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II.
Hysteria and the Question of Its Relation to the Sexual Emotions--The
Early Greek Theories of its Nature and Causation--The Gradual
Rise of Modern Views--Charcot--The Revolt Against Charcot's
Too Absolute Conclusions--Fallacies Involved--Charcot's Attitude
the Outcome of his Personal Temperament--Breuer and Freud--Their
Views Supplement and Complete Charcot's--At the Same Time
they Furnish a Justification for the Earlier Doctrine of Hysteria--But
They Must Not be Regarded as Final--The Diffused Hysteroid
Condition in Normal Persons--The Physiological Basis of Hysteria--True
Pathological Hysteria is Linked on to almost Normal States,
especially to Sex-hunger.
The nocturnal hallucinations of hysteria, as all careful students
of this condition now seem to agree, are closely allied to
the hysterical attack proper. Sollier, indeed, one of the
ablest of the more recent investigators of hysteria, has argued
with much force that the subjects of hysteria really live
in a state of pathological sleep, of vigilambulism.[251] He
regards all the various accidents of hysteria as having a
common basis in disturbances of sensibility, in the widest
sense of the word "sensibility,"--as the very foundation
of personality,--while anaesthesia is "the real _sigillum
hysteriae_." Whatever the form of hysteria, we are thus
only concerned with a more or less profound state of vigilambulism:
a state in which the subject seems, often even to himself,
to be more or less always asleep, whether the sleep may be
regarded as local or general. Sollier agrees with Fere that
the disorder of sensibility may be regarded as due to an exhaustion
of the sensory centres of the brain, whether as the result
of constitutional cerebral weakness, of the shock of a violent
emotion, or of some toxic influence on the cerebral cells.
We may, therefore, fitly turn from the auto-erotic phenomena
of sleep which in women generally, and especially in hysterical
women, seem to possess so much importance and significance,
to the question--which has been so divergently answered at
different periods and by different investigators--concerning
the causation of hysteria, and especially concerning its alleged
connection with conscious or unconscious sexual emotion.[252]
It was the belief of the ancient Greeks that hysteria came
from the womb; hence its name. We first find that statement
in Plato's _Timaeus_: "In men the organ of generation--becoming
rebellious and masterful, like an animal disobedient to reason,
and maddened with the sting of lust--seeks to gain absolute
sway; and the same is the case with the so-called womb, or
uterus, of women; the animal within them is desirous of procreating
children, and, when remaining unfruitful long beyond its proper
time, gets discontented and angry, and, wandering in every
direction through the body, closes up the passages of the
breath, and, by obstructing respiration,[253] drives them
to extremity, causing all varieties of disease."
Plato, it is true, cannot be said to reveal anywhere a very
scientific attitude toward Nature. Yet he was here probably
only giving expression to the current medical doctrine of
his day. We find precisely the same doctrine attributed to
Hippocrates, though without a clear distinction between hysteria
and epilepsy.[254] If we turn to the best Roman physicians
we find again that Aretaeus, "the Esquirol of antiquity,"
has set forth the same view, adding to his description of
the movements of the womb in hysteria: "It delights,
also, in fragrant smells, and advances toward them; and it
has an aversion to foetid smells, and flies from them; and,
on the whole, the womb is like an animal within an animal."[255]
Consequently, the treatment was by applying foetid smells
to the nose and rubbing fragrant ointments around the sexual
parts.[256]
The Arab physicians, who carried on the traditions of Greek
medicine, appear to have said nothing new about hysteria,
and possibly had little knowledge of it. In Christian mediaeval
Europe, also, nothing new was added to the theory of hysteria;
it was, indeed, less known medically than it had ever been,
and, in part it may be as a result of this ignorance, in part
as a result of general wretchedness (the hysterical phenomena
of witchcraft reaching their height, Michelet points out,
in the fourteenth century, which was a period of special misery
for the poor), it flourished more vigorously. Not alone have
we the records of nervous epidemics, but illuminated manuscripts,
ivories, miniatures, bas-reliefs, frescoes, and engravings
furnish the most vivid iconographic evidence of the prevalence
of hysteria in its most violent forms during the Middle Ages.
Much of this evidence is brought to the service of science
in the fascinating works of Dr. P. Richer, one of Charcot's
pupils.[257]
In the seventeenth century Ambroise Pare was still talking,
like Hippocrates, about "suffocation of the womb";
Forestus was still, like Aretaeus, applying friction to the
vulva; Fernel was still reproaching Galen, who had denied
that the movements of the womb produced hysteria.
It was in the seventeenth century (1618) that a French physician,
Charles Lepois (Carolus Piso), physician to Henry II, trusting,
as he said, to experience and reason, overthrew at one stroke
the doctrine of hysteria that had ruled almost unquestioned
for two thousand years, and showed that the malady occurred
at all ages and in both sexes, that its seat was not in the
womb, but in the brain, and that it must be considered a nervous
disease.[258] So revolutionary a doctrine could not fail to
meet with violent opposition, but it was confirmed by Willis,
and in 1681, we owe to the genius of Sydenham a picture of
hysteria which for lucidity, precision, and comprehensiveness
has only been excelled in our own times.
It was not possible any longer to maintain the womb theory
of Hippocrates in its crude form, but in modified forms, and
especially with the object of preserving the connection which
many observers continued to find between hysteria and the
sexual emotions, it still found supporters in the eighteenth
and even the nineteenth centuries. James, in the middle of
the eighteenth century, returned to the classical view, and
in his _Dictionary of Medicine_ maintained that the womb is
the seat of hysteria. Louyer Villermay in 1816 asserted that
the most frequent causes of hysteria are deprivation of the
pleasures of love, griefs connected with this passion, and
disorders of menstruation. Foville in 1833 and Landouzy in
1846 advocated somewhat similar views. The acute Laycock in
1840 quoted as "almost a medical proverb" the saying,
"_Salacitas major, major ad hysteriam proclivitas_,"
fully indorsing it. More recently still Clouston has defined
hysteria as "the loss of the inhibitory influence exercised
on the reproductive and sexual instincts of women by the higher
mental and moral functions" (a position evidently requiring
some modification in view of the fact that hysteria is by
no means confined to women), while the same authority remarks
that more or less concealed sexual phenomena are the chief
symptoms of "hysterical insanity."[259] Two gynaecologists
of high position in different parts of the world, Hegar in
Germany and Balls-Headley in Australia, attribute hysteria,
as well as anaemia, largely to unsatisfied sexual desire,
including the non-satisfaction of the "ideal feelings."[260]
Lombroso and Ferrero, again, while admitting that the sexual
feelings might be either heightened or depressed in hysteria,
referred to the frequency of what they termed "a paradoxical
sexual instinct" in the hysterical, by which, for instance,
sexual frigidity is combined with intense sexual pre-occupations;
and they also pointed out the significant fact that the crimes
of the hysterical nearly always revolve around the sexual
sphere.[261] Thus, even up to the time when the conception
of hysteria which absolutely ignored and excluded any sexual
relationship whatever had reached its height, independent
views favoring such a relationship still found expression.
