surprised you more than that I made no mention of the ‘anxiety’ which most nervous people complain of and themselves describe as their most terrible burden. Anxiety or dread can really develop tremendous intensity and in consequence be the cause of the maddest precautions. But in this matter at least I wished not to cut you short; on the contrary, I had determined to put the problem of nervous anxiety to you as clearly as possible and to discuss it at some length.

_Anxiety_ (or _dread_)[50] itself needs no description; everyone has personally experienced this sensation, or to speak more correctly this affective condition, at some time or other. But in my opinion not enough serious consideration has been given to the question why nervous persons in particular suffer from anxiety so much more intensely, and so much more altogether, than others. Perhaps it has been taken for granted that they should; indeed, the words “nervous” and “anxious” are used interchangeably, as if they meant the same thing. This is not justifiable, however; there are anxious people who are otherwise not in any way nervous and there are, besides, neurotics with numerous symptoms who exhibit no tendency to dread.

However this may be, one thing is certain, that the problem of anxiety is a nodal point, linking up all kinds of most important questions; a riddle, of which the solution must cast a flood of light upon our whole mental life. I do not claim that I can give you a complete solution; but you will certainly expect psycho-analysis to have attacked this problem too in a different manner from that adopted by academic medicine. Interest there centres upon the anatomical processes by which the anxiety condition comes about. We learn that the medulla oblongata is stimulated, and the patient is told that he is suffering from a neurosis in the vagal nerve. The medulla oblongata is a wondrous and beauteous object; I well remember how much time and labour I devoted to the study of it years ago. But to-day I must say I know of nothing less important for the psychological comprehension of anxiety than a knowledge of the nerve-paths by which the excitations travel.

One may consider anxiety for a long time without giving a thought to nervousness. You will understand me at once when I describe this form of anxiety as REAL ANXIETY, in contrast to neurotic anxiety. Now _real_ anxiety or dread appears to us a very natural and rational thing; we should call it a reaction to the perception of an external danger, of an injury which is expected and foreseen; it is bound up with the reflex of flight, and may be regarded as an expression of the instinct of self-preservation. The occasions of it, i.e. the objects and situations about which anxiety is felt, will obviously depend to a great extent upon the state of the person’s knowledge and feeling of power regarding the outer world. It seems to us quite natural that a savage should be afraid of a cannon or of an eclipse of the sun, while a white man who can handle the weapon and foretell the phenomenon remains unafraid in the same situation. At other times it is knowledge itself which inspires fear, because it reveals the danger sooner; thus a savage will recoil with terror at the sight of a track in the jungle which conveys nothing to an ignorant white man, but means that some wild beast is near at hand; and an experienced sailor will perceive with dread a little cloud on the horizon because it means an approaching hurricane, while to a passenger it looks quite insignificant.

The view that real anxiety is rational and expedient, however, will on deeper consideration be admitted to need thorough revision. In face of imminent danger the only expedient behaviour, actually, would be first a cool appraisement of the forces at disposal as compared with the magnitude of the danger at hand, and then a decision whether flight or defence, or possibly attack, offered the best prospect of a successful outcome. Dread, however, has no place in this scheme; everything to be done will be accomplished as well and probably better if dread does not develop. You will see too that when dread is excessive it becomes in the highest degree inexpedient; it paralyses every action, even that of flight. The reaction to danger usually consists in a combination of the two things, the fear-affect and the defensive action; the frightened animal is afraid _and_ flees, but the expedient element in this is the ‘flight,’ not the ‘being afraid.’

One is tempted therefore to assert that the development of anxiety is never expedient; perhaps a closer dissection of the situation in dread will give us a better insight into it. The first thing about it is the ‘readiness’ for danger, which expresses itself in heightened sensorial perception and in motor tension. This expectant readiness is obviously advantageous; indeed, absence of it may be responsible for grave results. It is then followed on the one hand by a motor action, taking the form primarily of flight and, on a higher level, of defensive action; and on the other hand by the condition we call a sensation of ‘anxiety’ or dread. The more the development of dread is limited to a flash, to a mere signal, the less does it hinder the transition from the state of anxious readiness to that of action, and the more expediently does the whole course of events proceed. The _anxious readiness_ therefore seems to me the expedient element, and the _development_ of anxiety the inexpedient element, in what we call anxiety or dread.

