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In other cases speaking is itself the adequate reflex menstrual water retention buy cabergoline 0.5 mg cheap, when, for instance, it is a lamentation or giving utterance to a tormenting secret. If there is no such reaction, whether in deeds or words, or in the mildest cases in tears, any recollection of the event retains its affective tone to begin with. A memory of such a trauma, even if it has not been abreacted, enters the great complex of associations, it comes alongside other experiences, which may contradict it, and is subjected to rectification by other ideas. After an accident, for instance, the memory of the danger and the (mitigated) repetition of the fright becomes associated with the memory of what happened afterwards rescue and the consciousness of present safety. In this way a normal person is able to bring about the disappearance of the accompanying affect through the process of association. Our observations have shown, on the other hand, that the memories which have become the determinants of hysterical phenomena persist for a long time with astonishing freshness and with the whole of their affective colouring. Not until they have been questioned under hypnosis do these memories emerge with the undiminished vividness of a recent event. Thus, for six whole months, one of our patients reproduced under hypnosis with hallucinatory vividness everything that had excited her on the same day of the previous year (during an attack of acute hysteria). A diary kept by her mother with out her knowledge proved the completeness of the reproduction. Another patient, partly under hypnosis and partly during spontaneous attacks, re-lived with hallucinatory clarity all the events of a hysterical psychosis which she had passed through ten years earlier and which she had for the most part forgotten till the moment at which it re-emerged. Moreover, certain memories of aetiological importance which dated back from fifteen to twenty-five years were found to be astonishingly intact and to possess remarkable sensory force, and when they returned they acted with all the affective strength of new experiences. Studies On Hysteria 13 this can only be explained on the view that these memories constitute an exception in their relation to all the wearing-away processes which we have discussed above. It appears, that is to say, that these memories correspond to traumas that have not been sufficiently abreacted; and if we enter more closely into the reasons which have prevented this, we find at least two sets of conditions under which the reaction to the trauma fails to occur. In the first group are those cases in which the patients have not reacted to a psychical trauma because the nature of the trauma excluded a reaction, as in the case of the apparently irreparable loss of a loved person or because social circumstance made a reaction impossible or because it was a question of things which the patient wished to forget, and therefore intentionally repressed from his conscious thought and inhibited and suppressed. It is precisely distressing things of this kind that, under hypnosis, we find are the basis of hysterical phenomena. The second group of conditions are determined, not by the content of the memories but by the psychical states in which the patient received the experiences in question. For we find, under hypnosis, among the causes of hysterical symptoms ideas which are not in themselves significant, but whose persistence is due to the fact that they originated during the prevalence of severely paralysing affects, such as fright, or during positively abnormal psychical states, such as the semi-hypnotic twilight state of day-dreaming, auto- hypnoses, and so on. In such cases it is the nature of the states which makes a reaction to the event impossible. Both kinds of conditions may, of course, be simultaneously present, and this, in fact, often occurs. It is so when a trauma which is operative in itself takes place while a severely paralysing affect prevails or during a modified state of consciousness. But it also seems to be true that in many people a psychical trauma produces one of these abnormal states, which, in turn, makes reaction impossible. Both of these groups of conditions, however, have in common the fact that the psychical traumas which have not been disposed of by reaction cannot be disposed of either by being worked over by means of association. In the first group the patient is determined to forget the distressing experiences and accordingly excludes them so far as possible from association; while in the second group the associative working-over fails to occur because there is no extensive associative connection between the normal state of consciousness and the pathological ones in which the ideas made their appearance. It may therefore be said that the ideas which have become pathological have persisted with such freshness and affective strength because they have been denied the normal wearing-away process by means of abreaction and reproduction in states of uninhibited association. In these views we concur with Binet and the two Janets, though we have had no experience of the remarkable findings they have made on anaesthetic patients. We should like to balance the familiar thesis that hypnosis is an artificial hysteria by another the basis and sine qua non of hysteria is the existence of hypnoid states. These states share with one another and with hypnosis, however much they may differ in other respects, one common feature: the ideas which emerge in them are very intense but are cut off from associative communication with the rest of the content of consciousness. Associations may take place between these hypnoid states, and their ideational content can in this way reach a more or less high degree of psychical organization. Moreover, the nature of these states and the extent to which they are cut off from the remaining conscious processes must be supposed to vary just as happens in hypnosis, which ranges from a light drowsiness to somnambulism, from complete recollection to total amnesia. If hypnoid states of this kind are already present before the onset of the manifest illness, they provide the soil in which the affect plants the pathogenic memory with its consequent somatic phenomena. We have found, however, that a severe trauma (such as occurs in a traumatic neurosis) or a laborious suppression (as of a sexual affect, for instance) can bring about a splitting-off of groups of ideas even in people who are in other respects unaffected; and this would be the mechanism of psychically acquired hysteria. Between the extremes of these two forms we must assume the existence of a series of cases within which the liability to dissociation in the subject and the affective magnitude of the trauma vary inversely. Studies On Hysteria 15 We have nothing new to say on the question of the origin of these dispositional hypnoid states. They often, it would seem, grow out of the day-dreams which are so common even in healthy people and to which needlework and similar occupations render women especially prone. This characterization holds good of their waking thoughts; but in their hypnoid states they are insane, as we all are in dreams. Whereas, however, our dream-psychoses have no effect upon our waking state, the products of hypnoid states intrude into waking life in the form of hysterical symptoms. Where this is present in a well-marked form, it exhibits the hallucinatory reproduction of a memory which was of importance in bringing about the onset of the hysteria the memory either of a single major trauma (which we find par excellence in what is called traumatic hysteria) or of a series of interconnected part-traumas (such as underlie common hysteria). Or, lastly, the attack may revive the events which have become emphasized owing to their coinciding with a moment of special disposition to trauma. There are also attacks, however, which appear to consist exclusively of motor phenomena and in which the phase of attitudes passionelles is absent. If one can succeed in getting into rapport with the patient during an attack such as this of generalized clonic spasms or cataleptic rigidity, or during an attaque de somneil [attack of sleep] or if, better still, one can succeed in provoking the attack under hypnosis one finds that here, too, there is an underlying memory of the psychical trauma or series of traumas, which usually comes to our notice in a hallucinatory phase. Thus, a little girl suffered for years from attacks of general convulsions which could well be, and indeed were, regarded as epileptic. She was hypnotized with a view to a differential diagnosis, and promptly had one of her attacks. Again, an employee who had become a hysteric as a result of being ill-treated by his superior, suffered from attacks in which he collapsed and fell into a frenzy of rage, but without uttering a word or giving any sign of a hallucination. It was possible to provoke an attack under hypnosis, and the patient then revealed that he was living through the scene in which his employer had abused him in the street and hit him with a stick. A few days later the patient came back and complained of having had another attack of the same kind. On this occasion it turned out under hypnosis that he had been re-living the scene to which the actual onset of the illness was related: the scene in the law-court when he failed to obtain satisfaction for his maltreatment. Studies On Hysteria 17 In all other respects, too, the memories which emerge, or can be aroused, in hysterical attacks correspond to the precipitating causes which we have found at the root of chronic hysterical symptoms. Like these latter causes, the memories underlying hysterical attacks relate to psychical traumas which have not been disposed of by abreaction or by associative thought activity. Like them, they are, whether completely or in essential elements, out of reach of the memory of normal consciousness and are found to belong to the ideational content of hypnoid states of consciousness with restricted association. Our observations have often taught us that a memory of this kind which has hitherto provoked attacks, ceases to be able to do so after the process of reaction and associative correction have been applied to it under hypnosis.