Of recent years, however, such views usually aroused violent
antagonism. The main current of opinion was with Briquet (1859),
who, treating the matter with considerable ability and a wide
induction of facts, indignantly repelled the idea that there
is any connection between hysteria and the sexual facts of
life, physical or psychic. As he himself admitted, Briquet
was moved to deny a sexual causation of hysteria by the thought
that such an origin would be degrading for women ("_a
quelque chose de degradant pour les femmes_").
It was, however, the genius of Charcot, and the influence
of his able pupils, which finally secured the overthrow of
the sexual theory of hysteria. Charcot emphatically anathematized
the visceral origin of hysteria; he declared that it is a
psychic disorder, and to leave no loop-hole of escape for
those who maintained a sexual causation he asserted that there
are no varieties of hysteria, that the disease is one and
indivisible. Charcot recognized no primordial cause of hysteria
beyond heredity, which here plays a more important part than
in any other neuropathic condition. Such heredity is either
direct or more occasionally by transformation, any deviation
of nutrition found in the ancestors (gout, diabetes, arthritis)
being a possible cause of hysteria in the descendants. "We
do not know anything about the nature of hysteria," Charcot
wrote in 1892; "we must make it objective in order to
recognize it. The dominant idea for us in the etiology of
hysteria is, in the widest sense, its hereditary predisposition.
The greater number of those suffering from this affection
are simply born _hysterisables_, and on them the occasional
causes act directly, either through autosuggestion or by causing
derangement of general nutrition, and more particularly of
the nutrition of the nervous system."[262] These views
were ably and decisively stated in Gilles de la Tourette's
_Traite de l'Hysterie_, written under the inspiration of Charcot.
While Charcot's doctrine was thus being affirmed and generally
accepted, there were at the same time workers in these fields
who, though they by no means ignored this doctrine of hysteria
or even rejected it, were inclined to think that it was too
absolutely stated. Writing in the _Dictionary of Psychological
Medicine_ at the same time as Charcot, Donkin, while deprecating
any exclusive emphasis on the sexual causation, pointed out
the enormous part played by the emotions in the production
of hysteria, and the great influence of puberty in women due
to the greater extent of the sexual organs, and the consequently
large area of central innervation involved, and thus rendered
liable to fall into a state of unstable equilibrium. Enforced
abstinence from the gratification of any of the inherent and
primitive desires, he pointed out, may be an adequate exciting
cause. Such a view as this indicated that to set aside the
ancient doctrine of a physical sexual cause of hysteria was
by no means to exclude a psychic sexual cause. Ten years earlier
Axenfeld and Huchard had pointed out that the reaction against
the sexual origin of hysteria was becoming excessive, and
they referred to the evidence brought forward by veterinary
surgeons showing that unsatisfied sexual desire in animals
may produce nervous symptoms very similar to hysteria.[263]
The present writer, when in 1894 briefly discussing hysteria
as an element in secondary sexual characterization, ventured
to reflect the view, confirmed by his own observation, that
there was a tendency to unduly minimize the sexual factor
in hysteria, and further pointed out that the old error of
a special connection between hysteria and the female sexual
organs, probably arose from the fact that in woman the organic
sexual sphere is larger than in man.[264]
When, indeed, we analyze the foundation of the once predominant
opinions of Charcot and his school regarding the sexual relationships
of hysteria, it becomes clear that many fallacies and misunderstandings
were involved. Briquet, Charcot's chief predecessor, acknowledged
that his own view was that a sexual origin of hysteria would
be "degrading to women"; that is to say, he admitted
that he was influenced by a foolish and improper prejudice,
for the belief that the unconscious and involuntary morbid
reaction of the nervous system to any disturbance of a great
primary instinct can have "_quelque chose de degradant_"
is itself an immoral belief; such disturbance of the nervous
system might or might not be caused, but in any case the alleged
"degradation" could only be the fiction of a distorted
imagination. Again, confusion had been caused by the ancient
error of making the physical sexual organs responsible for
hysteria, first the womb, more recently the ovaries; the outcome
of this belief was the extirpation of the sexual organs for
the cure of hysteria. Charcot condemned absolutely all such
operations as unscientific and dangerous, declaring that there
is no such thing as hysteria of menstrual origin.[265] Subsequently,
Angelucci and Pierracini carried out an international inquiry
into the results of the surgical treatment of hysteria, and
condemned it in the most unqualified manner.[266] It is clearly
demonstrated that the physical sexual organs are not the seat
of hysteria. It does not, however, follow that even physical
sexual desire, when repressed, is not a cause of hysteria.
The opinion that it was so formed an essential part of the
early doctrine of hysteria, and was embodied in the ancient
maxim: "_Nubat illa et morbus effugiet_." The womb,
it seemed to the ancients, was crying out for satisfaction,
and when that was received the disease vanished.[267] But
when it became clear that sexual desire, though ultimately
founded on the sexual apparatus, is a nervous and psychic
fact, to put the sexual organs out of count was not sufficient;
for the sexual emotions may exist before puberty, and persist
after complete removal of the sexual organs. Thus it has been
the object of many writers to repel the idea that unsatisfied
sexual desire can be a cause of hysteria. Briquet pointed
out that hysteria is rare among nuns and frequent among prostitutes.
Krafft-Ebing believed that most hysterical women are not anxious
for sexual satisfaction, and declared that "hysteria
caused through the non-satisfaction of the coarse sensual
sexual impulse I have never seen,"[268] while Pitres
and others refer to the frequently painful nature of sexual
hallucinations in the hysterical. But it soon becomes obvious
that the psychic sexual sphere is not confined to the gratification
of conscious physical sexual desire. It is not true that hysteria
is rare among nuns, some of the most tremendous epidemics
of hysteria, and the most carefully studied, having occurred
in convents,[269] while the hysterical phenomena sometimes
associated with revivals are well known. The supposed prevalence
among prostitutes would not be evidence against the sexual
relationships of hysteria; it has, however, been denied, even
by so great an authority as Parent-Duchatelet who found it
very rare, even in prostitutes in hospitals, when it was often
associated with masturbation; in prostitutes, however, who
returned to a respectable life, giving up their old habits,
he found hysteria common and severe.[270] The frequent absence
of physical sexual feeling, again, may quite reasonably be
taken as evidence of a disorder of the sexual emotions, while
the undoubted fact that sexual intercourse usually has little
beneficial effect on pronounced hysteria, and that sexual
excitement during sleep and sexual hallucinations are often
painful in the same condition, is far from showing that injury
or repression of the sexual emotions had nothing to do with
the production of the hysteria. It would be as reasonable
to argue that the evil effect of a heavy meal on a starving
man must be taken as evidence that he was not suffering from
starvation. The fact, indeed, on which Gilles de la Tourette
and others have remarked, that the hysterical often desire
not so much sexual intercourse as simple affection, would
tend to show that there is here a real analogy, and that starvation
or lesion of the sexual emotions may produce, like bodily
starvation, a rejection of those satisfactions which are demanded
in health. Thus, even a mainly _a priori_ examination of the
matter may lead us to see that many arguments brought forward
in favor of Charcot's position on this point fall to the ground
when we realize that the sexual emotions may constitute a
highly complex sphere, often hidden from observation, sometimes
not conscious at all, and liable to many lesions besides that
due to the non-satisfaction of sexual desire. At the same
time we are not thus enabled to overthrow any of the positive
results attained by Charcot and his school.
