Part 1

—————————————————————————————————————————————————————————————————————— Transcriber’s Note:

The name Freund at page 8, which is likely to be a reference to Freud, has been corrected accordingly.

The erroneous Roman number vli in footnote 15 is corrected to be vii just as a guess. ——————————————————————————————————————————————————————————————————————

THE INTERNATIONAL PSYCHO-ANALYTICAL LIBRARY

EDITED BY ERNEST JONES

NO. 2

PSYCHO-ANALYSIS

AND THE

WAR NEUROSES

by

Drs. S. FERENCZI (Budapest), KARL ABRAHAM (Berlin), ERNST SIMMEL (Berlin) and ERNEST JONES (London)

Introduction by Prof. SIGM. FREUD (Vienna)

THE INTERNATIONAL PSYCHO-ANALYTICAL PRESS LONDON VIENNA NEW YORK

1921

Copyright, 1921

C. Fromme, Printer, Vienna

CONTENTS

PAGE

I. Introduction by Prof. Sigm. Freud 1

II. Symposium held at the Fifth International Psycho-Analytical Congress at Budapest, September 1918:

1. Dr. S. Ferenczi 5

2. Dr. Karl Abraham 22

3. Dr. Ernst Simmel 30

III. War Shock and Freud’s Theory of the Neuroses, by Dr. Ernest Jones 44

I.

INTRODUCTION

BY PROFESSOR SIGM. FREUD, Vienna.

This little book on the War Neuroses, with which the Verlag opens the “Internationale psychoanalytische Bibliothek”, deals with a subject which until lately engaged the greatest current interest. When the subject came up for discussion at the Fifth Psycho-Analytical Congress at Budapest (September, 1918), official representatives of the Central European Powers were present to obtain information from the lectures and discussions. The hopeful result of this first meeting was the promise that psycho-analytical institutions should be established, where medical men qualified in analysis might find the means and time to study the nature of these puzzling illnesses and the therapeutic value of psycho-analysis in them. However, before these results could be achieved the war came to an end, the government organisations broke down, and interest in war neuroses gave place to other concerns. At the same time, significantly enough, most of the neurotic diseases which had been brought about by the war disappeared on the cessation of the war conditions. The opportunity, therefore, for a thorough investigation of these affections was unfortunately missed. However, one must add, it is to be hoped that it will be a very long time before such an opportunity again occurs. This episode, now a thing of the past, has not been without importance for the spread of the knowledge of psycho-analysis. Many medical men, who had previously held themselves aloof from psycho-analysis, have been brought into close touch with its theories through their service with the army compelling them to deal with the question of the war neuroses. The reader can easily gather from Ferenczi’s contribution to the subject with what hesitation and misgivings this advance was made. Some of the factors, such as the psycho-genetic origin of the symptoms, the significance of unconscious impulses, and the part that the primary advantage of being ill plays in the adjusting psychical conflicts (“flight into disease”), all of which had long before been discovered and described as operating in the neuroses of peace time, were found also in the war neuroses and almost generally accepted. The work of E. Simmel has shown what results may be obtained if the war neurotic is treated by the cathartic method, which, as is well known, was the first stage of the psycho-analytic technique.

From the advance thus made towards psycho-analysis, however, one need not assume that the opposition to it has been reconciled or neutralised. One might think that when a man, who had hitherto not accepted any of a number of connected conclusions, suddenly finds himself in the position of being convinced of the truth of a part of them, he would weaken in his opposition and adopt an attitude of respectful attention, lest the other part, of which he has no personal experience, and therefore upon which he is unable to form a personal opinion, should also prove to be correct.

This other part of the psycho-analytical theory which is not touched upon in the study of the war neuroses is that the driving forces which find expression in the formation of symptoms are sexual in nature, and that the neurosis is the result of the conflict between the ego and the sexual impulses which it has repudiated. The term “sexuality” is to be taken here in the broader sense customary in psycho-analysis, and not to be confused with the narrower sense of “genitality”. Now it is quite correct, as Ernest Jones points out in his contribution, that this part of the theory has not hitherto been demonstrated in relation to the war neuroses. The work which could prove this part has not yet been carried out. It may be that the war neuroses are unsuitable material for this proof. However, the opponents of psycho-analysis, whose repugnance to sexuality has shown itself to be stronger than their logic, have hastened to proclaim that investigation of the war neuroses has finally disproved this part of the psycho-analytical theory. In this pronouncement they have been guilty of a slight confusion. If the—up to the present superficial—investigation of war neuroses has not shown that the sexual theory of the neuroses is correct, that is quite another matter from showing that this theory is incorrect.

With an impartial attitude and some willingness it should not be difficult to find the way to further elucidation.

