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STUDIES ON HYSTERIA (1893-1895) PREFACE TO THE FIRST EDITION In 1893 we published a Preliminary Communication! on a new method of examining and treating hysterical phenomena. To this we added as concisely as possible the theoretical conclusions at which we had arrived. We are here reprinting this Preliminary Communicat...
It would be a grave breach of confidence to publish material of this kind, with the risk of the patients being recognized and their acquaintances becoming informed of facts which were confided only to the physician. It has therefore been impossible for us to make use of some of the most instructive and convincing of ou...
J. BREUER, S. FREUD April 1895 On the Psychical Mechanism of Hysterical Phenomena, Neurologisches Centralblatt, 1893, Nos. and 2. PREFACE TO THE SECOND EDITION The interest which, to an ever-increasing degree, is being directed to psycho-analysis seems now to be extending to these Studies on Hysteria. The publisher des...
Even to-day I regard them not as errors but as valuable first approximations to knowledge which could only be fully acquired after long and continuous efforts. The attentive reader will be able to detect in the present book the germs of all that has since been added to the theory of catharsis: for instance, the part pl...
This is in part because what is in question is often some experience which the patient dislikes discussing; but principally because he is genuinely unable to recollect it and often has no suspicion of the causal connection between the precipitating event and the pathological phenomenon. As a rule it is necessary to hyp...
strictly related to the precipitating trauma as the phenomena to which we have just alluded and which exhibit the connection quite clearly. The symptoms which we have been able to trace back to precipitating factors of this sort include neuralgias and anaesthesias of very various kinds, many of which had persisted for ...
A girl, watching beside a sick-bed in a torment of anxiety, fell into a twilight state and had a terrifying hallucination, while her right arm, which was hanging over the back of the chair, went to sleep; from this there developed a paresis of the same arm accompanied by contracture and anaesthesia. She tried to pray b...
It consists only in what might be called a symbolic relation between the precipitating cause and the pathological phenomenon - a relation such as healthy people form in dreams. For instance, a neuralgia may follow upon mental pain or vomiting upon a feeling of moral disgust. We have studied patients who used to make th...
Any experience which calls up distressing affects - such as those of fright, anxiety, shame or physical pain - may operate as a trauma of this kind; and whether it in fact does so depends naturally enough on the susceptibility of the person affected (as well as on another condition which will be mentioned later). In th...
We must presume rather that the psychical trauma - or more precisely the memory of the trauma - acts like a foreign body which long after its entry must continue to be regarded as an agent that is still at work; and we find the evidence for this in a highly remarkable phenomenon which at the same time lends an importan...
comment le magnétiseur aide a la guérison. II remet le sujet dans 1état ot le mal sest manifesté et combat par la parole le méme mal, mais renaissant. (We can now explain how the hypnotist promotes cure. He puts the subject back into the state in which his trouble first appeared and uses words to combat that trouble, a...
The first case of this kind that came under observation dates back to the year 1881, that is to say to the pre-suggestion era. A highly complicated case of hysteria was analysed in this way, and the symptoms, which sprang from separate causes, were separately removed. This observation was made possible by spontaneous a...
We have found the nearest approach to what we have to say on the theoretical and therapeutic sides of the question in some remarks, published from time to time, by Benedikt. These we shall deal with elsewhere. im Ul At first sight it seems extraordinary that events experienced so long ago should continue to operate so ...
If the reaction is suppressed, the affect remains attached to the memory. An injury that has been repaid, even if only in words, is recollected quite differently from one that has had to be accepted. Language recognizes this distinction, too, in its mental and physical consequences; it very characteristically describes...
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. Again, a persons memory of a humiliation is corrected by his putting the facts right, by considering his...
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 th...
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...
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 b...
In so doing, we have already been obliged to speak of abnormal states of consciousness in which these pathogenic ideas arise, and to emphasize the fact that the recollection of the operative psychical trauma is not to be found in the patients normal memory but in his memory when he is hypnotized. The longer we have bee...
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...
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. 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-dream...
Charcot, as is well known, has given us a schematic description of the major hysterical attack, according to which four phases can be distinguished in a complete attack: (1) the epileptoid phase, (2) the phase of large movements, (3) the phase of attitudes passionelles (the hallucinatory phase), and (4) the phase of te...
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 a...
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 tu...
The motor phenomena of hysterical attacks can be interpreted partly as universal forms of reaction appropriate to the affect accompanying the memory (such as kicking about and waving the arms and legs, which even young babies do), partly as a direct expression of these memories; but in part, like the hysterical stigmat...
During the attack, control over the whole of the somatic innervation passes over to the hypnoid consciousness. Normal consciousness, as well-known observations show, is not always entirely repressed. It may even be aware of the motor phenomena of the attack, while the accompanying psychical events are outside its knowl...
It can be provoked either by stimulation of a hysterogenic zone or by a new experience which sets it going owing to a similarity with the pathogenic experience. We hope to be able to show that these two kinds of determinant, though they appear to be so unlike, do not differ in essentials, but that in both a hyperaesthe...
19 Vv It will now be understood how it is that the psychotherapeutic procedure which we have described in these pages has a curative effect. Jt brings to an end the operative force of the idea which was not abreacted in the first instance, by allowing its strangulated affect to find a way out through speech; and it sub...