It may, however, be pointed out that Charcot's attitude toward
hysteria was the outcome of his own temperament. He was primarily
a neurologist, the bent of his genius was toward the investigation
of facts that could be objectively demonstrated. His first
interest in hysteria, dating from as far back as 1862, was
in hystero-epileptic convulsive attacks, and to the last he
remained indifferent to all facts which could not be objectively
demonstrated. That was the secret of the advances he was enabled
to make in neurology. For purely psychological investigation
he had no liking, and probably no aptitude. Anyone who was
privileged to observe his methods of work at the Salpetriere
will easily recall the great master's towering figure; the
disdainful expression, sometimes, even, it seemed, a little
sour; the lofty bearing which enthusiastic admirers called
Napoleonic. The questions addressed to the patient were cold,
distant, sometimes impatient. Charcot clearly had little faith
in the value of any results so attained. One may well believe,
also, that a man whose superficial personality was so haughty
and awe-inspiring to strangers would, in any case, have had
the greatest difficulty in penetrating the mysteries of a
psychic world so obscure and elusive as that presented by
the hysterical.[271]
The way was thus opened for further investigations on the
psychic side. Charcot had affirmed the power, not only of
physical traumatism, but even of psychic lesions--of moral
shocks--to provoke its manifestations, but his sole contribution
to the psychology of this psychic malady,--and this was borrowed
from the Nancy school,--lay in the one word "suggestibility";
the nature and mechanism of this psychic process he left wholly
unexplained. This step has been taken by others, in part by
Janet, who, from 1889 onward, has not only insisted that the
emotions stand in the first line among the causes of hysteria,
but has also pointed out some portion of the mechanism of
this process; thus, he saw the significance of the fact, already
recognized, that strong emotions tend to produce anaesthesia
and to lead to a condition of mental disaggregation, favorable
to abulia, or abolition of will-power. It remained to show
in detail the mechanism by which the most potent of all the
emotions effects its influence, and, by attempting to do this,
the Viennese investigators, Breuer and especially Freud, have
greatly aided the study of hysteria.[272] They have not, it
is important to remark, overturned the positive elements in
their great forerunner's work. Freud began as a disciple of
Charcot, and he himself remarks that, in his earlier investigations
of hysteria, he had no thought of finding any sexual etiology
for that malady; he would have regarded any such suggestion
as an insult to his patient. The results reached by these
workers were the outcome of long and detailed investigation.
Freud has investigated many cases of hysteria in minute detail,
often devoting to a single case over a hundred hours of work.
The patients, unlike those on whom the results of the French
school have been mainly founded, all belonged to the educated
classes, and it was thus possible to carry out an elaborate
psychic investigation which would be impossible among the
uneducated. Breuer and Freud insist on the fine qualities
of mind and character frequently found among the hysterical.
They cannot accept suggestibility as an invariable characteristic
of hysteria, only abnormal excitability; they are far from
agreeing with Janet (although on many points at one with him),
that psychic weakness marks hysteria; there is merely an appearance
of mental weakness, they say, because the mental activity
of the hysterical is split up, and only a part of it is conscious.[273]
The superiority of character of the hysterical is indicated
by the fact that the conflict between their ideas of right
and the bent of their inclinations is often an element in
the constitution of the hysterical state. Breuer and Freud
are prepared to assert that the hysterical are among "the
flower of humanity," and they refer to those qualities
of combined imaginative genius and practical energy which
characterized St. Theresa, "the patron saint of the hysterical."
To understand the position of Breuer and Freud we may start
from the phenomenon of "nervous shock" produced
by physical traumatism, often of a very slight character.
Charcot had shown that such "nervous shock," with
the chain of resulting symptoms, is nothing more or less than
hysteria. Breuer and Freud may be linked on to Charcot at
this point. They began by regarding the most typical hysteria
as really a _psychic traumatism_; that is to say, that it
starts in a lesion, or rather in repeated lesions, of the
emotional organism. It is true that the school of Charcot
admitted the influence of moral shock, especially of the emotion
of fear, but that merely as an "_agent provocateur_,"
and with a curious perversity Gilles de la Tourette, certainly
reflecting the attitude of Charcot, in his elaborate treatise
on hysteria fails to refer to the sphere of the sexual emotions
even when enumerating the "_agents provocateurs_."[274]
The influence of fear is not denied by Breuer and Freud, but
they have found that careful psychic analysis frequently shows
that the shock of a commonplace "fear" is really
rooted in a lesion of the sexual emotions. A typical and very
simple illustration is furnished in a case, recorded by Breuer,
in which a young girl of seventeen had her first hysterical
attack after a cat sprang on her shoulders as she was going
downstairs. Careful investigation showed that this girl had
been the object of somewhat ardent attentions from a young
man whose advances she had resisted, although her own sexual
emotions had been aroused. A few days before, she had been
surprised by this young man on these same dark stairs, and
had forcibly escaped from his hands. Here was the real psychic
traumatism, the operation of which merely became manifest
in the cat. "But in how many cases," asks Breuer,
"is a cat thus reckoned as a completely sufficient _causa
efficiens_?"