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These may now for the most part have become so much weakened that the expression of them in words seems to us only to be a figurative picture of them womens health yoga cheap 0.5mg cabergoline fast delivery, whereas in all probability the description was once meant literally; and hysteria is right in restoring the original meaning of the words in depicting its unusually strong innervations. Indeed, it is perhaps wrong to say that hysteria creates these sensations by symbolization. It may be that it does not take linguistic usage as its model at all, but that both hysteria and linguistic usage alike draw their material from a common source. She complained to me at that time of being troubled by a hallucination that her two doctors Breuer and I were hanging on two trees next each other in the garden. The hallucination disappeared after the analysis had brought out the following explanation. Now, therefore, that the case histories have brought forward evidence in support of our conclusions it may be permissible to state them at greater length. Even here, there is, of course, no question of dealing with the whole field of hysteria. In what follows little mention will be made of the brain and none whatever of molecules. Psychical processes will be dealt with in the language of psychology; and, indeed, it cannot possibly be otherwise. The substitution of one term for another would seem to be no more than a pointless disguise. Accordingly, I may perhaps be forgiven if I make almost exclusive use of psychological terms. When a science is making rapid advances, thoughts which were first expressed by single individuals quickly become common property. I hope, therefore, that I may be excused if few quotations are found in this discussion and if no strict distinction is made between what is my own and what originates elsewhere. Originality is claimed for very little of what will be found in the following pages. We are not of the opinion that all the phenomena of hysteria come about in the manner described by us in that paper, nor do we believe that they are all ideogenic, that is, determined by ideas. In this we differ from Moebius, who in 1888 proposed to define as hysterical all pathological phenomena that are caused by ideas. In giving this definition, Moebius is not merely proposing a modification in nomenclature and suggesting that in future we should only describe as hysterical those pathological phenomena which are ideogenic (determined by ideas); what he thinks is that all hysterical symptoms are ideogenic. I prefer to call it a generalization, the justification for which must first be tested. Studies On Hysteria 167 Before any discussion of the subject, we must obviously decide what we understand by hysteria. I regard hysteria as a clinical picture which has been empirically discovered and is based on observation, in just the same way as tubercular pulmonary phthisis. Clinical pictures of this kind that have been arrived at empirically are made more precise, deeper and clearer by the progress of our knowledge; but they ought not to be and cannot be disrupted by it. Aetiological research has shown that the various constituent processes of pulmonary phthisis have various causes: the tubercle is due to bacillus Kochii, and the disintegration of tissue, the formation of cavities and the septic fever are due to other microbes. In the same way hysteria must remain a clinical unity even if it turns out that its phenomena are determined by various causes, and that some of them are brought about by a psychical mechanism and others without it. It is my conviction that this is in fact so; only a part of the phenomena of hysteria are ideogenic, and the definition put forward by Moebius tears in half the clinical unity of hysteria, and indeed the unity of one and the same symptom in the same patient. In conformity with our experience of a large number of physiological processes, such as the secretion of saliva or tears, changes in the action of the heart, etc. Indeed, it seems certain that many phenomena which are described as hysterical are not caused by ideas alone. A woman may, when ever an affect arises, produce on her neck, breast and face an erythema appearing first in blotches and then becoming confluent. This is determined by ideas and therefore according to Moebius is a hysterical phenomenon. But this same erythema appears, though over a less extensive area, when the skin is irritated or touched, etc. Thus a phenomenon which is undoubtedly a complete unity would of one occasion be hysterical and on another occasion not. This applies in exactly the same way to the hysterical pain which are of so much practical importance. If we examine these rather more closely it appears that the fact of an idea being very vivid is not enough to produce them but that there must be a special abnormal condition of the apparatuses concerned with the conduction and sensation of pain, just as in the case of affective erythema an abnormal excitability of the vasomotors must be present. For the basic essential of the function of the perceptual apparatus is that its status quo ante should be capable of being restored with the greatest possible rapidity; otherwise no proper further perception could take place. The essential of memory, on the other hand, is that no such restoration should occur but that every perception should create changes that are permanent. It is impossible for one and the same organ to fulfil these two contradictory conditions. The mirror of a reflecting telescope cannot at the same time be a photographic plate. I am in agreement with Meynert, in the sense of believing, as I have said, that what gives hallucinations their objective character is an excitation of the perceptual apparatus (though I do not agree with him when he speaks of an excitation of the subcortical centres). Studies On Hysteria 169 this applies to sensory hallucinations and still more to hallucinations of pain. For it does not seem possible for a healthy person to endow the memory of a physical pain with even the degree of vividness, the distant approximation to the real sensation, which can, after all, be attained by optical and acoustic mnemic images. Even in the normal hallucinatory state of healthy people which occurs in sleep there are never, I believe, dreams of pain unless a real sensation of pain is present.