I shall not enter upon a discussion whether the words anxiety, fear, fright, mean the same or different things in common usage. In my opinion, _anxiety_ relates to the condition and ignores the object, whereas in the word _fear_ attention is directed to the object; _fright_ does actually seem to possess a special meaning—namely, it relates specifically to the condition induced when danger is unexpectedly encountered without previous anxious readiness. It might be said then that anxiety is a protection against fright.

It will not have escaped you that a certain ambiguity and indefiniteness exists in the use of the word ‘anxiety.’ It is generally understood to mean the subjective condition arising upon the perception of what we have called ‘developed’ anxiety; such a condition is called an affect. Now what is an affect, in a dynamic sense? It is certainly something very complex. An affect comprises first of all certain motor innervations or discharges; and, secondly, certain sensations, which moreover are of two kinds—namely, the perceptions of the motor actions which have been performed, and the directly pleasurable or painful sensations which give the affect what we call its dominant note. But I do not think that this description penetrates to the essence of an affect. With certain affects one seems to be able to see deeper, and to recognize that the core of it, binding the whole complex structure together, is of the nature of a _repetition_ of some particular very significant previous experience. This experience could only have been an exceedingly early impression of a universal type, to be found in the previous history of the species rather than of the individual. In order to be better understood I might say that an affective state is constructed like an hysterical attack, i.e. is the precipitate of a reminiscence. An hysterical attack is therefore comparable to a newly-formed individual affect, and the normal affect to a universal hysteria which has become a heritage.

Do not imagine that what I am telling you now about affects is the common property of normal psychology. On the contrary, these conceptions have grown on the soil of psycho-analysis and are only indigenous there. What psychology has to say about affects—the James-Lange theory, for instance—is utterly incomprehensible to us psycho-analysts and impossible for us to discuss. We do not however regard what we know of affects as at all final; it is a first attempt to take our bearings in this obscure region. To continue, then: we believe we know what this early impression is which is reproduced as a repetition in the anxiety-affect. We think it is the experience of _birth_—an experience which involves just such a concatenation of painful feelings, of discharges of excitation, and of bodily sensations, as to have become a prototype for all occasions on which life is endangered, ever after to be reproduced again in us as the dread or ‘anxiety’ condition. The enormous increase in stimulation effected by the interruption of the renewal of blood (the internal respiration) was the cause of the anxiety experience at birth—the first anxiety was therefore toxically induced. The name _Angst_ (anxiety)—_angustiæ_, _Enge_, a narrow place, a strait—accentuates the characteristic tightening in the breathing which was then the consequence of a real situation and is subsequently repeated almost invariably with an affect. It is very suggestive too that the first anxiety state arose on the occasion of the separation from the mother. We naturally believe that the disposition to reproduce this first anxiety condition has become so deeply ingrained in the organism, through countless generations, that no single individual can escape the anxiety affect; even though, like the legendary Macduff, he ‘was from his mother’s womb untimely ripped’ and so did not himself experience the act of birth. What the prototype of the anxiety condition may be for other animals than mammals we cannot say; neither do we know what the complex of sensations in them is which is equivalent to fear in us.

It may perhaps interest you to know how it was possible to arrive at such an idea as this—that birth is the source and prototype of the anxiety _affect_. Speculation had least of all to do with it; on the contrary, I borrowed a thought from the naïve intuitive mind of the people. Many years ago a number of young house-physicians, including myself, were sitting round a dinner-table, and one of the assistants at the obstetrical clinic was telling us all the funny stories of the last midwives’ examination. One of the candidates was asked what it meant when the meconium (child’s excreta) was present in the waters at birth, and promptly replied: “That the child is frightened.” She was ridiculed and failed. But I silently took her part and began to suspect that the poor unsophisticated woman’s unerring perception had revealed a very important connection.