In every case that they have investigated Breuer and Freud
have found some similar secret lesion of the psychic sexual
sphere. In one case a governess, whose training has been severely
upright, is, in spite of herself and without any encouragement,
led to experience for the father of the children under her
care an affection which she refuses to acknowledge even to
herself; in another, a young woman finds herself falling in
love with her brother-in-law; again, an innocent girl suddenly
discovers her uncle in the act of sexual intercourse with
her playmate, and a boy on his way home from school is subjected
to the coarse advances of a sexual invert. In nearly every
case, as Freud eventually found reason to believe, a primary
lesion of the sexual emotions dates from the period of puberty
and frequently of childhood, and in nearly every case the
intimately private nature of the lesion causes it to be carefully
hidden from everyone, and even to be unacknowledged by the
subject of it. In the earlier cases Breuer and Freud found
that a slight degree of hypnosis is necessary to bring the
lesion into consciousness, and the accuracy of the revelations
thus obtained has been tested by independent witness. Freud
has, however, long abandoned the induction of any degree of
hypnosis; he simply tries to arrange that the patient shall
feel absolutely free to tell her own story, and so proceeds
from the surface downwards, slowly finding and piecing together
such essential fragments of the history as may be recovered,
in the same way he remarks, as the archaeologist excavates
below the surface and recovers and puts together the fragments
of an antique statue. Much of the material found, however,
has only a symbolic value requiring interpretation and is
sometimes pure fantasy. Freud now attaches great importance
to dreams as symbolically representing much in the subject's
mental history which is otherwise difficult to reach.[275]
The subtle and slender clues which Freud frequently follows
in interpreting dreams cannot fail sometimes to arouse doubt
in his readers' minds, but he certainly seems to have been
often successful in thus reaching latent facts in consciousness.
The primary lesion may thus act as "a foreign body in
consciousness." Something is introduced into psychic
life which refuses to merge in the general flow of consciousness.
It cannot be accepted simply as other facts of life are accepted;
it cannot even be talked about, and so submitted to the slow
usure by which our experiences are worn down and gradually
transformed. Breuer illustrates what happens by reference
to the sneezing reflex. "When an irritation to the nasal
mucous membrane for some reason fails to liberate this reflex,
a feeling of excitement and tension arises. This excitement,
being unable to stream out along motor channels, now spreads
itself over the brain, inhibiting other activities.... _In
the highest spheres of human activity we may watch the same
process_." It is a result of this process that, as Breuer
and Freud found, the mere act of confession may greatly relieve
the hysterical symptoms produced by this psychic mechanism,
and in some cases may wholly and permanently remove them.
It is on this fact that they founded their method of treatment,
devised by Breuer and by him termed the cathartic method,
though Freud prefers to call it the "analytic" method.
It is, as Freud points out, the reverse of the hypnotic method
of suggestive treatment; there is the same difference, Freud
remarks, between the two methods as Leonardo da Vinci found
for the two technical methods of art, _per via di porre_ and
_per via di levare_; the hypnotic method, like painting, works
by putting in, the cathartic or analytic method, like sculpture,
works by taking out.[276]
It is part of the mechanism of this process, as understood
by these authors, that the physical symptoms of hysteria are
constituted, by a process of conversion, out of the injured
emotions, which then sink into the background or altogether
out of consciousness. Thus, they found the prolonged tension
of nursing a near and dear relative to be a very frequent
factor in the production of hysteria. For instance, an originally
rheumatic pain experienced by a daughter when nursing her
father becomes the symbol in memory of her painful psychic
excitement, and this perhaps for several reasons, but chiefly
because _its presence in consciousness almost exactly coincided
with that excitement_. In another way, again, nausea and vomiting
may become a symbol through the profound sense of disgust
with which some emotional shock was associated. Then the symbol
begins to have a life of its own, and draws hidden strength
from the emotion with which it is correlated. Breuer and Freud
have found by careful investigation that the pains and physical
troubles of hysteria are far from being capricious, but may
be traced in a varying manner to an origin in some incident,
some pain, some action, which was associated with a moment
of acute psychic agony. The process of conversion was an involuntary
escape from an intolerable emotion, comparable to the physical
pain sometimes sought in intense mental grief, and the patient
wins some relief from the tortured emotions, though at the
cost of psychic abnormality, of a more or less divided state
of consciousness and of physical pain, or else anaesthesia.
In Charcot's third stage of the hysterical convulsion, that
of "_attitudes passionnelles_," Breuer and Freud
see the hallucinatory reproduction of a recollection which
is full of significance for the origin of the hysterical manifestations.
The final result reached by these workers is clearly stated
by each writer. "The main observation of our predecessors,"
states Breuer,[277] "still preserved in the word 'hysteria,'
is nearer to the truth than the more recent view which puts
sexuality almost in the last line, with the object of protecting
the patient from moral reproaches. Certainly the sexual needs
of the hysterical are just as individual and as various in
force as those of the healthy. But they suffer from them,
and in large measure, indeed, they suffer precisely through
the struggle with them, through the effort to thrust sexuality
aside." "The weightiest fact," concludes Freud,[278]
"on which we strike in a thorough pursuit of the analysis
is this: From whatever side and from whatever symptoms we
start, we always unfailingly reach the region of the sexual
life. Here, first of all, an etiological condition of hysterical
states is revealed.... At the bottom of every case of hysteria--and
reproducible by an analytical effort after even an interval
of long years--may be found one or more facts of precocious
sexual experience belonging to earliest youth. I regard this
as an important result, as the discovery of a _caput Nili_
of neuropathology." Ten years later, enlarging rather
than restricting his conception, Freud remarks: "Sexuality
is not a mere _deus ex machina_ which intervenes but once
in the hysterical process; it is the motive force of every
separate symptom and every expression of a symptom. The morbid
phenomena constitute, to speak plainly, the patient's sexual
activity."[279] The actual hysterical fit, Freud now
states, may be regarded as "the substitute for a once
practiced and then abandoned _auto-erotic_ satisfaction,"
and similarly it may be regarded as an equivalent of coitus.[280]
It is natural to ask how this conception affects that elaborate
picture of hysteria laboriously achieved by Charcot and his
school. It cannot be said that it abolishes any of the positive
results reached by Charcot, but it certainly alters their
significance and value; it presents them in a new light and
changes the whole perspective. With his passion for getting
at tangible definite physical facts, Charcot was on very safe
ground. But he was content to neglect the psychic analysis
of hysteria, while yet proclaiming that hysteria is a purely
psychic disorder. He had no cause of hysteria to present save
only heredity. Freud certainly admits heredity, but, as he
points out, the part it plays has been overrated. It is too
vague and general to carry us far, and when a specific and
definite cause can be found, the part played by heredity recedes
to become merely a condition, the soil on which the "specific
etiology" works. Here probably Freud's enthusiasm at
first carried him too far and the most important modification
he has made in his views occurs at this point: he now attaches
a preponderant influence to heredity. He has realized that
sexual activity in one form or another is far too common in
childhood to make it possible to lay very great emphasis on
"traumatic lesions" of this character, and he has
also realized that an outcrop of fantasies may somewhat later
develop on these childish activities, intervening between
them and the subsequent morbid symptoms. He is thus led to
emphasize anew the significance of heredity, not, however,
in Charcot's sense, as general neuropathic disposition but
as "sexual constitution." The significance of "infantile
sexual lesions" has also tended to give place to that
of "infantilism of sexuality."[281]
The real merit of Freud's subtle investigations is that--while
possibly furnishing a justification of the imperfectly-understood
idea that had floated in the mind of observers ever since
the name "hysteria" was first invented--he has certainly
supplied a definite psychic explanation of a psychic malady.
