Freud Resources
> 1896c

The ætiology of hysteria

Freud, Sigmund 1896c, 'The ætiology of hysteria,' SE 3: 187-222.

Freud delivered the paper to the Society for Psychiatry and Neurology in Vienna on the evening of 12 April 1896. 1
[This paper was reproduced in Masson, Jeffrey Moussaieff 1984, Freud: The Assault on Truth: Freud's Suppression of the Seduction Theory, Faber and Faber, London, and as I have used it as the source for some quotations I have given page numbers from it.]

… Josef Breuer's momentous discovery: the symptoms of hysteria (apart from the stigmata) are determined by certain experiences of the patient's which have operated in a traumatic fashion and which are being reproduced in his psychical life in the form of mnemic symbols. What we have to do is to apply Breuer's method—or one which is essentially the same—so as to lead the patient's attention back from his symptom to the scene in which and through which the symptom arose; and, having thus located the scene, we remove the symptom by bringing about, during the reproduction of the traumatic scene, a subsequent correction of the psychical course of events which took place at the time.  Masson: 253

If you submit my assertion that the ætiology [260] of hysteria lies in the sexual life to the strictest examination, you will find that it is supported by the fact that in some eighteen cases of hysteria I have been able to discover this connection in every single symptom, and, where the circumstances allowed, to confirm it by therapeutic success.  …  These eighteen cases are at the same time all the cases on which I have been able to carry out the work of analysis. 2  SE 3: 199; Masson: 259-60

… we may be tempted to hazard the explanation that hysterics are peculiarly constituted creatures—probably on account of some hereditary disposition or degenerative atrophy—in whom a shrinking from sexuality, which normally plays some part at puberty, is raised to a pathological pitch and is permanently retained; that they are, as it were, people who are psychically inadequate to meeting the demands of sexuality.  This view, of course, leaves hysteria in men out of account.  Masson: 261

[NB:  Freud is not arguing that this is the correct ætiology of hysteria; I wanted the quotation because of this differential view of men's preparedness for sex.]

I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood but which can be reproduced through the work of psychoanalysis in spite of the intervening decades.  I believe [264] that this is an important finding, the discovery of a caput Nili [source of the Nile] in neuropathology …  Masson: 263-4.  [Freud's italics]

Doubts about the genuineness of the infantile sexual scenes can, however, be deprived of their force here and now by more than one argument.  In the first place, the behavior of patients while they are reproducing these infantile experiences is in every respect incompatible with the assumption that the scenes are anything else than a reality which is being felt with distress and reproduced 3 with the greatest reluctance. 4  264‑5

[ conclusive proof of the seduction hypothesis]  …  the patients  …  still attempt to withhold belief  …
         This latter piece of behaviour seems to provide conclusive proof.  Why should patients assure me so emphatically of their unbelief, if what they want to discredit is something which—from whatever motive—they themselves have invented?  SE 3: 204.  Masson: 265.

[Check this and type a longer quotation and add it to the file for 1896c:] … patients 'have no feeling of remembering the scenes.'  SE 3: 204.  Quoted in Crews 1986: 58.

All of this is true; but it must be remembered that at the time I wrote it I had not yet freed myself from my overvaluation of reality and my low valuation of phantasy. 5  SE 3: 204 n. 1.

Events of this sort strengthen our impression that the patients must really have experienced what they reproduce under the compulsion of analysis as scenes from their childhood.  But another and stronger proof of this is furnished by the relationship of the infantile scenes to the content of the whole of the rest of the case history.  It is exactly like putting together a child's picture-puzzle: after many attempts, we become absolutely certain in the end which piece belongs in the empty gap; for only that one piece fills out the picture and at the same time allows its irregular edges to be fitted into the edges of the other pieces in such a manner as to leave no free space and to entail no overlapping.  In the same way, the contents of the infantile scenes turn out to be indispensable supplements to the associative and logical framework of the neurosis, whose insertion makes its course of development for the first time evident, or even, as we might often say, self-evident.  SE 3: 205.