Now let us turn to neurotic anxiety; what are the special manifestations and conditions found in the anxiety of nervous persons? There is a great deal to be described here. First of all, we find a general apprehensiveness in them, a ‘free-floating’ anxiety, as we call it, ready to attach itself to any thought which is at all appropriate, affecting judgements, inducing expectations, lying in wait for any opportunity to find a justification for itself. We call this condition ‘_expectant dread_’ or ‘anxious expectation.’ People who are tormented with this kind of anxiety always anticipate the worst of all possible outcomes, interpret every chance happening as an evil omen, and exploit every uncertainty to mean the worst. The tendency to this kind of expectation of evil is found as a character-trait in many people who cannot be described as ill in any other way, and we call them ‘overanxious’ or pessimistic; but a marked degree of expectant dread is an invariable accompaniment of the nervous disorder which I have called anxiety-neurosis and include among the actual neuroses.

In contrast to this type of anxiety, a second form of it is found to be much more circumscribed in the mind, and attached to definite objects and situations. This is the anxiety of the extraordinarily various and often very peculiar phobias. Stanley Hall, the distinguished American psychologist, has recently taken the trouble to designate a whole series of these phobias by gorgeous Greek titles; they sound like the ten plagues of Egypt, except that there are far more than ten of them. Just listen to the things that can become the object or content of a phobia: darkness, open air, open spaces, cats, spiders, caterpillars, snakes, mice, thunder, sharp points, blood, enclosed places, crowds, loneliness, crossing bridges, travelling by land or sea, and so on. As a first attempt to take one’s bearings in this chaos we may divide them into three groups. Many of the objects and situations feared are rather sinister, even to us normal people, they have some connection with danger; and these phobias are not entirely incomprehensible to us, although their intensity seems very much exaggerated. Most of us, for instance, have a feeling of repulsion upon encountering a snake. It may be said that the snake-phobia is universal in mankind. Charles Darwin has described most vividly how he could not control his dread of a snake that darted at him, although he knew that he was protected from it by a thick plate of glass. The second group consists of situations that still have some relation to danger, but to one that is usually belittled or not emphasized by us; most situation-phobias belong to this group. We know that there is more chance of meeting with a disaster in a railway train than at home—namely, a collision; we also know that a ship may sink, whereupon it is usual to be drowned; but we do not brood upon these dangers and we travel without anxiety by train and boat. Nor can it be denied that if a bridge were to break at the moment we were crossing it we should be hurled into the torrent, but that only happens so very occasionally that it is not a danger worth considering. Solitude too has its dangers, which in certain circumstances we avoid, but there is no question of never being able to endure it for a moment under any conditions. The same thing applies to crowds, enclosed spaces, thunderstorms, and so on. What is foreign to us in these phobias is not so much their content as their intensity. The anxiety accompanying a phobia is positively indescribable! And we sometimes get the impression that neurotics are not really at all fearful of those things which can, under certain conditions, arouse anxiety in us and which they call by the same names.

There remains a third group which is entirely unintelligible to us. When a strong full-grown man is afraid to cross a street or square in his own so familiar town, or when a healthy well-developed woman becomes almost senseless with fear because a cat has brushed against her dress or a mouse has scurried through the room, how can we see the connection with danger which is obviously present to these people? With this kind of animal-phobia it is no question of an increased intensity of common human antipathies; to prove the contrary, there are numbers of people who, for instance, cannot pass a cat without attracting and petting it. A mouse is a thing that so many women are afraid of, and yet it is at the same time a very favourite pet name;[51] many a girl who is delighted to be called so by her lover will scream with terror at the sight of the dainty little creature itself. The behaviour of the man who is afraid to cross streets and squares only suggests one thing to us—that he behaves like a little child. A child is directly taught that such situations are dangerous, and the man’s anxiety too is allayed when he is led by someone across the open space.

The two forms of anxiety described, the ‘free-floating’ expectant dread and that attached to phobias, are independent of each other. The one is not the other at a further stage; they are only rarely combined, and then as if fortuitously. The most intense general apprehensiveness does not necessarily lead to a phobia; people who have been hampered all their lives by agoraphobia may be quite free from pessimistic expectant dread. Many phobias, e.g. fear of open spaces, of railway travelling, are demonstrably acquired first in later life; others, such as fear of darkness, thunder, animals, seem to have existed from the beginning. The former signify serious illness, the latter are more of the nature of idiosyncrasies, peculiarities; anyone exhibiting one of these latter may be suspected of harbouring others similar to it. I must add that we group all these phobias under _anxiety-hysteria_, that is, we regard them as closely allied to the well-known disorder called conversion-hysteria.