He has succeeded in presenting clearly, at the expense of
much labor, insight, and sympathy, a dynamic view of the psychic
processes involved in the constitution of the hysterical state,
and such a view seems to show that the physical symptoms laboriously
brought to light by Charcot are largely but epiphenomena and
by-products of an emotional process, often of tragic significance
to the subject, which is taking place in the most sensitive
recess of the psychic organism. That the picture of the mechanism
involved, presented to us by Professor Freud, cannot be regarded
as a final and complete account of the matter, may readily
be admitted. It has developed in Freud's own hands, and some
of the developments will require very considerable confirmation
before they can be accepted as generally true.[282] But these
investigations have at least served to open the door, which
Charcot had inconsistently held closed, into the deeper mysteries
of hysteria, and have shown that here, if anywhere, further
research will be profitable. They have also served to show
that hysteria may be definitely regarded as, in very many
cases at least, a manifestation of the sexual emotions and
their lesions; in other words, a transformation of auto-erotism.
The conception of hysteria so vigorously enforced by Charcot
and his school is thus now beginning to appear incomplete.
But we have to recognize that that incompleteness was right
and necessary. A strong reaction was needed against a widespread
view of hysteria that was in large measure scientifically
false. It was necessary to show clearly that hysteria is a
definite disorder, even when the sexual organs and emotions
are swept wholly out of consideration; and it was also necessary
to show that the lying and dissimulation so widely attributed
to the hysterical were merely the result of an ignorant and
unscientific misinterpretation of psychic elements of the
disease. This was finally and triumphantly achieved by Charcot's
school.
There is only one other point in the explanation of hysteria
which I will here refer to, and that because it is usually
ignored, and because it has relationship to the general psychology
of the sexual emotions. I refer to that physiological hysteria
which is the normal counterpart of the pathological hysteria
which has been described in its physical details by Charcot,
and to which alone the term should strictly be applied. Even
though hysteria as a disease may be described as one and indivisible,
there are yet to be found, among the ordinary and fairly healthy
population, vague and diffused hysteroid symptoms which are
dissipated in a healthy environment, or pass nearly unnoted,
only to develop in a small proportion of cases, under the
influence of a more pronounced heredity, or a severe physical
or psychic lesion, into that definite morbid state which is
properly called hysteria.
This diffused hysteroid condition may be illustrated by the
results of a psychological investigation carried on in America
by Miss Gertrude Stein among the ordinary male and female
students of Harvard University and Radcliffe College. The
object of the investigation was to study, with the aid of
a planchette, the varying liability to automatic movements
among normal individuals. Nearly one hundred students were
submitted to experiment. It was found that automatic responses
could be obtained in two sittings from all but a small proportion
of the students of both sexes, but that there were two types
of individual who showed a special aptitude. One type (probably
showing the embryonic form of neurasthenia) was a nervous,
high-strung, imaginative type, not easily influenced from
without, and not so much suggestible as autosuggestible. The
other type, which is significant from our present point of
view, is thus described by Miss Stein: "In general the
individuals, often blonde and pale, are distinctly phlegmatic.
If emotional, decidedly of the weakest, sentimental order.
They may be either large, healthy, rather heavy, and lacking
in vigor or they may be what we call anaemic and phlegmatic.
Their power of concentrated attention is very small. They
describe themselves as never being held by their work; they
say that their minds wander easily; that they work on after
they are tired, and just keep pegging away. They are very
apt to have premonitory conversations, they anticipate the
words of their friends, they imagine whole conversations that
afterward come true. The feeling of having been there is very
common with them; that is, they feel under given circumstances
that they have had that identical experience before in all
its details. They are often fatalistic in their ideas. They
indulge in day-dreams. As a rule, they are highly suggestible."[283]
There we have a picture of the physical constitution and psychic
temperament on which the classical symptoms of hysteria might
easily be built up.[284] But these persons were ordinary students,
and while a few of their characteristics are what is commonly
and vaguely called "morbid," on the whole they must
be regarded as ordinarily healthy individuals. They have the
congenital constitution and predisposition on which some severe
psychic lesion at the "psychological moment" might
develop the most definite and obstinate symptoms of hysteria,
but under favorable circumstances they will be ordinary men
and women, of no more than ordinary abnormality or ordinary
power. They are among the many who have been called to hysteria
at birth; they may never be among the few who are chosen.
We may have to recognize that on the side of the sexual emotions,
as well as in general constitution, a condition may be traced
among normal persons that is hysteroid in character, and serves
as the healthy counterpart of a condition which in hysteria
is morbid. In women such a condition Has been traced (though
misnamed) by Dr. King.[285]
Dr. King describes what he calls "sexual hysteria in
women," which he considers a chief variety of hysteria.
He adds, however, that it is not strictly a disease, but simply
an automatic reaction of the reproductive system, which tends
to become abnormal under conditions of civilization, and to
be perpetuated in a morbid form. In this condition he finds
twelve characters: 1. Time of life, usually between puberty
and climacteric. 2. Attacks rarely occur when subject is alone.
3. Subject appears unconscious, but is not really so. 4. She
is instinctively ashamed afterward. 5. It occurs usually in
single women, or in those, single or married, whose sexual
needs are unsatisfied. 6. No external evidence of disease,
and (as Aitken pointed out) the nates are not flattened; the
woman's physical condition is not impaired, and she may be
specially attractive to men. 7. Warmth of climate and the
season of spring and summer are conducive to the condition.
8. The paroxysm in short and temporary. 9. While light touches
are painful, firm pressure and rough handling give relief.
10. It may occur in the occupied, but an idle, purposeless
life is conducive. 11. The subject delights in exciting sympathy
and in being fondled and caressed. 12. There is defect of
will and a strong stimulus is required to lead to action.
Among civilized women, the author proceeds, this condition
does not appear to subserve any useful purpose. "Let
us, however, go back to aboriginal woman--to woman of the
woods and the fields. Let us picture ourselves a young aboriginal
Venus in one of her earliest hysterical paroxysms. In doing
so, let us not forget some of the twelve characteristics previously
mentioned. She will not be 'acting her part' alone, or, if
alone, it will be in a place where someone else is likely
soon to discover her. Let this Venus be now discovered by
a youthful Apollo of the woods, a man with fully developed
animal instincts. He and she, like any other animals, are
in the free field of Nature. He cannot but observe to himself:
'This woman is not dead; she breathes and is warm; she does
not look ill; she is plump and rosy.' He speaks to her; she
neither hears (apparently) nor responds. Her eyes are closed.
