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ANALYSE, 1920, PART 2.

This number of the Zeitschrift opens with a short article by Abraham, on "Prognosis of Psycho-Analytic Treatment in Middle Age." He begins by quoting Freud's opinion, from one of his earlier works, that after a certain age the success of analysis is very doubtful and goes on to say that in most cases this is certainly true. But psycho-analysis is full of surprises and it is undesirable to approach any of its problems with a priori expectations. Psycho-analysis itself must be used as an instrument of research to ascertain whether and under what conditions success can be achieved with patients who are no longer young.

Having undertaken several analyses of patients over 40, and of some over 50, years of age, the author finds that a considerable number react very favourably to psycho-analysis and that some of his best successes are amongst them. His first case of this type was a man of 50, suffering from melancholic depression, who was relieved in five months and became able to resume his work, after various fruitless attempts at cure by other methods. The neurosis had assumed its severe form 15 months previously, although there had always been a nervous disposition and there were evident signs of a chronic tendency. Other cases followed, including two cases of obsessional neurosis, in men of 50 and 53 years respectively. Excellent results were obtained with both, and also with a woman of 41 years. They had all shown symptoms since childhood, but in all cases the neurosis had not developed to an incapacitating extent until between the ages of 30 and 40. There were similar successes with other cases, and also a number of failures and partial successes.

From these facts it became apparent that the explanation of such different results in various cases is a simple one. Good results may be expected when the neurosis does not break out in full severity until some considerable time after puberty, and when the patient has enjoyed a comparatively normal sexual life, and been capable of normal social activity, for some time. The unsatisfactory cases are those of patients who already showed well-developed obsessional symptoms, etc., in childhood. But patients of this class, even at an early age, provide most of the failures in analytic treatment, and the conclusion is that the age of the neurosis is a more important factor in determining the probability of success than the age of the patient. This corresponds with experience in the psychoses.

The question arises as to how far it is possible to retrace and revive the infantile sexuality in such patients; experience shows that this is by no means impossible, and in some cases can be achieved to an extent only to be expected in very young patients.

Many of these cases differ in one point from the usual type under analysis, namely, in the lack of initiative frequently shown by them. They have to be prompted to begin the communication of their ideas at the start of each sitting. They seem unable to find their thoughts independently, but any little remark will set them going. In this respect they are infantile, and this characteristic is also common in the analyses of children, but in them often vanishes when the negative transference is uppermost. Abraham also calls attention to the problem as to why certain cases of neurosis in children prove unamenable to treatment, and he remarks on the desirability of obtaining further evidence on this point.

The next contribution is a small one, in French, from de Saussure (Geneva), called "Le Complexe de Jocaste," in which he raises the interesting problem of incestuous love on the part of a mother for her son. He remarks that Freud has dealt very fully with the Oedipus-situation, but has said nothing of the corresponding attitude of Jocasta, the mother of Oedipus, in her incestuous love for her son. The author gives details of two cases observed by him of obvious infatuation, hardly distinguishable from sexual desire, on the part of a woman for an adult son. He thinks it is important to establish a definition of the distinction between normal maternal love and a mother's incestuous attachment to a son, and makes various suggestions towards such a distinction, particularly, that normal maternal love is dominating and protective, whereas in the cases of sexual desire for the son he sees a more wifely dependence and submission (masochism and exclusivism).

These questions are extremely interesting in themselves, and it is unfortunate that de Saussure's knowledge of psycho-analytic theory and research does not appear to have been sufficient to enable him more fruitfully to investigate the cases under his observation. Freud of course has taken Oedipus as a type, representing the primary experience and unconscious foundation of heterosexual love in every man. Jocasta is hardly a simple universal type of this kind, since in infancy no woman is the mother of a son to whom an incestuous fixation of Libido can be attached. So that a Jocasta-complex can never be a primary infantile experience as the Oedipus-complex is. The nearest approach to it would be the case of little girls who 'mother' a younger brother and also make him the object of sexual impulses, probably by a transference from the father, but this case would be complicated by the Electra-complex.

Apart from this, however, psycho-analytic literature is not wanting in references1 to the fact that children of one sex always become unconsciously associated with the parent of that sex, and that a woman's love for her son is closely bound up with her father-fixation. Probably every analysis gives proof of this transference from the parents to the children of a given person. The author has arrived at this possibility, but it is not clear why he designates women with a father-fixation as 'homosexuelles.' His question as to the distinction between normal maternal love and incestuous attachment ignores the fact that this distinction is, in every relationship, sexual or otherwise, a matter of the degree of consciousness of the underlying sexual attraction and not of the degree of intensity of love, in itself; since every human relationship of any kind with another person will fall into line with, and be founded

1 Ernest Jones, Papers on Psycho-Analysis. "The Phantasy of the Reversal of Generations," p. 659.

on, some infantile sexual situation in the Unconscious1, in most cases an incestuous one. Moreover, the maternal instinct is part of the sexual instinct in woman, and is largely a sublimation and further development of the partial-components of her sexual instinct (anal-erotism and various kinds of activity in other impulses); so that in this way it may well happen that a fixation on the pregenital phase of development might show itself later in an abnormal fascination, instead of in normal love, for a child.