The third form taken by neurotic anxiety brings us to an enigma; there is no visible connection at all between the anxiety and the danger dreaded. This anxiety occurs in hysteria, for instance, accompanying the hysterical symptoms; or under various conditions of excitement in which, it is true, we should expect some affect to be displayed, but least of all an anxiety-affect; or without reference to any conditions, incomprehensible both to us and to the patient, an unrelated anxiety-attack. We may look far and wide without discovering a danger or an occasion which could even be exaggerated to account for it. These spontaneous attacks show therefore that the complex condition which we describe as anxiety can be split up into components. The whole attack can be represented (as a substitute) by a single intensively developed symptom—shuddering, faintness, palpitation of the heart, inability to breathe—and the general feeling which we recognize as anxiety may be absent or may have become unnoticeable. And yet these states which are termed ‘anxiety-equivalents’ have the same clinical and ætiological validity as anxiety itself.

Two questions arise now: Is it possible to bring neurotic anxiety, in which such a small part or none at all is played by danger, into relation with ‘real anxiety,’ which is essentially a reaction to danger? And, how is neurotic anxiety to be understood? We will at present hold fast to the expectation that where there is anxiety there must be something of which one is afraid.

Clinical observation yields various clues to the comprehension of neurotic anxiety, and I will now discuss their significance with you.

(_a_) It is not difficult to see that expectant dread or general apprehensiveness stands in intimate relation to certain processes in the sexual life—let us say, to certain modes of Libido-utilization. The simplest and most instructive case of this kind arises in people who expose themselves to what is called frustrated excitation, i.e. when a powerful sexual excitation experiences insufficient discharge and is not carried on to a satisfying termination. This occurs, for instance, in men during the time of an engagement to marry, and in women whose husbands are not sufficiently potent, or who perform the sexual act too rapidly or incompletely with a view to preventing conception. Under these conditions the libidinal excitation disappears and anxiety appears in place of it, both in the form of expectant dread and in that of attacks and anxiety-equivalents. The precautionary measure of _coitus interruptus_, when practised as a customary sexual régime, is so regularly the cause of anxiety-neurosis in men, and even more so in women, that medical practitioners would be wise to enquire first of all into the possibility of such an ætiology in all such cases. Innumerable examples show that the anxiety-neurosis vanishes when the sexual malpractice is given up.

So far as I know, the fact that a connection exists between sexual restraint and anxiety conditions is no longer disputed, even by physicians who hold aloof from psycho-analysis. Nevertheless I can well imagine that they do not neglect to invert the connection, and to put forward the view that such persons are predisposed to apprehensiveness and consequently practise caution in sexual matters. Against this, however, decisive evidence is found in the reactions in women, in whom the sexual function is essentially passive, so that its course is determined by the treatment accorded by the man. The more ‘temperament,’ i.e. the more inclination for sexual intercourse and capacity for satisfaction, a woman has, the more certainly will she react with anxiety manifestations to the man’s impotence or to _coitus interruptus_; whereas such abuse entails far less serious results with anæsthetic women or those in whom the sexual hunger is less strong.

Sexual abstinence, which is nowadays so warmly recommended by physicians, of course only has the same significance for anxiety conditions when the Libido which is denied a satisfactory outlet is correspondingly insistent, and is not being utilized to a large extent in sublimation. Whether or not illness will ensue is indeed always a matter of the quantitative factor. Even apart from illness, it is easy to see in the sphere of character-formation that sexual restraint goes hand in hand with a certain anxiousness and cautiousness, whereas fearlessness and a boldly adventurous spirit bring with them a free tolerance of sexual needs. However these relations may be altered and complicated by the manifold influences of civilization, it remains incontestible that for the average human being anxiety is closely connected with sexual limitation.