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It seemed to me a matter of indifference what degree of hypnosis according to one or other of the scales that have been proposed for measuring it was reached by this non somnambulistic state; for women's health gov faq birth control methods purchase cabergoline 0.25 mg online, as we know, each of the various forms taken by suggestibility is in any case independent of the others, and the bringing about of catalepsy, automatic movements, and so on, does not work either for or against what I required for my purposes, namely that the awakening of forgotten memories should be made easier. I feel sure that many other physicians who practise psychotherapy can get out of such difficulties with more skill than I can. It seems to me, however, that if one can reckon with such frequency on finding oneself in an embarrassing situation through the use of a particular word, one will be wise to avoid both the word and the embarrassment. It is possible that in this way I obtained with only a slight effort the deepest degree of hypnosis that could be reached in the particular case. Studies On Hysteria 98 But in doing without somnambulism I might be depriving myself of a precondition without which the cathartic method seemed unusable. For that method clearly rested on the patients in their changed state of consciousness having access to memories and being able to recognize connections which appeared not to be present in their normal state of consciousness. I was saved from this new embarrassment by remembering that I had myself seen Bernheim producing evidence that the memories of events during somnambulism are only apparently forgotten in the waking state and can be revived by a mild word of command and a pressure with the hand intended to indicate a different state of consciousness. He had, for instance, given a woman in a state of somnambulism a negative hallucination to the effect that he was no longer present, and had then endeavoured to draw her attention to himself in a great variety of ways, including some of a decidedly aggressive kind. After she had been woken up he asked her to tell him what he had done to her while she thought he was not there. He insisted that she could remember everything and laid his hand on her forehead to help her to recall it. Studies On Hysteria 99 this astonishing and instructive experiment served as my model. I decided to start from the assumption that my patients knew everything that was of any pathogenic significance and that it was only a question of obliging them to communicate it. At the moment at which I relax my pressure you will see something in front of you or something will come into your head. It has always pointed the way which the analysis should take and has enabled me to carry through every such analysis to an end without the use of somnambulism. I told them I was ready to repeat the procedure as often as they liked and they would see the same thing every time. They had rejected the memory that had come up or the idea that had occurred to them, on the ground that it was unserviceable and an irrelevant interruption; and after they had told it to me it always proved to be what was wanted. I can affirm that this forgetting is often intentional and desired; and its success is never more than apparent. I found it even more surprising perhaps that it was possible by the same procedure to bring back numbers and dates which, on the face of it, had long since been forgotten, and so to reveal how unexpectedly accurate memory can be. The fact that in looking for numbers and dates our choice is so limited enables us to call to our help a proposition familiar to us from the theory of aphasia, namely that recognizing something is a lighter task for memory than thinking of it spontaneously. Thus, if a patient is unable to remember the year or month or day when a particular event occurred, we can repeat to him the dates of the possibly relevant years, the names of the twelve months and the thirty-one numbers of the days of the month, assuring him that when we come to the right number or the right name his eyes will open of their own accord or that he will feel which is the right one. In the great majority of cases the patient will in fact decide on a particular date. It was because it was his birthday that I was expecting the event we were talking about. I was treating a woman of thirty-eight, suffering from anxiety neurosis (agoraphobia, attacks of fear of death, etc. Like so many such patients, she had a disinclination to admitting that she had acquired these troubles in her married life and would have liked to push them back into her early youth. Thus she told me that she was seventeen when she had had a first attack of dizziness, with anxiety and feelings of faintness, in the street in her small native town, and that these attacks had recurred from time to time, till a few years ago they had given place to her present disorder. I suspected that these first attacks of dizziness, in which the anxiety faded more and more into the background, were hysterical and I made up my mind to embark on an analysis of them. To begin with she only knew that this first attack came over her while the was out shopping in the principal street. I shall press on your head, and when I relax the pressure, you will think of something or see something, and you must tell me what that is. A few weeks earlier another girl had died, and that had made a great stir in the town. Now, can you remember what you were thinking about when you felt dizzy in the streetfi I can remember now that when I heard of her death I felt it was dreadful to be going to a ball, while she was dead. But I still required to know of some precipitating factor which had provoked the memory at that particular time. There might, I thought, be something else at work as well that had aroused or reinforced the hysterical disposition of a girl who had till then been normal. And now I remember, too, what an impression it made on me that my only period that year should have had to come on just before the ball. It required complete confidence in my technique on my side, and the occurrence to the patient of a few key ideas, before it was possible to re-awaken, after an interval of twenty-one years, these details of a forgotten experience in a sceptical person who was, in fact, in a waking state. Studies On Hysteria 101 After this long but unavoidable digression I will return to the case of Miss Lucy R. As I have said, then, my attempts at hypnosis with her did not produce somnambulism. She simply lay quietly in a state open to some mild degree of influence, with her eyes closed all the time, her features somewhat rigid, and without moving hand or foot. I asked her if she could remember the occasion on which she first had the smell of burnt pudding. The housekeeper, the cook and the French governess seem to have thought that I was putting myself above my station. I was in this state of uncertainty at the time, and thought I should be leaving the house; but I have stayed on. It had turned out in fact to have been an objective sensation originally, and one which was intimately associated with an experience a little scene in which opposing affects had been in conflict with each other: her regret at leaving the children and the slights which were nevertheless urging her to make up her mind to do so.