The war neuroses, in so far as they differ from the ordinary neuroses of peace time through particular peculiarities, are to be regarded as traumatic neuroses, whose existence has been rendered possible or promoted through an ego-conflict. In Abraham’s contribution there are plain indications of this ego-conflict; the English and American authors whom Jones quotes have also recognised it. The conflict takes place between the old ego of peace time and the new war-ego of the soldier, and it becomes acute as soon as the peace-ego is faced with the danger of being killed through the risky undertakings of his newly formed parasitical double. Or one might put it, the old ego protects itself from the danger to life by flight into the traumatic neurosis in defending itself against the new ego which it recognises as threatening its life. The National Army was therefore the condition, and fruitful soil, for the appearance of war neuroses; they could not occur in professional soldiers, or mercenaries.

The other feature of the war neurosis is that it is a traumatic neurosis, such as is well known to occur in peace time after fright or severe accidents, without any reference to an ego-conflict.

The theory of the sexual aetiology of the neuroses, or as we prefer to call it, the sexual hunger (libido) theory, was originally put forward only as regards the transference neuroses of peace conditions, and can be easily demonstrated in them by using the analytic technique. But its application to those other affections, which more recently we have grouped together as the narcissistic neuroses, meets with difficulties. Ordinary cases of Dementia praecox, Paranoia and Melancholia are fundamentally very unsuitable material for the proof of the sexual hunger (libido) theory and for reaching an understanding of it, for which reason psychiatrists, who neglect the transference neuroses cannot be reconciled to it. The traumatic neuroses (of peace time) have always been reckoned to be the most refractory in this respect, so that the appearance of the war neuroses does not add any fresh factor to the former situation.

Only by advancing and making use of the idea of a “narcissistic sexual hunger (libido)”, that is to say, a mass of sexual energy that attaches itself to the ego and satisfies itself with this as otherwise it does only with an object, has it been possible to extend the sexual hunger (libido) theory to the narcissistic neuroses, and this entirely legitimate development of the concept of sexuality bids fair to do for these severer neuroses and for the psychoses all that one can expect from an empirically and tentatively progressing theory. The traumatic neurosis of peace time will also fit into this group when researches into the correlation undoubtedly subsisting between shock, anxiety, and narcissistic sexual hunger (libido) have reached success.

If the traumatic and war neuroses emphasise the influence of the danger to life and not at all, or not clearly enough, that of the “denial of love”, on the other hand the aetiological claim of the former factor appearing there so powerfully, is lacking in the usual transference neuroses of peace time. Indeed it is vulgarly supposed that these latter sufferings are only promoted by indulgence, high-living and ease, which provide an interesting contrast to the conditions of life under which the war neuroses break out. If psycho-analysts, who find their patients have become ill through the “denial of love”, through the ungratified demands of the sexual hunger (libido), were to follow the example of their opponents, they would maintain that either there are no danger neuroses, or that the affections following on terror are not neuroses. This has naturally never crossed their minds. On the contrary, they see the convenient possibility of combining in one conception the two apparently divergent sets of facts. In the traumatic and war neuroses the ego of the individual protects itself from a danger that either threatens it from without, or is embodied in a form of the ego itself, in the transference neuroses of peace time the ego regards its own sexual hunger (libido) as a foe, the demands of which appear threatening to it. In both cases the ego fears an injury; in the one case through the sexual hunger (libido) and in the other from outside forces. One might even say that in the case of the war neuroses the thing feared, is after all an inner foe, in distinction from the pure traumatic neuroses and approximating to the transference neuroses. The theoretical difficulties which stand in the way of such a unifying conception do not appear to be insurmountable; one can with full right designate the repression which underlies every neurosis, as a reaction to a trauma, as an elementary traumatic neurosis.

Spring 1919.

II.

SYMPOSIUM

HELD AT THE FIFTH INTERNATIONAL PSYCHO-ANALYTICAL CONGRESS BUDAPEST, SEPTEMBER 1918

1. DR. S. FERENCZI, Budapest.

_Ladies and Gentlemen_,

With your permission I will commence my exposition of the very serious and important subject that is the theme of my lecture to-day with the recital of a little story which will lead us straightway into the revolutionising events of this war. A Hungarian, who had the opportunity of observing at close quarters a part of the revolutionary upheaval in Russia, told me that the new revolutionary rulers of a Russian town found with consternation that the change from the old to the new regime had not taken place as rapidly as it should have done according to their doctrinal calculations. According to the teachings of the materialistic idea of history they could have set up the new social order immediately after they had got the entire power into their hands. Instead of this, irresponsible elements, which were antagonistic to any new order of things, obtained the upper hand, so that the power gradually slipped from the hands of the originators of the revolution. Then the leaders of the movement put their heads together in order to find out what had gone wrong in their calculations. Finally they agreed that perhaps the materialistic idea was after all too one-sided, as it only took into consideration the economic and commercial relations, and had forgotten to take into account one small matter, the feelings and thoughts of man, in a word, the psyche. They were sufficiently consistent to send emissaries immediately to German speaking countries, in order to obtain psychological works, so that they might get at least subsequently some knowledge of this neglected science. Many thousands of human lives fell victims, perhaps to no purpose, to this omission of the revolutionaries; the failure of their efforts resulted in their making one discovery however, namely, that of the mind.