I have by no means told you all the observations which point to this genetic connection between Libido and anxiety. There is, for instance, the effect upon anxiety states of certain periods of life, such as puberty and the menopause, in which the production of Libido is considerably augmented. In many states of excitement too, the mingling of sexual excitation with anxiety may be directly observed, as well as the final replacement of the libidinal excitation by anxiety. The impression received from all this is a double one; first, that it is a matter of an accumulation of Libido, debarred from its normal utilization; and secondly, that the question is one of somatic processes only. How anxiety develops out of sexual desire is at present obscure; we can only ascertain that desire is lacking and anxiety is found in its place.

(_b_) A second clue is obtained from analysis of the psychoneuroses, in particular, of hysteria. We have heard that anxiety frequently accompanies the symptoms in this disease, and that unattached anxiety may also be chronically present or come to expression in attacks. The patients cannot say what it is they fear; they link it up by unmistakable secondary elaboration to the most convenient phobias: of dying, of going mad, of having a stroke, etc. When we subject to analysis the situation in which the anxiety, or the symptom accompanied by anxiety, arose, we can as a rule discover what normal mental process has been checked in its course and replaced by a manifestation of anxiety. To express it differently: we construe the unconscious process as though it had not undergone repression and had gone through unhindered into consciousness. This process would have been accompanied by a particular affect and now we discover, to our astonishment, that this affect, which would normally accompany the mental process through into consciousness, is in every case replaced by anxiety, no matter what particular type it had previously been. So that when we have a hysterical anxiety condition before us, its unconscious correlative may be an excitation of a similar character, such as apprehension, shame, embarrassment; or quite as possibly a ‘positive’ libidinal excitation; or an antagonistic, aggressive one, such as rage or anger. Anxiety is thus general current coin for which all the affects are exchanged, or can be exchanged, when the corresponding ideational content is under repression.

(_c_) A third observation is provided by patients whose symptoms take the form of obsessive acts, and who seem to be remarkably immune from anxiety. When we restrain them from carrying out their obsessive performances, their washing, their ceremonies, etc., or when they themselves venture an attempt to abandon one of their compulsions, they are forced by an appalling dread to yield to the compulsion and to carry out the act. We perceive that the anxiety was concealed under the obsessive act and that this is only performed to escape the feeling of dread. In the obsessional neurosis, therefore, the anxiety which would otherwise ensue is replaced by the symptom-formation; and when we turn to hysteria we find a similar relation existing—as a consequence of the process of repression either a pure developed anxiety, or anxiety with symptom-formation, or, symptom-formation without anxiety. In an abstract sense, therefore, it seems correct to say that symptoms altogether are formed purely for the purpose of escaping the otherwise inevitable development of anxiety. Thus anxiety comes to the forefront of our interest in the problems of the neuroses.

We concluded from our observations on the anxiety-neurosis that the diversion of the Libido away from its normal form of utilization, a diversion which releases anxiety, took place on the basis of somatic processes. The analyses of hysterical and obsessional neuroses furnish the additional conclusion that a similar diversion with a similar result can follow from opposition on the part of psychical agents (_Instanzen_). We know as much as this, therefore, about the origin of neurotic anxiety; it still sounds rather indefinite. But for the moment I know of no path which will take us further. The second task we undertook, that of establishing a connection between neurotic anxiety (abnormally utilized Libido) and ‘real anxiety’ (which corresponds with the reaction to danger), seems even more difficult to accomplish. One would think there could be no comparison between the two things, and yet there are no means by which the sensations of neurotic anxiety can be distinguished from those of real anxiety.

The desired connection may be found with the help of the antithesis, so often put forward, between the Ego and the Libido. As we know, the development of anxiety is the reaction of the Ego to danger and the signal preparatory to flight; it is then not a great step to imagine that in neurotic anxiety also the Ego is attempting a flight, from the demands of its Libido, and is treating this internal danger as if it were an external one. Then our expectation, that where anxiety is present there must be something of which one is afraid, would be fulfilled. The analogy goes further than this, however. Just as the tension prompting the attempt to flee from external danger is resolved into holding one’s ground and taking appropriate defensive measures, so the development of neurotic anxiety yields to a symptom-formation, which enables the anxiety to be ‘bound.’