The author's suggestion, that normal maternal love is protective, is true, but not exclusively; for as a boy becomes a man his attitude to the mother gradually assumes more and more an active character, so that 'protection' may be exercised by both mother and son, in varying degrees, according to the case. The exclusivism which he sees in these cases is likely to be related to the father-fixation or to narcissism, but the masochistic traits to repressed sadism (regression to pregenital phase), rather than to any approximation to a wifely attitude (genital phase) in the woman. But the results of analyses of cases such as he describes would certainly be interesting and valuable, particularly as, so far as we know, little or nothing has hitherto been published on the subject.

The study entitled "An Unconscious Phantasy of Pregnancy in a Man under the guise of Traumatic Hysteria," by Eisler, which was published in part in the previous number of the Zeitschrift, is here concluded. This is an extremely interesting and remarkable case, and is very well presented. The main interest of it depends upon the very strongly accentuated anal-erotism of the patient; Eisler's report extends our knowledge of this impulse and its development, together with that of the character-traits derived from it. He reminds us of two of Freud's studies (of obsessional cases) and of Ernest Jones' works on this subject 2, and points out the value of further research.

The patient in this case was an employee on the tramway service, aged 33; 2 years previously he had fallen from his car and been taken unconscious to hospital suffering from injuries to the head, arm and side (all on the left). They proved to be slight, but an X-ray examination was made of the left side. After recovery and resumption of work the neurosis developed; it consisted in attacks of pain in the left loin, which increased with time in frequency and severity until he was quite incapacitated by them. After all attempts to discover organic injury had failed, the case was diagnosed as traumatic hysteria and sent for psycho-analysis. In spite of some difficulties the case proved very suitable for analysis which effected a cure in seven months.

A strongly-marked transference evinced itself in two peculiar symptomatic acts which occurred in the first few days of the treatment. One of these was an ostensible fainting-fit, in which the man fell on his face beside the doctor, thus betraying his passive-homosexual tendencies. The other had a similar meaning; in fact a feminine attitude towards the doctor governed all the transference-manifestations. As the analysis proceeded the emphasis on the fall from the car as an important occurrence gradually declined, and a subsequent event came more and more into the foreground of the picture. This was the X-ray examination of his left side performed at the hospital. It turned out that on this occasion the patient had been very much excited and nervous beforehand, and very much disappointed with what actually occurred.

1 Freud, Neurosenlehre, IVte Folge, p. 394.

2 Ernest Jones, Papers on Psycho-Analysis, pp. 540 and 664.

In his anxiety he had expected that some kind of operation would be there and then performed, or at least that the doctor would suddenly plunge an instrument into his side! The whole affair had rapidly fallen out of conscious importance, but became a crystallizing-point for a passive-homosexual wishphantasy, subsequently expressed by the hysterical pain attacks in the left loin.

These attacks were described as follows. About 24 hours before one came on, he would become restless and silent and extremely irritable, especially to his wife; as time went on he could not endure her near him. He showed marked defiance and treated his illness as his private and personal affair exclusively and resented any enquiry as to his condition. (The resentment at intrusion into anal-erotic pre-occupations.) As the attack came on severe constipation set in, which no drug was able to relieve. On the following day the pain in the left loin began, and in a few hours became so overpowering that he could neither sit nor stand. He had to lie on his left side with a little pillow under him, but could not keep still owing to the pain. After a time he would feel a thrill going through his limbs; then flatus would pass and, lastly, an evacuation of the bowels would occur.

This description eventually suggested to the analyst the idea that the attack could only be an unconscious imitation (by the neurosis-mechanism in which the anal-impulse played the leading rôle) of a confinement (the constipation being a conversion-symptom of a pregnancy); it appeared to be closely connected with the X-ray experience. As a child of ten, the patient had heard a neighbour's wife groaning and shrieking in childbirth for two days, the doctor at last having had to extract the child with instruments. He had been able to look on through the window and clearly remembered the scene; a very dim recollection came back to him of the dead dismembered child in a basin. Analysis further revealed the left loin as a symbolic substitute for a female genital organ (left = female), possibly in part through the prehistoric association of loins with procreation ("child of his loins," etc.), also seen in the myth of the creation of Eve out of the rib of Adam. The patient recalled how on two occasions as a boy, he had fled from his irate grandfather and been overtaken and thrashed while suffering from a violent stitch in the left side. At the age of 15, on account of diphtheria, he was given an inoculation of antitoxin with a hypodermic needle in the left side by a doctor. Other details pointed to a strong accentuation, during puberty, of the anal and passive-homosexual impulses.