He touches, moves, and handles her at his pleasure. She makes
no resistance. What will this primitive Apollo do next? He
will cure the fit, and bring the woman back to consciousness,
satisfy her emotions, and restore her volition--not by delicate
touches that might be 'agonizing' to her hyperesthetic skin,
but by vigorous massage, passive motions, and succussion that
would be painless. The emotional process on the part of the
woman would end, perhaps, with mingled laughter, tears, and
shame; and when accused afterward of the part which the ancestrally
acquired properties of her nervous system had compelled her
to act, as a preliminary to the event, what woman would not
deny it and be angry? But the course of Nature having been
followed, the natural purpose of the hysterical paroxysm accomplished,
there would remain as a result of the treatment--instead of
one discontented woman--two happy people, and the possible
beginning of a third."
"Natural, primary sexual hysteria in woman," King
concludes, "is a temporary modification of the nervous
government of the body and the distribution of nerve-force
(occurring for the most part, as we see it to-day, in prudish
women of strong moral principle, whose volition has disposed
them to resist every sort of liberty or approach from the
other sex), consisting in a transient abdication of the general,
volitional, and self-preservational ego, while the reins of
government are temporarily assigned to the usurping power
of the reproductive ego, so that the reproductive government
overrules the government by volition, and thus, as it were,
forcibly compels the woman's organism to so dispose itself,
at a suitable time and place, as to allow, invite, and secure
the approach of the other sex, whether she will or not, to
the end that Nature's imperious demand for reproduction shall
be obeyed."
This perhaps rather fantastic description is not a presentation
of hysteria in the technical sense, but we may admit that
it presents a state which, if not the real physiological counterpart
of the hysterical convulsion, is yet distinctly analogous
to the latter. The sexual orgasm has this correspondence with
the hysterical fit, that they both serve to discharge the
nervous centres and relieve emotional tension. It may even
happen, especially in the less severe forms of hysteria, that
the sexual orgasm takes place during the hysterical fit; this
was found by Rosenthal, of Vienna, to be always the case in
the semiconscious paroxysms of a young girl whose condition
was easily cured;[286] no doubt such cases would be more frequently
found if they were sought for. In severe forms of hysteria,
however, it frequently happens, as so many observers have
noted, that normal sexual excitement has ceased to give satisfaction,
has become painful, perverted, paradoxical. Freud has enabled
us to see how a shock to the sexual emotions, injuring the
emotional life at its source, can scarcely fail sometimes
to produce such a result. But the necessity for nervous explosion
still persists.[287] It may, indeed, persist, even in an abnormally
strong degree, in consequence of the inhibition of normal
activities generally. The convulsive fit is the only form
of relief open to the tension. "A lady whom I long attended,"
remarks Ashwell, "always rejoiced when the fit was over,
since it relieved her system generally, and especially her
brain, from painful irritation which had existed for several
previous days." That the fit mostly fails to give real
satisfaction, and that it fails to cure the disease, is due
to the fact that it is a morbid form of relief. The same character
of hysteria is seen, with more satisfactory results for the
most part, in the influence of external nervous shock. It
was the misunderstood influence of such shocks in removing
hysteria which in former times led to the refusal to regard
hysteria as a serious disease. During the Rebellion of 1745-46
in Scotland, Cullen remarks that there was little hysteria.
The same was true of the French Revolution and of the Irish
Rebellion, while Rush (in a study _On the Influence of the
American Revolution on the Human Body_) observed that many
hysterical women were "restored to perfect health by
the events of the time." In such cases the emotional
tension is given an opportunity of explosion in new and impersonal
channels, and the chain of morbid personal emotions is broken.
It has been urged by some that the fact that the sexual orgasm
usually fails to remove the disorder in true hysteria excludes
a sexual factor of hysteria. It is really, one may point out,
an argument in favor of such an element as one of the factors
of hysteria. If there were no initial lesion of the sexual
emotions, if the natural healthy sexual channel still remained
free for the passage of the emotional overflow, then we should
expect that it would much oftener come into play in the removal
of hysteria. In the more healthy, merely hysteroid condition,
the psychic sexual organism is not injured, and still responds
normally, removing the abnormal symptoms when allowed to do
so. It is the confusion between this almost natural condition
and the truly morbid condition, alone properly called hysteria,
which led to the ancient opinion, inaugurated by Plato and
Hippocrates, that hysteria may be cured by marriage.[288]
The difference may be illustrated by the difference between
a distended bladder which is still able to contract normally
on its contents when at last an opportunity of doing so is
afforded and the bladder in which distension has been so prolonged
that nervous control had been lost and spontaneous expulsion
has become impossible. The first condition corresponds to
the constitution, which, while simulating the hysterical condition,
is healthy enough to react normally in spite of psychic lesions;
the second corresponds to a state in which, owing to the prolonged
stress of psychic traumatism,--sexual or not,--a definite
condition of hysteria has arisen. The one state is healthy,
though abnormal; the other is one of pronounced morbidity.
The condition of true hysteria is thus linked on to almost
healthy states, and especially to a condition which may be
described as one of sex-hunger. Such a suggestion may help
us to see these puzzling phenomena in their true nature and
perspective.
At this point I may refer to the interesting parallel, and
probable real relationship, between hysteria and chlorosis.
As Luzet has said, hysteria and chlorosis are sisters. We
have seen that there is some ground for regarding hysteria
as an exaggerated form of a normal process which is really
an auto-erotic phenomenon. There is some ground, also, for
regarding chlorosis as the exaggeration of a physiological
state connected with sexual conditions, more specifically
with the preparation for maternity. Hysteria is so frequently
associated with anaemic conditions that Biernacki has argued
that such conditions really constitute the primary and fundamental
cause of hysteria (_Neurologisches Centralblatt_, March, 1898).
And, centuries before Biernacki, Sydenham had stated his belief
that poverty of the blood is the chief cause of hysteria.
It would be some confirmation of this position if we could
believe that chlorosis, like hysteria, is in some degree a
congenital condition. This was the view of Virchow, who regarded
chlorosis as essentially dependent on a congenital hyoplasia
of the arterial system. Stieda, on the basis of an elaborate
study of twenty-three cases, has endeavored to prove that
chlorosis is due to a congenital defect of development (_Zeitschrift
fuer Geburtshuelfe und Gynaekologie_, vol. xxxii, Part I,
1895). His facts tend to prove that in chlorosis there are
signs of general ill-development, and that, in particular,
there is imperfect development of the breasts and sexual organs,
with a tendency to contracted pelvis. Charrin, again, regards
utero-ovarian inadequacy as at least one of the factors of
chlorosis. Chlorosis, in its extreme form, may thus be regarded
as a disorder of development, a sign of physical degeneracy.
Even if not strictly a cause, a congenital condition may,
as Stockman believes (_British Medical Journal_, December
14, 1895), be a predisposing influence.
However it may be in extreme cases, there is very considerable
evidence to indicate that the ordinary anaemia of young women
may be due to a storing up of iron in the system, and is so
far normal, being a preparation for the function of reproduction.