Our difficulty in comprehension now lies elsewhere. The anxiety which signifies the flight of the Ego from its Libido is nevertheless supposed to have had its source in that Libido. This is obscure, and we are warned not to forget that the Libido of a given person is fundamentally part of that person and cannot be contrasted with him as if it were something external. It is the question of the topographical dynamics of anxiety-development that is still obscure to us—what kind of mental energies are being expended and to what systems do they belong? I cannot promise you to answer this question also; but we will not neglect to follow up two other clues, and in so doing will again summon direct observation and analytic investigation to aid our speculation. We will turn to the sources of anxiety in children, and to the origin of the neurotic anxiety which is attached to phobias.

Apprehensiveness is very common among children, and it is difficult enough to decide whether it is real or neurotic anxiety. Indeed the very value of this distinction is called in question by the attitude of children themselves. For on the one hand we are not surprised that children are afraid of strangers, of strange objects and situations, and we account for this reaction to ourselves very easily by reflecting on their weakness and ignorance. Thus we ascribe to the child a strong tendency to real anxiety and should regard it as only practical if this apprehensiveness had been transmitted by inheritance. The child would only be repeating the behaviour of prehistoric man and of primitive man to-day who, in consequence of his ignorance and helplessness, experiences a dread of anything new and strange, and of much that is familiar to him, none of which any longer inspires fear in us. It would also correspond to our expectations if the phobias of children were at least in part such as might be attributed to those primeval periods of human development.

On the other hand, it cannot be overlooked that children are not all equally apprehensive, and that the very children who are more than usually timid in the face of all kinds of objects and situations are just those who later on become neurotic. The neurotic disposition is therefore betrayed, amongst other signs, by a marked tendency to real anxiety; apprehensiveness rather than nervousness appears to be primary; and we arrive at the conclusion that the child, and later the adult, experiences a dread of the strength of his Libido, simply because he is afraid of everything. The derivation of anxiety from the Libido itself would then be discarded; and investigation of the conditions of real anxiety would logically lead to the view that the consciousness of personal weakness and helplessness—inferiority, as A. Adler calls it—when it is able to maintain itself into later life is the final cause of neurosis.

This sounds so simple and plausible that it has a claim on our attention. It is true that it would involve shifting the point of view from which we regard the problem of nervousness. That such feelings of inferiority do persist into later life—together with a disposition to anxiety and symptom-formation—seems so well established that much more explanation is required when, in an exceptional case, what we call ‘health’ is the outcome. But what can be learnt from the close observation of apprehensiveness in children? The small child is first of all afraid of strange people; situations become important only on account of the people concerned in them, and objects always much later. But the child is not afraid of these strange people because he attributes evil intentions to them, comparing their strength with his weakness, and thus recognizing in them a danger to his existence, his safety, and his freedom from pain. Such a conception of a child, so suspicious and terrified of an overpowering aggressivity in the world, is a very poor sort of theoretical construction. On the contrary, the child starts back in fright from a strange figure because he is used to—and therefore expects—a beloved and familiar figure, primarily his mother. It is his disappointment and longing which are transformed into dread—his Libido, unable to be expended, and at that time not to be held suspended, is discharged through being converted into dread. It can hardly be a coincidence too that in this situation, which is the prototype of childish anxiety, the condition of the primary anxiety state during birth, a separation from the mother, is again reproduced.