In all eighteen cases (cases of pure hysteria and of hysteria combined with obsessions, and comprising sex men and twelve women) I have, as I have said, come to learn of sexual experiences of this kind in childhood.  I can divide my cases into three groups, according to the origin of the sexual stimulation.  In the first group it is a question of assaults—of single, or at any rate isolated, instances of abuse, mostly practised on female children, by adults who were strangers, and who, incidentally knew how to avoid inflicting gross, mechanical injury.  In these assaults there was no question of the child's consent, and the first effect of the experience was preponderantly one of fright.  The second group consists of the much more numerous cases in which some adult looking after the child—a nursery maid or governess of tutor, or, unhappily all too often, a close relative—has initiated the child into sexual intercourse and have maintained a regular love relationship with it—a love relationship, moreover,with its mental side developed—which has often lasted for years.  The third group, finally contains child-relationships proper—sexual relations between two children of different sexes, mostly a brother and sister …  Masson: 268

It is true that we feel impelled to make a synthesis, when we survey the number of striking conditions that we have come to know: the fact that in order to form a hysterical symptom a defensive effort against a distressing idea must be present, that this idea must exhibit a logical or associative connection with an unconscious memory through a few or many intermediate links, which themselves, too, remain unconscious at the moment, that this unconscious memory must have a sexual content, that its content must be an experience which occurred during a certain infantile period of life.  Masson: 274

Another set of exceedingly common hysterical phenomena—painful need to urinate, the sensation accompanying defæcation, intestinal disturbances, choking and vomiting, indigestion and disgust at food—were also shown in my analyses (and with surprising regularity) to be derivatives of the same childhood experiences and were explained without difficulty by certain invariable peculiarities of those experiences.  For the idea of these infantile sexual scenes is very repellent to the feelings of a sexually normal individual; they include all the abuses know to debauched and impotent persons, among whom the buccal cavity and the rectum are misused for sexual purposes.  For physicians, astonishment at this soon gives way to a complete understanding.  One cannot expect people who have no hesitation in satisfying their sexual desires upon children to take exception to nuances in the methods of obtaining that satisfaction. 6  All the strange conditions under which the incongruous pair continue their love relations—on the one hand the adult, who cannot escape his share in the mutual dependence necessarily entailed by a sexual relationship, and who is at the same time armed with complete authority and the right to punish, and can exchange the one role for the other to the uninhibited satisfaction of his whims, and on the other hand the child, who in [her] helplessness is at the mercy of this arbitrary use of power, who is prematurely aroused to every kind of sensibility and exposed to every sort of disappointment, and whose exercise of the sexual performances assigned to [her] is often interrupted by [her] imperfect control of [her] natural needs—all these grotesque and yet tragic disparities distinctly mark the later development of the individual and of [her] neurosis, with countless permanent effects which deserve to be traced in the greatest detail. 7  Masson 1984: 275—Masson 1992: 175.

I have elsewhere tried to express this in the formula: hysterical symptoms are over-determined.  Masson 1984: 277 [Freud's italics].

1 Masson 1984: 3.

2 SE 3: 199; Masson 1984: 259-260.

3 Masson 1984: 9-10, in quoting this passage, points out in a note (194, n. 5) that the German here reads 'höchst ungern erinnerte Realität' so that the translation should read: 'and remembered with the greatest reluctance.'

4 SE 3: 204; and reproduced in Masson 1984: 264-5.

5 SE 3: 204 n. 1.

6 This sentence (only) as translated (in a footnote) by Jeffrey Moussaieff Masson in: Masson, Jeffrey Moussaieff 1984, Freud: The Assault on Truth: Freud's Suppression of the Seduction Theory, Faber and Faber, London: 275.  Previous sentences as translated by Strachey in SE.

7 Freud Sigmund 1896c, The ætiology of hysteria, trs. and quoted in Jeffrey Masson, 1992 [1990], Final Analysis: The Making and Unmaking of a Psychoanalyst, Fontana, London: 175 [replacing 'his' in Masson's translation by the more appropriate 'her'].  This quotation continues, in the same paragraph, the material translated by Strachey.

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