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If womens health consultants order cabergoline without prescription, for instance, it were able to break through as a result of some change of emotional condition or mood, this break through by the insulting purpose would be felt subsequently with unpleasure. Let us now suppose, however, that the possibility is presented of deriving a good joke from the material of the words and thoughts used for the insult the possibility, that is, of releasing pleasure from other sources which are not obstructed by the same suppression. This second development of pleasure could, nevertheless, not occur unless the insult were permitted; but as soon as the latter is permitted the new release of pleasure is also joined to it. Experience with tendentious jokes shows that in such circumstances the suppressed purpose can, with the assistance of the pleasure from the joke, gain sufficient strength to overcome the inhibition, which would otherwise be stronger than it. But the enjoyment obtained is not only that produced by the joke: it is incomparably greater. It is so much greater than the pleasure from the joke that we must suppose that the hitherto suppressed purpose has succeeded in making its way through, perhaps without any diminution whatever. It is in such circumstances that the tendentious joke is received with the heartiest laughter. An examination of the determinants of laughing will perhaps lead us to a plainer idea of what happens when a joke affords assistance against suppression. A possibility of generating pleasure supervenes in a situation in which another possibility of pleasure is obstructed so that, as far as the latter alone is concerned, no pleasure would arise. The result is a generation of pleasure far greater than that offered by the supervening possibility. This has acted, as it were, as an incentive bonus with the assistance of the offer of a small amount of pleasure, a much greater one, which would otherwise have been hard to achieve, has been gained. Jokes and Their Relation To the Unconscious 1727 We are now able to state the formula for the mode of operation of tendentious jokes. They put themselves at the service of purposes in order that, by means of using the pleasure from jokes as a fore-pleasure, they may produce new pleasure by lifting suppressions and repressions. If now we survey the course of development of the joke, we may say that from its beginning to its perfecting it remains true to its essential nature. It begins as play, in order to derive pleasure from the free use of words and thoughts. As soon as the strengthening of reasoning puts an end to this play with words as being senseless, and with thoughts as being nonsensical, it changes into a jest, in order that it may retain these sources of pleasure and be able to achieve fresh pleasure from the liberation of nonsense. Reason, critical judgement, suppression these are the forces against which it fights in succession; it holds fast to the original sources of verbal pleasure and, from the stage of the jest onwards, opens new sources of pleasure for itself by lifting inhibitions. The pleasure that it produces, whether it is pleasure in play or pleasure in lifting inhibitions, can invariably be traced back to economy in psychical expenditure, provided that this view does not contradict the essential nature of pleasure and that it proves itself fruitful in other directions. But this is not necessary, because it is only playing with thoughts that inevitably leads to nonsense; the other source of pleasure in jokes, playing with words, only gives that impression occasionally and does not invariably provoke the implied criticism. The twofold root of the pleasure in jokes from playing with words and playing with thoughts, which corresponds to the very important distinction between verbal and conceptual jokes makes it perceptibly more difficult to arrive at a concise formulation of general statements about jokes. Playing with words produces manifest pleasure as a result of the factors that have been enumerated above (recognition, and so on), and is consequently only to a small degree liable to suppression. Playing with thoughts cannot have its motive in this kind of pleasure; it meets with very energetic suppression, and the pleasure which it can yield is only pleasure in the lifting of an inhibition. It can accordingly be said that the pleasure in jokes exhibits a core of original pleasure in play and a casing of pleasure in lifting inhibitions. It serves as a means of intensifying the effect of the joke, but only when it acts obtrusively, so that the bewilderment can hurry ahead of the understanding by a perceptible moment of time. The latter then damps down his annoyance by determining to tell them himself later on. But on the one hand the possibility cannot be excluded of other motives as well having a share in the production of jokes, and on the other hand, bearing in mind some familiar experiences, we must raise the general question of the subjective determinants of jokes. We can only succeed here and there in advancing from an understanding of a particular joke to a knowledge of the subjective determinants in the mind of the person who made it. It is a remarkable coincidence that precisely the example of the joke on which we began our investigations of the technique of jokes also gives us a glimpse into the subjective determinants of jokes. I sat beside Salomon Rothschild and he treated me quite as his equal quite famillionairely. The poet evidently takes the greatest satisfaction in this creation of his, for he makes Hirsch- Hyacinth into a great talker and gives him the most amusing and plain-spoken speeches, and even lets him display the practical philosophy of a Sancho Panza. It is a pity that Heine, who seems to have had no taste for dramatic construction, dropped this delightful character so soon. There are not a few passages in which the poet himself seems to be speaking, under a thing disguise, through the mouth of Hirsch-Hyacinth, and it soon becomes a certainty that this character is only a self-parody. I recall a story told by an old aunt of my own, who had married into the Heine family, how one day, when she was an attractive young woman, she found sitting next her at the family dinner-table a person who struck her as uninviting and whom the rest of the company treated contemptuously. It was only many years later that she realized that this negligent and neglected cousin had been the poet Heinrich Heine. There is not a little evidence to show how much Heine suffered both in his youth and later from this rejection by his rich relations. For this reason it is not easy to try to make any more definite statement about the nature of these personal determinants. Indeed, we shall be disinclined in general to claim such complicated determinants for the origin of every individual joke. Nor are the jokes produced by other famous men any more easily accessible to our examination. We get an impression that the subjective determinants of the joke-work are often not far removed from those of neurotic illness when we learn, for instance, of Lichtenberg that he was a severely hypochrondriacal man, with all kinds of eccentricities. The great majority of jokes, and especially those that are constantly being newly produced in connection with the events of the day, are circulated anonymously; one would be curious to learn from what sort of people such productions originate. If one has occasion as doctor to make the acquaintance of one of those people who, though not remarkable in other ways, are well known in their circle as jokers and the originators of many viable jokes, one may be surprised to discover that the joker is a disunited personality, disposed to neurotic disorders. The insufficiency of documentary evidence, however, will certainly prevent our setting up a hypothesis that a psychoneurotic constitution of this kind is a habitual or necessary subjective condition for the construction of jokes. A more transparent case is offered, once more, by the Jewish jokes, which, as I have already mentioned (p.