The first phobias of situations in children concern darkness and loneliness; the former is often retained throughout life; common to both is the desire for the absent attendant, for the mother, therefore. I once heard a child who was afraid of the darkness call out: “Auntie, talk to me, I’m frightened.” “But what good will that do? You can’t see me;” to which the child replied: “If someone talks, it gets lighter.” The longing felt _in_ the darkness is thus transformed into fear _of_ the darkness. Far from finding that neurotic anxiety is only secondary and a special case of real anxiety, we see on the contrary that there is something in the small child which behaves like real anxiety and has an essential feature in common with neurotic anxiety—namely, origin in undischarged Libido. Of genuine ‘real anxiety’ the child seems to bring very little into the world. In all those situations which can become the conditions of phobias later, on heights, on narrow bridges over water, in trains and boats, the small child shows no fear—the less it knows the less it fears. It is much to be wished that it had inherited more of these life-preserving instincts; the task of looking after it and preventing it from exposing itself to one danger after another would have been very much lightened. Actually, you see, a child overestimates his powers, to begin with, and behaves without fear because he does not recognize dangers. He will run along the edge of the water, climb upon the window-sill, play with sharp things and with fire, in short, do anything that injures him and alarms his attendants. Since he cannot be allowed to learn it himself through bitter experience, it is entirely due to training that real anxiety does eventually awake in him.

Now if some children embrace this training in apprehensiveness very readily, and then find for themselves dangers which they have not been warned against, it is explicable on the ground that these children have inherently a greater amount of libidinal need in their constitution than others, or else that they have been spoiled early with libidinal gratifications. It is no wonder if those who later become nervous also belong to this type as children; we know that the most favourable circumstance for the development of a neurosis lies in the inability to tolerate a considerable degree of pent-up Libido for any length of time. You will observe now that here the constitutional factor, which we have never denied, comes into its own. We protest only when others emphasize it to the exclusion of all other claims, and when they introduce the constitutional factor even where according to the unanimous findings both of observation and of analysis, it does not belong, or only plays a minor part.

Let us sum up the conclusions drawn from the observation of apprehensiveness in children: Infantile dread has very little to do with real anxiety (dread of real danger), but is, on the other hand, closely allied to the neurotic anxiety of adults. It is derived like the latter from undischarged Libido, and it substitutes some other external object or some situation for the love-object which it misses.

Now you will be glad to hear that the analysis of phobias has little more to teach us than we have learnt already. The same thing happens in them as in the anxiety of children; Libido that cannot be discharged is continuously being converted into an apparently ‘real’ anxiety, and so an insignificant external danger is taken as a representative of what the Libido desires. The agreement between the two forms of anxiety is not surprising; for infantile phobias are not merely prototypes of those which appear later in anxiety-hysteria, but they are a direct preliminary condition and prelude of them. Every hysterical phobia can be traced back to a childish dread, of which it is a continuation, even if it has a different content and must be called by a different name. The difference between the two conditions lies in their mechanism. In order that the Libido should be converted into anxiety in the adult it is no longer sufficient that the Libido should be momentarily unable to be utilized. The adult has long since learned to maintain such Libido suspended, or to apply it in different ways. But, when the Libido is attached to a mental excitation which has undergone repression, conditions similar to those in the child, in whom there is not yet any distinction between conscious and unconscious, are re-established; and by a regression to the infantile phobia a bridge, so to speak, is provided by which the conversion of Libido into anxiety can be conveniently effected. As you will remember, we have treated repression at some length, but in so doing we have been concerned exclusively with the fate of the _idea_ to be repressed; naturally, because this was easier to recognize and to present. But we have so far ignored the question of what happened to the _affect_ attached to this idea, and now we learn for the first time that it is the immediate fate of the affect to be converted into anxiety, no matter what quality of affect it would otherwise have been had it run a normal course. This transformation of affect is, moreover, by far the more important effect of the process of repression. It is not so easy to present to you; for we cannot maintain the existence of unconscious affects in the same sense as that of unconscious ideas. An idea remains up to a point the same, whether it is conscious or unconscious; we can indicate something that corresponds to an unconscious idea. But an affect is a process involving a discharge of energy, and it is to be regarded quite differently from an idea; without searching examination and clarification of our hypotheses concerning mental processes, we cannot tell what corresponds with it in the Unconscious—and that cannot be undertaken here. However, we will preserve the impression we have gained, that the development of anxiety is closely connected with the unconscious system.