Some observations of Bunge's seem to throw much light on the
real cause of what may be termed physiological chlorosis.
He found by a series of experiments on animals of different
ages that young animals contain a much greater amount of iron
in their tissues than adult animals; that, for instance, the
body of a rabbit an hour after birth contains more than four
times as much iron as that of a rabbit two and a half months
old. It thus appears probable that at the period of puberty,
and later, there is a storage of iron in the system preparatory
to the exercise of the maternal functions. It is precisely
between the ages of fifteen and twenty-three, as Stockman
found by an analysis of his own cases (_British Medical Journal_,
December 14, 1895), that the majority of cases occur; there
was, indeed, he found, no case in which the first onset was
later than the age of twenty-three. A similar result is revealed
by the charts of Lloyd Jones, which cover a vastly greater
number of cases.
We owe to Lloyd Jones an important contribution to the knowledge
of chlorosis in its physiological or normal relationships.
He has shown that chlorosis is but the exaggeration of a condition
that is normal at puberty (and, in many women, at each menstrual
period), and which, there is good reason to believe, even
has a favorable influence on fertility. He found that light-complexioned
persons are more fertile than the dark-complexioned, and that
at the same time the blood of the latter is of less specific
gravity, containing less haemoglobin. Lloyd Jones also reached
the generalization that girls who have had chlorosis are often
remarkably pretty, so that the tendency to chlorosis is associated
with all the sexual and reproductive aptitudes that make a
woman attractive to a man. His conclusion is that the normal
condition of which chlorosis is the extreme and pathological
condition, is a preparation for motherhood (E. Lloyd Jones,
"Chlorosis: The Special Anaemia of Young Women,"
1897; also numerous reports to the British Medical Association,
published in the _British Medical Journal_. There was an interesting
discussion of the theories of chlorosis at the Moscow International
Medical Congress, in 1898; see proceedings of the congress,
volume in, section v, pp. 224 et seq.).
We may thus, perhaps, understand why it is that hysteria and
anaemia are often combined, and why they are both most frequently
found in adolescent young women who have yet had no sexual
experiences. Chlorosis is a physical phenomenon; hysteria,
largely a psychic phenomenon; yet, both alike may, to some
extent at least, be regarded as sexual aptitude showing itself
in extreme and pathological forms.
FOOTNOTES:
[251] _Genese et Nature de l'Hysterie_, 1898; and, for Sollier's
latest statement, see "Hysterie et Sommeil," _Archives
de Neurologie_, May and June, 1907. Lombroso (_L'Uomo Delinquente_,
1889, vol. ii, p. 329), referring to the diminished metabolism
of the hysterical, had already compared them to hibernating
animals, while Babinsky states that the hysterical are in
a state of subconsciousness, a state, as Metchnikoff remarks
(_Essais optimistes_, p. 270), reminiscent of our prehistoric
past.
[252] Professor Freud, while welcoming the introduction of
the term "auto-erotism," remarks that it should
not be made to include the whole of hysteria. This I fully
admit, and have never questioned. Hysteria is far too large
and complex a phenomenon to be classed as entirely a manifestation
of auto-erotism, but certain aspects of it are admirable illustrations
of auto-erotic transformation.
[253] The hysterical phenomenon of _globus hystericus_ was
long afterward attributed to obstruction of respiration by
the womb. The interesting case has been recorded by E. Bloch
(_Wiener Klinische Wochenschrift_, 1907, p. 1649) of a lady
who had the feeling of a ball rising from her stomach to her
throat, and then sinking. This feeling was associated with
thoughts of her husband's rising and falling penis, and was
always most liable to occur when she wished for coitus.
[254] As Gilles de la Tourette points out, it is not difficult
to show that epilepsy, the _morbus sacer_ of the ancients,
owed much of its sacred character to this confusion with hysteria.
Those priestesses who, struck by the _morbus sacer_, gave
forth their oracles amid convulsions, were certainly not the
victims of epilepsy, but of hysteria (_Traite de l'Hysterie_,
vol. i, p. 3).
[255] Aretaeus, _On the Causes and Symptoms of Acute Diseases_,
Book ii, Chapter II.
[256] It may be noted that this treatment furnishes another
instance of the continuity of therapeutic methods, through
all changes of theory, from the earliest to the latest times.
Drugs of unpleasant odor, like asafoetida, have always been
used in hysteria, and scientific medicine to-day still finds
that asafoetida is a powerful sedative to the uterus, controlling
nervous conditions during pregnancy and arresting uterine
irritation when abortion is threatened (see, e.g., Warman,
_Der Frauenarzt_, August, 1895). Again, the rubbing of fragrant
ointments into the sexual regions is but a form of that massage
which is one of the modern methods of treating the sexual
disorders of women.
[257] _Les Demoniaques dans l'Art_, 1887; _Les Malades et
les Difformes dans l'Art_, 1889.
[258] Glafira Abricosoff, of Moscow, in her Paris thesis,
_L'Hysterie aux xvii et xviii siecles_, 1897, presents a summary
of the various views held at this time; as also Gilles de
la Tourette, _Traite de l'Hysterie_, vol. i, Chapter I.
[259] _Edinburgh Medical Journal_, June, 1883, p. 1123, and
_Mental Diseases_, 1887, p. 488.
[260] Hegar, _Zusammenhang der Geschlechtskrankheiten mit
nervoesen Leiden_, Stuttgart, 1885. (Hegar, however, went
much further than this, and was largely responsible for the
surgical treatment of hysteria now generally recognized as
worse than futile.) Balls-Headley, "Etiology of Nervous
Diseases of the Female Genital Organs," Allbutt and Playfair,
_System of Gynecology_, 1896, p. 141.
[261] Lombroso and Ferrero, _La Donna Delinquente_, 1893,
pp. 613-14.
[262] Charcot and Marie, article on "Hysteria,"
Tuke's _Dictionary of Psychological Medicine_.
[263] Axenfeld and Huchard, _Traite des Nevroses_, 1883, pp.
1092-94. Icard (_La Femme pendant la Periode Menstruelle_,
pp. 120-21) has also referred to recorded cases of hysteria
in animals (Coste's and Peter's cases), as has Gilles de la
Tourette (op. cit., vol. i, p. 123). See also, for references,
Fere, _L'Instinct Sexuel_, p. 59.
[264] _Man and Woman_, 4th ed., p. 326. A distinguished gynaecologist,
Matthews Duncan, had remarked some years earlier (_Lancet_,
May 18, 1889) that hysteria, though not a womb disease, "especially
attaches itself to the generative system, because the genital
system, more than any other, exerts emotional power over the
individual, power also in morals, power in social questions."
[265] Gilles de la Tourette, _Archives de Tocologie et de
Gynecologie_, June, 1895.