A somewhat similar thing has occurred among neurologists during the war. The war has produced an enormous number of nervous disorders which call for elucidation and cure; however, the familiar organic-mechanistic explanation hitherto adopted—which in some way corresponds to the materialistic idea of history in sociology—completely failed. The mass-experiment of the war has produced various severe neuroses, including those in which there could be no question of a mechanical influence, and the neurologists have likewise been forced to recognise that something was missing in their calculations, and this something was again—the psyche.

To some extent we can forgive sociology for this omission; indeed the estimation of mental elements in the science of society has hitherto been in fact a very trifling one. However, we cannot spare neurologists the reproach of having so long disregarded the pioneer researches of Breuer and Freud concerning the psychical determination of many nervous disturbances, and of having required the terrible experiences of the war to set them right in this respect. And yet a science—psycho-analysis—has existed for more than twenty years to which many investigators had devoted the whole of their efforts, and which had helped us to unexpected and important knowledge of the mechanisms of mental life and its disturbances.

In my lecture today I shall confine myself to demonstrating the introduction of psycho-analysis into modern neurology, an introduction which has been effected to some small extent openly, but for the most part with hesitation and under false colours, and I will briefly communicate the theoretical principles upon which rest the psycho-analytical conceptions of the “traumatic neuroses” which have been observed during the war[1].

Soon after the outbreak of the war there flamed up again the great controversy, which had been carried on for more than ten years, concerning the nature of the traumatic neuroses which Oppenheim had in his time placed in a class by themselves. Oppenheim hastened to make use of the experiences of the war, which exposed so many thousands of men to sudden shocks, as supporting his old views, according to which the phenomena of these neuroses always came about, as the result of physical alterations in the nervous centres, (or in the peripheral nerves which secondarily affect those of the centre). The nature of the shock itself and its influence upon the method of functioning he described in very general, one might even say, phantastic terms. Links were “cut out” from the chain of the innervation mechanism, most delicate elements “displaced”, paths “blocked”, connections torn asunder, obstacles to conduction created, etc. With these and similar comparisons, from which, however, all basis in fact was tacking, Oppenheim sketched an impressive picture of the material correlation of the traumatic neuroses.

The alterations in structure which would take place in the brain through the trauma Oppenheim conceived as a delicate physical process similar to that which occurs in the iron filing when it comes into contact with the magnet.

The sarcastic Gaupp designates such specious physical and physiological speculations as brain mythology and molecular mythology. But in our opinion he does mythology an injustice.

The material brought forward by Oppenheim to support his views was in no way suited to uphold his abstruse theories. To be sure, he described with his usual precision characteristic symptoms, which this war has produced in deplorable numbers, and also gave to them somewhat high-sounding names (Akinesia amnestica, Myotonoklonia trepidans) that said nothing as to their nature; these descriptions, however, are not especially convincing with reference to his theoretical conceptions[2].

There were, it is true, many who agreed with Oppenheim’s views, though for the most part with limitations. Goldscheider holds that the cause of these nervous symptoms is partly physical and partly psychical; Cassierer, Schuster and Birnbaum are of the same opinion. Wollenberg’s question, as to whether the war neuroses were caused through emotion or shock, Aschaffenburg answered by stating that there was here concerned the joint effect of emotion and concussion. As one of the few who obstinately persisted in maintaining the mechanistic idea I will mention Lilienstein, who categorically demanded that the word and the concept of “mind”, also that of “functional” and “psychic”, and more especially that of “psycho-genesis” should be struck out of the medical terminology; he maintained that this would simplify the conflict and facilitate the investigation, treatment and examination of the casualties; the progressive anatomical technique would certainly sooner or later discover the material foundations of the neuroses.

We must here refer to the train of thought pursued by V. Sarbó, who seeks for the cause of the war neuroses in the microscopical destruction of tissue and hemorrhages in the central organ of the nervous system; these, he says, originate through direct concussion, sudden pressure of the cerebro-spinal fluid, compression of the spinal cord in the foramen magnum, etc. V. Sarbó’s theory is only supported by a few authors. In this connection I might mention Sachs and Freud, who consider that the shock puts the nerve cells into a condition of heightened excitability and exhaustability, which is then the immediate cause of the neuroses. Finally, Bauer and Fauser look upon the traumatic neuroses as the nervous results of disturbances of the endocrine glands produced by the shock, and as similar therefore to the post-traumatic Basedow’s disease.