I said that conversion into anxiety, or better, discharge in the form of anxiety, was the immediate fate of Libido which encounters repression; I must add that it is not the only or the final fate of it. In the neuroses, processes take place which are intended to prevent the development of anxiety, and which succeed in so doing by various means. In the phobias, for instance, two stages in the neurotic process are clearly discernible. The first effects the repressions and conversion of the Libido into anxiety, which is then attached to some external danger. The second consists in building up all those precautions and safeguards by which all contact with this externalized danger shall be avoided. Repression is an attempt at flight on the part of the Ego from the Libido which it feels to be dangerous; the phobia may be compared to a fortification against the outer danger which now stands for the dreaded Libido. The weakness of this defensive system in the phobias is of course that the fortress which is so well guarded from without remains exposed to danger from within; projection externally of danger from Libido can never be a very successful measure. In the other neuroses, therefore, other defensive systems are employed against the possibility of the development of anxiety; this is a very interesting part of the psychology of the neuroses. Unfortunately it would take us too far afield and also it would require a thorough grounding in special knowledge of the subject. I will merely add this. I have already spoken of the ‘counter-charges’ that are instituted by the Ego upon repression, which must be maintained so that the repression can persist. It is the task of this counter-charge to carry out the various forms of defence against the development of anxiety after repression.

To return to the phobias: I may now hope that you realize how inadequate it is to attempt merely to explain their content, and to take no interest in them apart from their derivation—this or that object or situation which has been made into a phobia. The content of the phobia has an importance comparable to that of the manifest dream—it is a façade. With all due modifications, it is to be admitted that among the contents of the various phobias many are found which, as Stanley Hall points out, are specially suited by phylogenetic inheritance to become objects of dread. It is even in agreement with this that many of these dreaded things have no connection with danger, except through a _symbolic_ relation to it.

Thus we are convinced of the quite central position which the problem of anxiety fills in the psychology of the neuroses. We have received a strong impression of how the development of anxiety is bound up with the fate of the Libido and with the unconscious system. There is only one unconnected thread, only one gap in our structure, the fact, which after all can hardly be disputed, that ‘real anxiety’ must be regarded as an expression of the Ego’s instinct for self-preservation.

TWENTY-SIXTH LECTURE
THE THEORY OF THE LIBIDO: NARCISSISM

We have repeatedly, and again quite recently, referred to the distinction between the sexual and the Ego-instincts. First of all, repression showed how they can oppose each other, how the sexual instincts are then apparently brought to submission, and required to procure their satisfaction by circuitous regressive paths, where in their impregnability they obtain compensation for their defeat. Then it appeared that from the outset they each have a different relation to the task-mistress Necessity, so that their developments are different and they acquire different attitudes to the reality-principle. Finally we believe we can observe that the sexual instincts are connected by much closer ties with the affective state of anxiety than are the Ego-instincts—a conclusion which in one important point only still seems incomplete. In support of it we may bring forward the further remarkable fact that want of satisfaction of hunger or thirst, the two most elemental of the self-preservative instincts, never results in conversion of them into anxiety, whereas the conversion of unsatisfied Libido into anxiety is, as we have heard, a very well-known and frequently-observed phenomenon.

Our justification for distinguishing between sexual and Ego-instincts can surely not be contested; it is indeed assumed by the existence of the sexual instinct as a special activity in the individual. The only question is what significance is to be attached to this distinction, how radical and decisive we intend to consider it. The answer to this depends upon what we can ascertain about the extent to which the sexual instincts, both in their bodily and their mental manifestations, conduct themselves differently from the other instincts which we set against them; and how important the results arising from these differences are found to be. We have of course no motive for maintaining any difference in the fundamental nature of the two groups of instincts, and, by the way, it would be difficult to apprehend any. They both present themselves to us merely as descriptions of the sources of energy in the individual, and the discussion whether fundamentally they are one, or essentially different, and if one, when they became separated from each other, cannot be carried through on the basis of these concepts alone, but must be grounded on the biological facts underlying them. At present we know too little about this, and even if we knew more it would not be relevant to the task of psycho-analysis.

We should clearly also profit very little by emphasizing the primordial unity of all the instincts, as Jung has done, and describing all the energies which flow from them as ‘Libido.’ We should then be compelled to speak of sexual and asexual Libido, since the sexual function is not to be eliminated from the field of mental life by any such device. The name Libido, however, remains properly reserved for the instinctive forces of the sexual life, as we have hitherto employed it.