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Psychical treatment was almost the only sort at the disposal of the peoples of antiquity menstruation volume discount 0.5 mg cabergoline visa, and they invariably reinforced the effects of therapeutic potions and other therapeutic measures by intensive mental treatment. Such familiar procedures as the use of magical formulas and purificatory baths, or the elicitation of oracular dreams by sleeping in the temple precincts, can only have had a curative effect by psychical means. Words are the most important media by which one man seeks to bring his influence to bear on another; words are a good method of producing mental changes in the person to whom they are addressed. So that there is no longer anything puzzling in the assertion that the magic of words can remove the symptoms of illness, and especially such as are themselves founded on mental states. All the mental influences which have proved effective in curing illnesses have something incalculable about them. Affects, concentration of the will, distracting the attention, expectation coloured by faith all of these forces, which occasionally remove an illness, sometimes fail to do so without there being anything in the character of the illness to account for the different result. What stands in the way of regularity in the therapeutic results achieved is evidently the autocratic nature of the personalities of the subjects, with their variety of mental differences. Psychical (Or Mental) Treatment 1595 Quite a number of different methods of treatment have thus arisen, some of them simple to arrive at and others which could only be reached on the basis of complex hypotheses. He himself may succeed in doing this with only a limited number of patients, whereas other patients, according to their inclinations and degree of education, will be attracted to other physicians. Such a distribution will serve a useful purpose; but if the right of a patient to make a free choice of his doctor were suspended, an important precondition for influencing him mentally would be abolished. There are many very effective mental procedures which the physician is obliged to renounce. This applies in particular to the provocation of strong affects the most powerful of all the means by which the mind affects the body. The vicissitudes of life often cure illnesses through the experience of great joy, through the satisfaction of needs or the fulfilment of wishes. The physician, who is often impotent outside his profession, cannot compete along these lines. It might be more within his power to employ fear and fright for therapeutic ends; but, except in the case of children, he must have the gravest doubts about the use of such double-edged tools. On the other hand, the physician must rule out any relations with his patient that are bound up with tender feelings, owing to their implications in practical life. Thus from the first his power to bring about mental changes in his patients seems so restricted that mental treatment conducted on a deliberate plan would seem to offer no advantages over the earlier haphazard method. He may, for instance, persistently oblige a person who believes he is paralysed to carry out the movements of which he professes himself incapable; or he may refuse to fall in with the wishes of an anxious patient who insists on being examined for an illness from which he is quite certainly not suffering. In these instances the physician will be taking the right course, but such isolated cases would scarcely justify us in setting up mental treatment as a special therapeutic procedure. There exists, nevertheless, a queer and unforeseeable method which offers the physician a possibility of exercising a profound, even though transitory, influence on the mental life of his patients and of employing that influence for therapeutic purposes. The various means by which hypnosis can be brought about have at first sight little in common. It is possible to hypnotize someone by getting him to stare fixedly at a bright object for some minutes, or by holding a watch to his ear for a similar length of time, or by repeatedly passing the open hands, at a short distance away, over his face and limbs. It will be observed that all the procedures have in common a fixing of the attention; in those first mentioned the attention is fatigued by slight and monotonous sensory stimuli. It is not yet satisfactorily explained, however, how it comes about that mere talking produces exactly the same state as the other procedures. Experienced hypnotists assert that by these means a definite hypnotic change can be brought about in some eighty per cent of subjects. There is no way of telling beforehand, however, which subjects are hypnotizable and which are not. Illness is far from being one of the necessary preconditions of hypnosis: normal people are said to be particularly easy to hypnotize, while some neurotics can only be hypnotized with great difficulty and the insane are completely resistant. But hypnosis is in no sense a sleep like our nocturnal sleep or like the sleep produced by drugs. Changes occur in it and mental functions are retained during it which are absent in normal sleep. Psychical (Or Mental) Treatment 1597 Some of the phenomena of hypnosis (for instance, alterations in muscular activity) possess a merely scientific interest. While the subject behaves to the rest of the external world as though he were asleep, that is, as though all his senses were diverted from it, he is awake in his relation to the person who hypnotized him; he hears and sees him alone, and him he understands and answers. This phenomenon, which is described as rapport in the case of hypnosis, finds a parallel in the way in which some people sleep for instance, a mother who is nursing her baby. It is so striking that it may well lead us to an understanding of the relation between the hypnotic subject and the hypnotist. And the manner in which this obedience and credulity are carried out reveals a characteristic of the hypnotic state, namely that in the hypnotized subject the influence of the mind over the body is extraordinarily increased. This implies on the one hand obedience but on the other an increase in the physical influence of an idea. Psychical (Or Mental) Treatment 1598 the same thing happens in the domain of sense perceptions. But after all we have no reason for doubts on the point; for he behaves exactly as though he had them, he expresses all the appropriate emotions, and in some circumstances he can even describe his imaginary perceptions and experiences after the hypnosis is at an end. He was evidently so credulous in relation to the hypnotist that he was convinced that there must be a snake to be seen when the hypnotist told him so; and this conviction had such a strong effect on his body that he really saw the snake a thing which, incidentally, can sometimes happen even to people who have not been hypnotized. It may be remarked, by the way, that, outside hypnosis and in real life, credulity such as the subject has in relation to his hypnotist is shown only by a child towards his beloved parents, and that an attitude of similar subjection on the part of one person towards another has only one parallel, though a complete one namely in certain love-relationships where there is extreme devotion. A combination of exclusive attachment and credulous obedience is in general among the characteristics of love. Psychical (Or Mental) Treatment 1599 Some further points may be mentioned in connection with the state of hypnosis.