Strümpell was one of the first to oppose the purely organic-mechanistic idea of the war neuroses. He had, moreover, for some time previously referred to certain psychical factors in the causation of the traumatic neuroses. He made the accurate observation that in railway accidents, etc., those who suffered from a severe neurosis were for the most part those who had an _interest_ in being able to prove an injury as caused by the trauma: for example, persons who were insured against accidents and wished to obtain a large sum of money, or those who instituted proceedings against the railway company for compensation for injury. Similar or much more severe shocks have, however, no lasting nervous results if the accident happens during sport through one’s own carelessness, especially under circumstances that exclude the hope of compensation for injury as those mentioned, so that the patient has no interest in remaining ill, but every interest in the speediest recovery. Strümpell asserts that the shock neuroses always develop secondarily and purely psycho-genetically as the result of desire of gain; he gave medical men the well-meant advice not to take seriously the complaints of these patients, like Oppenheim, but to bring them back as soon as possible to life and work through the smallest allowance or through withdrawal of their pension. The representations of Strümpell created a great impression in the medical world even in peace time; they led to the idea of the “compensation hysteria”; the sufferers, however, were treated not much better than if they were malingerers. Strümpell now suggests that the war neuroses are also neuroses of covetousness, which serve the patients’ purpose in getting free from the military authorities with the highest possible pension. Accordingly he demands a strict examination and expert opinion of the neuroses occurring in military persons. The content of the pathogenic ideas is always a wish—the wish for material compensation, for remaining far from infections and danger—and this wish acts along auto-suggestive paths in fixing more firmly the symptoms, the persistence of morbid sensations and of innervation disturbances of motility.

Much of the foregoing train of thought of Strümpell sounds to the analyst very probable. For he knows from his analytical experience that neurotic symptoms in general represent wish fulfilments, and also the fixation of unpleasant mental impressions and their pathogenic state is familiar to him. Still he has to reproach the one-sidedness of Strümpell’s train of thought: for instance, in the undue prominence of the cognitive aspect of the pathogenic experience and the neglect of its affective side, as well as the complete ignoring of the unconscious psychical processes, with which already Kurt Singer, Schuster and Gaupp had reproached him. Strümpell also has a presentiment that these neurotic forms of illness can only be explained by means of a psychical investigation; he does not, however, tell us his method of work with reference to this. Probably he understands by psychical exploration simply a careful questioning of the patient as to his material circumstances and concerning his motives for seeking a pension. We must on the other hand protect ourselves in that he calls this exploration “a method of individual psycho-analysis”. There is only one procedure that has a right to this name, that which the strict method of psycho-analysis has made its own.

As an argument in favour of the psycho-genesis of the war neuroses it is a remarkable fact, which has been pointed out by Mörchen, Bonhöffer and others, that the traumatic neuroses are practically never seen in prisoners of war. The prisoners of war have no interest in remaining sick after being captured, and they cannot reckon on compensation, pension and sympathy from their surroundings while they are away from home. They feel themselves in their captivity secure for the time being from the dangers of the war. The theory of the mechanistic shock can never explain to us this difference in the behaviour of our own soldiers and prisoners of war.

Evidence as regards the psycho-genesis rapidly accumulated. Schuster and many other observers refer to the disproportion between the trauma and its results on the nervous system. Severe neuroses arise from minimal shocks, while it is just the severe wounds accompanied by great shock that for the most part are not followed by nervous disturbances. Kurt Singer lays still greater stress on the disproportion between trauma and neurosis, and even endeavours to explain this fact psychologically: “In the kind of psychic trauma that comes on in a flash, in the terror, in the paralysing horror, we are concerned with cases of difficulty or impossibility of adaptation to the stimulus”. In a severe wound there is a discharge of the suddenly increased tension without anything further; when, however, no severe external injury exists the excessive affect is discharged “by means of a sudden abreaction through physical phenomena”. As the Freudian expression “abreaction” shows, psycho-analysis must have been in the mind of the writer when he thought out this theory. The expression sounds like a delayed response to the Breuer-Freudian conversion theory. However, it soon appears that Singer represents this process far too rationalistically; he looks upon the symptoms of the traumatic neuroses as the result of an effort on the part of the patient to find a comprehensible explanation of the (to him) inexplicable morbid process. Thus the work of this author is still far removed from the dynamic conception of the psychical processes of which psycho-analysis has taught us.