[266] _Rivista Sperimentale di Freniatria_, 1897, p. 290;
summarized in the _Journal of Mental Science_, January, 1898.
[267] From the earliest times it was held that menstruation
favors hysteria; more recently, Landouzy recorded a number
of observations showing that hysterical attacks coincide with
perfectly healthy menstruation; while Ball has maintained
that it is only during menstruation that hysteria appears
in its true color. See the opinions collected by Icard, _La
Femme pendant la Periode Menstruelle_, pp. 75-81.
[268] Krafft-Ebing, "Ueber Neurosen und Psychosen durch
Sexuelle Abstinenz," _Jahrbuecher fuer Psychiatrie_,
vol. iii, 1888. It must, however, be added that the relief
of hysteria by sexual satisfaction is not rare, and that Rosenthal
finds that the convulsions are thus diminished. (_Allgemeine
Wiener Medizinal-Zeitung_, Nos. 46 and 47, 1887.) So they
are also, in simple and uncomplicated cases, according to
Mongeri, by pregnancy.
[269] "All doctors who have patients in convents,"
remarks Marro (_La Puberta_, p. 338), "know how hysteria
dominates among them;" he adds that his own experience
confirms that of Raciborski, who found that nuns devoted to
the contemplative life are more liable to hysteria than those
who are occupied in teaching or in nursing. It must be added,
however, that there is not unanimity as to the prevalence
of hysteria in convents. Brachet was of the same opinion as
Briquet, and so considered it rare. Imbert-Goubeyre, also
(_La Stigmatisation_, p. 436) states that during more than
forty years of medical life, though he has been connected
with a number of religious communities, he has not found in
them a single hysterical subject, the reason being, he remarks,
that the unbalanced and extravagant are refused admission
to the cloister.
[270] Parent-Duchatelet, _De la Prostitution_, vol. i, p.
242.
[271] It may not be unnecessary to point out that here and
throughout, in speaking of the psychic mechanism of hysteria,
I do not admit that any process can be _purely_ psychic. As
Fere puts it in an admirable study of hysteria (_Twentieth
Century Practice of Medicine_, 1897, vol. x, p. 556): "In
the genesis of hysterical troubles everything takes place
as if the psychical and the somatic phenomena were two aspects
of the same biological fact."
[272] Pierre Janet, _L'Automatisme Psychologique_, 1889; _L'Etat
mental des Hysteriques_, 1894; _Nevroses et Idees fixes_,
1898; Breuer und Freud, _Studien ueber Hysterie_, Vienna,
1895; the best introduction to Freud's work is, however, to
be found in the two series of his _Sammlung Kleiner Schriften
zur Neurosenlehre_, published in a collected form in 1906
and 1909. It may be added that a useful selection of Freud's
papers has lately (1909) been published in English.
[273] We might, perhaps, even say that in hysteria the so-called
higher centres have an abnormally strong inhibitory influence
over the lower centres. Gioffredi (_Gazzetta degli Ospedali_,
October 1, 1895) has shown that some hysterical symptoms,
such as mutism, can be cured by etherization, thus loosening
the control of the higher centres.
[274] Charcot's school could not fail to recognize the erotic
tone which often dominates hysterical hallucinations. Gilles
de la Tourette seeks to minimize it by the remark that "it
is more mental than real." He means to say that it is
more psychic than physical, but he implies that the physical
element in sex is alone "real," a strange assumption
in any case, as well as destructive of Gilles de la Tourette's
own fundamental assertion that hysteria is a real disease
and yet purely psychic.
[275] See, e.g., his substantial volume, _Die Traumdeutung_,
1900, 2d ed. 1909.
[276] _Sammlung_, first series, p. 208.
[277] _Studien ueber Hysterie_, p. 217.
[278] _Sammlung_, first series, p. 162.
[279] _Sammlung_, second series, p. 102.
[280] Ib. p. 146.
[281] _Sammlung_, first series, p. 229. Freud has developed
his conception of sexual constitution in _Drei Abhandlungen
zur Sexualtheorie_, 1905.
[282] As Moll remarks, Freud's conceptions are still somewhat
subjective, and in need of objective demonstration; but whatever
may be thought of their theories, he adds, there can be no
doubt that Breuer and Freud have done a great service by calling
attention to the important action of the sexual life on the
nervous system.
[283] Gertrude Stein, "Cultivated Motor Automatism,"
_Psychological Review_, May, 1898.
[284] Charcot's most faithful followers refuse to recognize
a "hysteric temperament," and are quite right, if
such a conception is used to destroy the conception of hysteria
as a definite disease. We cannot, however, fail to recognize
a diathesis which, while still apparently healthy, is predisposed
to hysteria. So distinguished a disciple of Charcot as Janet
thoroughly recognizes this, and argues (_L'Etat mental_, etc.,
p. 298) that "we may find in the habits, the passions,
the psychic automatism of the normal man, the germ of all
hysterical phenomena." Fere held a somewhat similar view.
[285] A.F.A. King, "Hysteria," _American Journal
of Obstetrics_, May 18, 1891.
[286] M. Rosenthal, _Diseases of the Nervous System_, vol.
ii, p. 44. Fere notes similar cases (_Twentieth Century Practice
of Medicine_, vol. x, p. 551). Long previously, Gall had recorded
the case of a young widow of ardent temperament who had convulsive
attacks, apparently of hysterical nature, which always terminated
in sexual orgasm (_Fonctions du Cerveau_, 1825, vol. iii,
p. 245).
[287] There seems to be a greater necessity for such explosive
manifestations in women than in men, whatever the reason may
be. I have brought together some of the evidence pointing
in this direction in _Man and Woman_, 4th ed., revised and
enlarged, Chapters xii and xiii.
[288] There is no doubt an element of real truth in this ancient
belief, though it mainly holds good of minor cases of hysteria.
Many excellent authorities accept it. "Hysteria is certainly
common in the single," Herman remarks (_Diseases of Women_,
1898, p. 33), "and is generally cured by a happy marriage."
Loewenfeld (_Sexualleben und Nervenleiden_, p. 153) says that
"it cannot be denied that marriage produces a beneficial
change in the general condition of many hysterical patients,"
though, he adds, it will not remove the hysterical temperament.
The advantage of marriage for the hysterical is not necessarily
due, solely or at all, to the exercise of sexual functions.
This is pointed out by Mongeri, who observes (_Allgemeine
Zeitschrift fuer Psychiatrie_, 1901, Heft 5, p. 917): "I
have known and treated several hysterical girls who are now
married, and do not show the least neuropathic indications.
Some of these no longer have any wish for sexual gratification,
and even fulfil their marital duties unwillingly, though loving
their husbands and living with them in an extremely happy
way. In my opinion, marriage is a sovereign remedy for neuropathic
women, who need to find a support in another personality,
able to share with them the battle of life." |
|