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Pictures and drawings by famous artists exist which depict coitus a tergo menstruation 3 weeks straight best purchase for cabergoline, a latere, etc. If one wants to enjoy oneself it is usual to make oneself as comfortable as possible: this of course is true for both the primal instincts, hunger and love. Most of the peoples of antiquity took their meals in a lying position and it is normal in coitus to-day to lie down just as comfortably as did our ancestors. Lying down implies more or less a wish to stay in the desired situation for some time. His brows are wrinkled and his gaze is directed sideways with an expression of repugnance. This interchange is easiest to grasp if one recalls that the big toes lie on the inner sides of the feet. While he was still an apprentice, living in the house of his master Verrocchio, a charge of forbidden homosexual practices was brought against him, along with some other young people, which ended in his acquittal. He seems to have fallen under this suspicion because he had employed a boy of bad reputation as a model. The last of these pupils, Francesco Melzi, accompanied him to France, remained with him up to his death and was named by him as his heir. Among his biographers, to whom a psychological approach is often very alien, there is to my knowledge only one, Edmondo Solmi, who has approached the solution of the problem; but a writer who has chosen Leonardo as the hero of a great historical novel, Dmitry Sergeyevich Merezhkovsky, has made a similar reading of this unusual man the basis of his portrait and has given clear expression to his conception, not indeed in plain language, but (after the way of writers of imagination) in plastic terms. For that (line of conduct) is the way to become acquainted with the Creator of so many wonderful things, and this is the way to love so great an Inventor. For in truth great love springs from great knowledge of the beloved object, and if you know it but little you will be able to love it only a little or not at all. Leonardo da Vinci forms the second work of a great historical trilogy entitled Christ and Antichrist. It is not true that human beings delay loving or hating until they have studied and become familiar with the nature of the object to which these affects apply. On the contrary they love impulsively, from emotional motives which have nothing to do with knowledge, and whose operation is at most weakened by reflection and consideration. Leonardo, then, could only have meant that the love practised by human beings was not of the proper and unobjectionable kind: one should love in such a way as to hold back the affect, subject it to the process of reflection and only let it take its course when it has stood up to the test of thought. And at the same time we understand that he wishes to tell us that it happens so in his case and that it would be worth while for everyone else to treat love and hatred as he does. His affects were controlled and subjected to the instinct for research; he did not love and hate, but asked himself about the origin and significance of what he was to love or hate. Thus he was bound at first to appear indifferent to good and evil, beauty and ugliness. During this work of investigation love and hate threw off their positive or negative signs and were both alike transformed into intellectual interest. In reality Leonardo was not devoid of passion; he did not lack the divine spark which is directly or indirectly the driving force il primo motore behind all human activity. He had merely converted his passion into a thirst for knowledge; he then applied himself to investigation with the persistence, constancy and penetration which is derived from passion, and at the climax of intellectual labour, when knowledge had been won, he allowed the long restrained affect to break loose and to flow away freely, as a stream of water drawn from a river is allowed to flow away when its work is done. When, at the climax of a discovery, he could survey a large portion of the whole nexus, he was overcome by emotion, and in ecstatic language praised the splendour of the part of creation that he had studied, or in religious phraseology the greatness of his Creator. A conversion of psychical instinctual force into various forms of activity can perhaps no more be achieved without loss than a conversion of physical forces. The example of Leonardo teaches us how many other things we have to take into account in connection with these processes. The postponement of loving until full knowledge is acquired ends in a substitution of the latter for the former. A man who has won his way to a state of knowledge cannot properly be said to love and hate; he remains beyond love and hatred. The stormy passions of a nature that inspires and consumes, passions in which other men have enjoyed their richest experience, appear not to have touched him. A man who has begun to have an inkling of the grandeur of the universe with all its complexities and its laws readily forgets his own insignificant self. Lost in admiration and filled with true humility, he all too easily forgets that he himself is a part of those active forces and that in accordance with the scale of his personal strength the way is open for him to try to alter a small portion of the destined course of the world a world in which the small is still no less wonderful and significant than the great. It is probable that at that time he already overrated the value to the artist of these branches of knowledge. And finally the instinct, which had become overwhelming, swept him away until the connection with the demands of his art was severed, so that he discovered the general laws of mechanics and divined the history of the stratification and fossilization in the Arno valley, and until he could enter in large letters in his book the discovery: Il sole non si move. Leonardo Da Vinci And A Memory Of His Childhood 2254 Then, when he made the attempt to return from investigation to his starting point, the exercise of his art, he found himself disturbed by the new direction of his interests and the changed nature of his mental activity. What interested him in a picture was above all a problem; and behind the first one he saw countless other problems arising, just as he used to in his endless and inexhaustible investigation of nature. He was no longer able to limit his demands, to see the work of art in isolation and to tear it from the wide context to which he knew it belonged. After the most exhausting efforts to bring to expression in it everything which was connected with it in his thoughts, he was forced to abandon it in an unfinished state or to declare that it was incomplete. The artist had once taken the investigator into his service to assist him; now the servant had become the stronger and suppressed his master. Our psycho-analytic studies of neurotic people have however led us to form two further expectations which it would be gratifying to find confirmed in each particular case. Thus a person of this sort would, for example, pursue research with the same passionate devotion that another would give to his love, and he would be able to investigate instead of loving. We would venture to infer that it is not only in the example of the instinct to investigate that there has been a sexual reinforcement, but also in most other cases where an instinct is of special intensity. The sexual instinct is particularly well fitted to make contributions of this kind since it is endowed with a capacity for sublimation: that is, it has the power to replace its immediate aim by other aims which may be valued more highly and which are not sexual.

