FREUD'S THEORY OF HYSTERIA: A REPLY TO ASCHAFFENBURG

1 If I try to answer Aschaffenburg's—on the whole—very moderate and cautious criticism of Freud's theory of hysteria, I do so in order to prevent the baby from being thrown out with the bath-water. Aschaffenburg, of course, does not assert that Freud's importance ends with his theory of hysteria. But the medical public (psychiatrists included) know Freud mainly from this side of his work, and for this reason adverse criticism could easily throw a shadow on Freud's other scientific achievements. I would like to remark at the start that my reply is not directed to Aschaffenburg personally, but to the whole school of thought whose views and aspirations have found eloquent expression in Aschaffenburg's lecture.

2 His criticism is confined exclusively to the role which sexuality, according to Freud, plays in the formation of the psychoneuroses. What he says, therefore, does not affect the wider range of Freud's psychology, that is, the psychology of dreams, jokes, and disturbances of ordinary thinking caused by feeling-toned constellations. It affects only the psychology of sexuality, the determinants of hysterical symptoms, and the methods of psychanalysis. In all these fields Freud has to his credit unique achievements, which can be contested only by one who has never taken the trouble to check Freud's thought-processes experimentally. I say "achievements," though this does not mean that I subscribe unconditionally to all Freud's theorems. But it is also an achievement, and often no small one, to propound ingenious problems. This achievement cannot be disputed even by Freud's most vigorous opponents.

3 To avoid being unnecessarily diffuse, I shall leave out of account all those points which are not affected by Aschaffenburg's criticism, and shall confine myself only to those it attacks.

4 Freud maintains that he has found the root of most psychoneuroses to be a psychosexual trauma. Is this assertion nonsense?

5 Aschaffenburg takes his stand on the view, generally accepted today, that hysteria is a psychogenic illness. It therefore has its roots in the psyche. It would be a work of supererogation to point out that an essential component of the psyche is sexuality, a component of whose extent and importance we can form absolutely no conception in the present unsatisfactory state of empirical psychology. We know only that one meets sexuality everywhere. Is there any other psychic factor, any other basic drive except hunger and its derivates, that has a similar importance in human psychology? I could not name one. It stands to reason that such a large and weighty component of the psyche must give rise to a correspondingly large number of emotional conflicts and affective disturbances, and a glance at real life teaches us nothing to the contrary. Freud's view can therefore claim a high degree of probability at the outset, in so far as he derives hysteria primarily from psychosexual conflicts.

6 Now what about Freud's particular view that all hysteria is reducible to sexuality?

7 Freud has not examined all the hysterias there are. His proposition is therefore subject to the general limitation which applies to empirical axioms. He has simply found his view confirmed in the cases observed by him, which constitute an infinitely small fraction of all cases of hysteria. It is even conceivable that there are several forms of hysteria which Freud has not yet observed at all. Finally, it is also possible that Freud's material, under the constellation of his writings, has become somewhat one-sided.

8 We may therefore modify his dictum, with the consent of the author, as follows: An indefinitely large number of cases of hysteria derive from sexual roots.

9 Has anyone proved that this is not so? By "prove" I naturally mean applying Freud's psychanalytic methods and not just carrying out a rigorous examination of the patient and then declaring that nothing sexual can be found. All such "proofs" are of course worthless from the start. Otherwise we would have to admit that a person who examines a bacterial culture with a magnifying-glass and asserts that there are no bacteria in it is right. The application of psychanalytic methods is, logically, a sine qua non.

10 Aschaffenburg's objection that an entirely traumatic hysteria contains nothing sexual and goes back to other, very clear traumata seems to me very apt. But the limits of traumatic hysteria, as Aschaffenburg's example shows (flower-pot falling followed by aphonia), are very wide. At that rate countless cases of hysteria could be put into the category of "traumatic" hysteria, for how often does a mild fright produce a new symptom! Aschaffenburg will surely not believe that anyone can be so naïve as to seek the cause of the symptom in that little affect alone. The obvious inference is that the patient was hysterical long before. When for instance a shot is fired and a passing girl gets abasia, we can safely assume that the vessel, long since full, has merely overflowed. No special feat of interpretation is needed to prove this. So these and a legion of similar cases prove nothing against Freud.

11 It is rather different in the case of physical traumata and hysterias about insurance money. Here, where the trauma and the highly affective prospect of money coincide, an emotional situation arises which makes the outbreak of a specific form of hysteria appear at least very plausible. It is possible that Freud's view is not valid in these cases. For lack of other experiences I incline to this opinion. But if we want to be absolutely fair and absolutely scientific, we would certainly have to show first that a sexual constellation really never did pave the way for the hysteria, i.e., that nothing of this sort comes out under analysis. At any rate the allegation of traumatic hysteria proves, at best, only that not all cases of hysteria have a sexual root. But this does not controvert Freud s basic proposition, as modified above.

12 There is no other way to refute it than by the use of psychanalytic methods. Anyone who does not use them will never refute Freud; for it must be proved by means of the methods inaugurated by him that factors can be found in hysteria other than sexual ones, or that these methods are totally unsuited to bringing intimate psychic material to light.

13 Under these conditions, can Aschaffenburg...