Before going on to discuss the infantile origin of the neurosis from the external (accidental) aspect, Eisler goes in detail into the constitutional aspect, and describes the extent and importance of the anal-complex and previous anal-symptoms in the case. In character, the patient showed many traits which we know to be derived from this complex.

He was a practical man, with a strong sense of reality,' and a good memory, with definite ambitions and reasoned opinions. He had greatly improved his position by prudence and foresight in changing his occupation. He had a passion for collecting, for keeping diaries and 'commonplace' books, and for accumulating old menus and bills, which were kept in pedantic order. He kept in his head' a great deal of useful knowledge which he liked to impress upon others. He was greatly interested in biological problems and theories of 'creation.' His dearest wish was to settle on the land and breed poultry, one which the analyst thinks he will probably carry out. He was first apprenticed to a baker where he enjoyed the kneading and moulding of the bread and learnt cooking. Later he became an assistant in a chemical laboratory

where the aromatic scents and odours of the drugs pleased him. His attitude to money revealed the anal-erotic in one respect only; he disliked dirty paper-money so much that he would overcome his economical nature to the point of spending it needlessly, if he did not give it to his wife! As regards time, he was extraordinarily sensitive, punctual and exact, and so economical that he loved to 'do two things at once,' to read while eating, to think while walking and so on (which Eisler remarks was known as a characteristic of Caesar's); this was traced back to a pleasure in performing defaecation and micturition at the same moment. Also the patient had a compulsion to do everything thoroughly, which extended to a dislike of anything not whole and complete, anything mended, or previously used by another person. These two last points Dr Eisler recommends to Dr Ernest Jones for inclusion in his paper on Anal-erotic Character-traits.

The pleasurable interest in the defaecatory act had been early sublimated into character-traits, but the libidinous interest in the product had been less successfully resolved. It was clear that this anal-interest had played a dominating part and had coloured the whole of the infantile sexuality. The curiosity-impulse was related entirely to faeces originally, and later to its substitutes, and was connected with the frequent confinements of his mother. The sadistic impulse was also related exclusively to the anal-product and its derivatives (children), connecting with death-wishes against younger brothers and sisters, evinced in many symptomatic acts and in several 'accidents' while he was a tram-car driver. (Compare 'the dead dismembered child' previously mentioned.) The smelling-complex was likewise here connected, as it always is; but although the patient had no dislike of the odour of faeces he was extraordinarily sensitive about the odour of decomposition (he could detect the presence of a corpse in a house he was passing), this also connecting with deathwishes, as did his mouth-erotism too. He could eat nothing which was unconsciously associated with anything dead; he was nervous about being poisoned (a fixed impregnation-symbol). Various symptoms and acts connected with the mouth and teeth pointed to their constituting substitutes for anus (cloaca) and child. The flatuscomplex also pointed in the same direction; through the association of flatus with thought he believed he had a prophetic gift-that he could foretell the weather, or the arrival of a stranger (= child) and so on.

In the first year of his marriage, seven years before, the patient had suffered from a severe hysterical disturbance of the bowel function. He would be seized by an irresistible need to defaecate and be forced to leave his car for the purpose, only to find himself unable to pass a motion. He was subjected to every possible kind of examination for this malady but no disease was discovered. The symptoms gradually changed to an extremely severe and obstinate form of constipation which finally threatened his livelihood, after which it gradually subsided. Numerous means were employed to relieve it, but only one satisfied the patient, and this was the introduction of pessaries into the rectum by a doctor. This mono-symptomatic hysterical illness was elucidated by the analysis and found to be the expression of the unconscious wish that a child should result from the marriage, although actually he had decided not to have children until later, when he could better afford it. Various circumstances in connection with his marriage were of importance, notably that his mother was at the time confined of her youngest child. His desire for children was limited to male offspring, which pointed to a strongly narcissistic tendency in the wish (as opposed to the hetero-sexual desire for a child of the opposite sex). The nervous constipation represented the conflict about the hoped-for child-it must be 'postponed.'

As further evidence of the paramount influence of the anal-complex the author describes in detail the peculiar reserve characteristic of the patient. This proved the main expression of the resistance in the analysis, but was already constitutional in the case and not elaborated for the purpose. Eisler points out that hate has received more attention from psycho-analysts in its connection with the development of control of the anal-function, but that as a psychical accompaniment reserve actually takes first place. He remarks that this trait is capable of most extensive adaptation to the other psychical

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