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This is merely due to our being obliged to operate with the scientific terms pregnancy 6 weeks ultrasound purchase cabergoline with amex, that is to say with the figurative language, peculiar to psychology (or, more precisely, to depth psychology). We could not otherwise describe the processes in question at all, and indeed we could not have become aware of them. The deficiencies in our description would probably vanish if we were already in a position to replace the psychological terms by physiological or chemical ones. It is true that they too are only part of a figurative language; but it is one with which we have long been familiar and which is perhaps a simpler one as well. On the other hand it should be made quite clear that the uncertainty of our speculation has been greatly increased by the necessity for borrowing from the science of biology. We may expect it to give us the most surprising information and we cannot guess what answers it will return in a few dozen years to the questions we have put to it. They may be of a kind which will blow away the whole of our artificial structure of hypotheses. If so, it may be asked why I have embarked upon such a line of thought as the present one, and in particular why I have decided to make it public. Well I cannot deny that some of the analogies, correlations and connections which it contains seemed to me to deserve consideration. We retained this name after we had been obliged by the findings of psycho-analysis to connect them less closely with reproduction. With the hypothesis of narcissistic libido and the extension of the concept of libido to the individual cells, the sexual instinct was transformed for us into Eros, which seeks to force together and hold together the portions of living substance. What are commonly called the sexual instincts are looked upon by us as the part of Eros which is directed towards objects. These speculations seek to solve the riddle of life by supposing that these two instincts were struggling with each other from the very first. To begin with we applied that name to all the instinctual trends (of which we had no closer knowledge) which could be distinguished from the sexual instincts directed towards an object; and we opposed the ego-instincts to the sexual instincts of which the libido is the manifestation. These narcissistic self-preservative instincts had thenceforward to be counted among the libidinal sexual instincts. The opposition between the ego-instincts and the sexual instincts was transformed into one between the ego-instincts and the object-instincts, both of a libidinal nature. But in its place a fresh opposition appeared between the libidinal (ego- and object-) instincts and others, which must be presumed to be present in the ego and which may perhaps actually be observed in the destructive instincts. Our speculations have transformed this opposition into one between the life instincts (Eros) and the death instincts. This characteristic would be shared by all the component instincts and in their case would aim at returning once more to a particular stage in the course of development. These are matters over which the pleasure principle has as yet no control; but it does not follow that any of them are necessarily opposed to it, and we have still to solve the problem of the relation of the instinctual processes of repetition to the dominance of the pleasure principle. We have found that one of the earliest and most important functions of the mental apparatus is to bind the instinctual impulses which impinge on it, to replace the primary process prevailing in them by the secondary process and convert their freely mobile cathectic energy into a mainly quiescent (tonic) cathexis. While this transformation is taking place no attention can be paid to the development of unpleasure; but this does not imply the suspension of the pleasure principle. On the contrary, the transformation occurs on behalf of the pleasure principle; the binding is a preparatory act which introduces and assures the dominance of the pleasure principle. Let us make a sharper distinction than we have hitherto made between function and tendency. The pleasure principle, then, is a tendency operating in the service of a function whose business it is to free the mental apparatus entirely from excitation or to keep the amount of excitation in it constant or to keep it as low as possible. We cannot yet decide with certainty in favour of any of these ways of putting it; but it is clear that the function thus described would be concerned with the most universal endeavour of all living substance namely to return to the quiescence of the inorganic world. We have all experienced how the greatest pleasure attainable by us, that of the sexual act, is associated with a momentary extinction of a highly intensified excitation. The binding of an instinctual impulse would be a preliminary function designed to prepare the excitation for its final elimination in the pleasure of discharge. Beyond the Pleasure Principle 3762 this raises the question of whether feelings of pleasure and unpleasure can be produced equally from bound and from unbound excitatory processes. And there seems to be no doubt whatever that the unbound or primary processes give rise to far more intense feelings in both directions than the bound or secondary ones. Moreover the primary processes are the earlier in time; at the beginning of mental life there are no others, and we may infer that if the pleasure principle had not already been operative in them it could never have been established for the later ones. We thus reach what is at bottom no very simple conclusion, namely that at the beginning of mental life the struggle for pleasure was far more intense than later but not so unrestricted: it had to submit to frequent interruptions. In later times the dominance of the pleasure principle is very much more secure, but it itself has no more escaped the process of taming than the other instincts in general. In any case, whatever it is that causes the appearance of feelings of pleasure and unpleasure in processes of excitation must be present in the secondary process just as it is in the primary one. Our consciousness communicates to us feelings from within not only of pleasure and unpleasure but also of a peculiar tension which in its turn can be either pleasurable or unpleasurable. Should the difference between these feelings enable us to distinguish between bound and unbound processes of energyfi Another striking fact is that the life instincts have so much more contact with our internal perception emerging as breakers of the peace and constantly producing tensions whose release is felt as pleasure while the death instincts seem to do their work unobtrusively. It is true that it keeps watch upon stimuli from without, which are regarded as dangers by both kinds of instincts; but it is more especially on guard against increases of stimulation from within, which would make the task of living more difficult. This in turn raises a host of other questions to which we can at present find no answer. We must be ready, too, to abandon a path that we have followed for a time, if it seems to be leading to no good end. Only believers, who demand that science shall be a substitute for the catechism they have given up, will blame an investigator for developing or even transforming his views. We may take comfort, too, for the slow advances of our scientific knowledge in the words of the poet: Was man nicht erfliegen kann, muss man erhinken. It is true that individual psychology is concerned with the individual man and explores the paths by which he seeks to find satisfaction for his instinctual impulses; but only rarely and under certain exceptional conditions is individual psychology in a position to disregard the relations of this individual to others. Group Psychology And the Analysis Of the Ego 3766 the individual in the relations which have already been mentioned to his parents and to his brothers and sisters, to the person he is in love with, to his friend, and to his physician comes under the influence of only a single person, or of a very small number of persons, each one of whom has become enormously important to him. Now in speaking of social or group psychology it has become usual to leave these relations on one side and to isolate as the subject of inquiry the influencing of an individual by a large number of people simultaneously, people with whom he is connected by something, though otherwise they may in many respects be strangers to him. Group psychology is therefore concerned with the individual man as a member of a race, of a nation, of a caste, of a profession, of an institution, or as a component part of a crowd of people who have been organized into a group at some particular time for some definite purpose. But we may perhaps venture to object that it seems difficult to attribute to the factor of number a significance so great as to make it capable by itself of arousing in our mental life a new instinct that is otherwise not brought into play. Our expectation is therefore directed towards two other possibilities: that the social instinct may not be a primitive one and insusceptible of dissection, and that it may be possible to discover the beginnings of its development in a narrower circle, such as that of the family. Although group psychology is only in its infancy, it embraces an immense number of separate issues and offers to investigators countless problems which have hitherto not even been properly distinguished from one another. The mere classification of the different forms of group formation and the description of the mental phenomena produced by them require a great expenditure of observation and exposition, and have already given rise to a copious literature. Anyone who compares the narrow dimensions of this little book with the wide extent of group psychology will at once be able to guess that only a few points chosen from the whole material are to be dealt with here. And they will in fact only be a few questions with which the depth-psychology of psycho-analysis is specially concerned.

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But human images can never be repeated womens health study purchase cabergoline with a visa, and profound differences between the two great men are not lacking. In Leonardo it is plausible to associate his disturbance with that inhibition in his development which withdrew everything erotic, and hence psychology too, from his sphere of interest. Address Delivered In the Goethe House At Frankfurt 4579 I think that Goethe would not have rejected psycho-analysis in an unfriendly spirit, as so many of our contemporaries have done. He himself approached it at a number of points, recognized much through his own insight that we have since been able to confirm, and some views, which have brought criticism and mockery down upon us, were expounded by him as self-evident. Thus he was familiar with the incomparable strength of the first affective ties of human creatures. Goethe paraphrases the content of dream-life in the evocative words: Was von Menschen nicht gewusst Oder nicht bedacht, Durch das Labyrinth der Brust Wandelt in der Nacht. Behind this magic we recognize the ancient, venerable and incontestably correct pronouncement of Aristotle that dreaming is the continuation of our mental activity into the state of sleep combined with the recognition of the unconscious which psycho-analysis first added to it. Address Delivered In the Goethe House At Frankfurt 4580 In what is perhaps his most sublime poetical creation, Iphigenie, Goethe shows us a striking instance of expiation, of the freeing of a suffering mind from the burden of guilt, and he makes this catharsis come about through a passionate outburst of feeling under the beneficent influence of loving sympathy. Indeed, he himself repeatedly made attempts at giving psychological help as for example to the unfortunate man who is named as Kraft in the Letters, and to Professor Plessing, of whom he tells in the Campagne in Frankreich; and the procedure which he applied goes beyond the method of the Catholic Confessional and approximates in some remarkable details to the technique of our psycho-analysis. There is an example of psychotherapeutic influence which is described by Goethe as a jest, but which I should like to quote in full since it may not be well known and yet is very characteristic. Frau Herder was still in a state of tension of the most hypochondriacal kind over all the unpleasant things that had happened to her at Carlsbad. Indeed, it is perhaps more than a chance coincidence when in Die Wahlverwandtschaften he applies to love an idea taken from the sphere of chemistry a connection to which the name of psycho- analysis itself bears witness. I am prepared for the reproach that we analysts have forfeited the right to place ourselves under the patronage of Goethe because we have offended against the respect due to him by trying to apply analysis to him himself: we have degraded the great man to the position of an object of analytic investigation. Address Delivered In the Goethe House At Frankfurt 4581 We all, who revere Goethe, put up, without too much protest, with the efforts of his biographers, who try to recreate his life from existing accounts and indications. Even the best and fullest of them could not answer the two questions which alone seem worth knowing about. It would not throw any light on the riddle of the miraculous gift that makes an artist, and it could not help us to comprehend any better the value and the effect of his works. And yet there is no doubt that such a biography does satisfy a powerful need in us. We feel this very distinctly if the legacy of history unkindly refuses the satisfaction of this need for example in the case of Shakespeare. It is undeniably painful to all of us that even now we do not know who was the author of the Comedies, Tragedies and Sonnets of Shakespeare; whether it was in fact the untutored son of the provincial citizen of Stratford, who attained a modest position as an actor in London, or whether it was, rather, the nobly-born and highly cultivated, passionately wayward, to some extent declasse aristocrat, Edward de Vere, Seventeenth Earl of Oxford, hereditary Lord Great Chamberlain of England. People generally say that it is our desire to bring ourselves nearer to such a man in a human way as well. Let us grant this; it is, then, the need to acquire affective relations with such men, to add them to the fathers, teachers, exemplars whom we have known or whose influence we have already experienced, in the expectation that their personalities will be just as fine and admirable as those works of art of theirs which we possess. Address Delivered In the Goethe House At Frankfurt 4582 All the same, we may admit that there is still another motive force at work. It is true that the biographer does not want to depose his hero, but he does want to bring him nearer to us. That means, however, reducing the distance that separates him from us: it still tends in effect towards degradation. Our attitude to fathers and teachers is, after all, an ambivalent one since our reverence for them regularly conceals a component of hostile rebellion. That is a psychological fatality; it cannot be altered without forcible suppression of the truth and is bound to extend to our relations with the great men whose life histories we wish to investigate. When psycho-analysis puts itself at the service of biography, it naturally has the right to be treated no more harshly than the latter itself. Since it is one of the principal functions of our thinking to master the material of the external world psychically, it seems to me that thanks are due to psycho-analysis if, when it is applied to a great man, it contributes to the understanding of his great achievement. This is because Goethe was not only, as a poet, a great self-revealer, but also, in spite of the abundance of autobiographical records, a careful concealer. We cannot help thinking here of the words of Mephistopheles: Das Beste, was du wissen kannst, Darfst du den Buben doch nicht sagen. If we yield to the legitimate need to distinguish particular types in this multiplicity, we shall at the start have the choice as to what characteristics and what points of view we shall take as the basis of our differentiation. For that purpose physical qualities will doubtless serve no less well than mental ones; the most valuable distinctions will be those which promise to present a regular combination of physical and mental characteristics. It is doubtful whether we are as yet in a position to discover types to fulfil this requirement as we shall no doubt be able to do later, on some basis of which we are still ignorant. If we confine our effort to setting up purely psychological types, the libidinal situation will have a first claim to serve as a basis for our classification. It may fairly be demanded that this classification should not merely be deduced from our knowledge or our hypotheses about the libido, but that it should be easily confirmed in actual experience and that it should contribute to the clarification of the mass of our observations and help us to grasp them. It may at once be admitted that these libidinal types need not be the only possible ones even in the psychical field, and that, if we proceeded from other qualities, we might perhaps establish a whole set of other psychological types. But it must be required of all such types that they shall not coincide with clinical pictures. On the contrary, they must comprehend all the variations which according to our practical judgement fall within the limits of the normal. In their extreme developments, however, they may well approximate to clinical pictures and in that way help to bridge the gulf that is supposed to lie between the normal and the pathological. According, then, as the libido is predominantly allocated to the provinces of the mental apparatus, we can distinguish three main libidinal types. To give names to these types is not particularly easy; following the lines of our depth-psychology, I should like to call them the erotic, the narcissistic and the obsessional types. Erotics are those whose main interest the relatively largest part of whose libido is turned towards love. They are dominated by the fear of loss of love and are therefore especially dependent on others who may withhold their love from them. Variants of it occur according as it is blended with another type and in proportion to the amount of aggressiveness present in it. From the social and cultural standpoint this type represents the elementary instinctual demands of the id, to which the other psychical agencies have become compliant. The second type is what I have termed the obsessional type a name which may at first seem strange. It is distinguished by the predominance of the super-ego, which is separated from the ego under great tension. People of this type are dominated by fear of their conscience instead of fear of losing love. They develop a high degree of self- reliance; and, from the social standpoint, they are the true, pre-eminently conservative vehicles of civilization. The third type, justly called the narcissistic type, is mainly to be described in negative terms. There is no tension between ego and super-ego (indeed, on the strength of this type one would scarcely have arrived at the hypothesis of a super-ego), and there is no preponderance of erotic needs.