If by uncovering the psychical mechanism of hysterical phenomena we have taken a step forward along the path first traced so successfully by Charcot with his explanation and artificial imitation of hystero-traumatic paralyses, we cannot conceal from ourselves that this has brought us nearer to an understanding only of ...
She had great poetic and imaginative gifts, which were under the control of a sharp and critical common sense. Owing to this latter quality she was completely unsuggestible; she was only influenced by arguments, never by mere assertions. Her willpower was energetic, tenacious and persistent; sometimes it reached the pi...
While everyone thought she was attending, she was living through fairy tales in her imagination; but she was always on the spot when she was spoken to, so that no one was aware of it. She pursued this activity almost continuously while she was engaged on her household duties, which she discharged unexceptionably. I sha...
A number of chronic symptoms persisted till December, 1881. (D) Gradual cessation of the pathological states and symptoms up to June, 1882. In July, 1880, the patients father, of whom she was passionately fond, fell ill of a peripleuritic abscess which failed to clear up to which he succumbed in April, 1881. During the...
There developed in rapid succession a series of severe disturbances which were apparently quite new: left-sided occipital headache; convergent squint (diplopia), markedly increased by excitement; complaints that the walls of the room seemed to be falling over (affection of the obliquus); disturbances of vision which it...
feelings of anxiety. It was while the patient was in this condition that I under took her treatment, and I at once recognized the seriousness of the psychical disturbance with which I had to deal. Two entirely distinct states of consciousness were present which alternated very frequently and without warning and which b...
These interruptions gradually increased till they reached the dimensions that have just been described; and during the climax of the illness, when the contractures had extended to the left side of her body, it was only for a short time during the day that she was to any degree normal. But the disturbances invaded even ...
Later she lost her command of grammar and syntax; she no longer conjugated verbs, and eventually she used only infinitives, for the most part incorrectly formed from weak past participles; and she omitted both the definite and indefinite article. In the process of time she became almost completely deprived of words. Sh...
When I guessed this and obliged her to talk about it, the inhibition, which had made any other kind of utterance impossible as well, disappeared. This change coincided with a return of the power of movement to the extremities of the left side of her body, in March, 1881. Her paraphasia receded; but thenceforward she sp...
A violent outburst of excitement was succeeded by profound stupor which lasted about two days and from which she emerged in a greatly changed state. At first she was far quieter and her feelings of anxiety were much diminished. The contracture of her right arm and leg persisted as well as their anaesthesia, though this...
contact with things and lively, except for the sudden interruptions caused by one of her hallucinatory absences. She now spoke only English and could not understand what was said to her in German. Those about her were obliged to talk to her in English; even the nurse learned to make herself to some extent understood in...
Some ten days after her fathers death a consultant was brought in, whom, like all strangers, she completely ignored while I demonstrated all her peculiarities to him. Thats like an examination,! she said, laughing, when I got her to read a French text aloud in English. The other physician intervened in the conversation...
If during this she was able to narrate the hallucinations she had had in the course of the day, she would wake up clear in mind, calm and cheerful. She would sit down to work and write or draw far into the night quite rationally. At about four she would go to bed. Next day the whole series of events would be repeated. ...
I had never threatened her with this removal from her home, which she regarded with horror, but she herself had, without saying so, expected and dreaded it. This event made it clear once more how much the affect of anxiety dominated her psychical disorder. Just as after her fathers death a calmer condition had set in, ...
This pattern of waking at night and sleeping in the afternoons seems to have been carried over into her own illness and to have persisted long after the sleep had been replaced by a hypnotic state.) After the deep sleep had lasted about an hour she grew restless, tossed to and fro and kept repeating tormenting, torment...
charming, in the style of Hans Andersens Picture-book without Pictures, and, indeed, they were probably constructed on that model. As a rule their starting-point or central situation was of a girl anxiously sitting by a sick-bed. But she also built up her stories on quite other topics. - A few moments after she had fin...
It was not, however, until the deterioration of her mental condition, which followed when her state of somnambulism was forcibly broken into in the way already described, that her evening narratives ceased to have the character of more or less freely-created poetical compositions and changed into a string of frightful ...
She aptly described this procedure, speaking seriously, as a talking cure, while she referred to it jokingly as chimney-sweeping. She knew that after she had given utterance to her hallucinations she would lose all her obstinacy and what she described as her energy; and when, after some comparatively long interval, she...
I had been able to avoid the use of narcotics, since the verbal utterance of her hallucinations calmed her even though it might not induce sleep; but when she was in the country the nights on which she had not obtained hypnotic relief were so unbearable that in spite of everything it was necessary to have recourse to c...
On one occasion, though, her pet made an attack on a cat, and it was splendid to see the way in which the frail girl seized a whip in her left hand and beat off the huge beast with it to rescue his victim. Later, she looked after some poor, sick people, and this helped her greatly. It was after I returned from a holida...
But the situation only became tolerable after I had arranged for the patient to be brought back to Vienna for a week and evening after evening made her tell me three to five stories. When I had accomplished this, everything that had accumulated during the weeks of my absence had been worked off. It was only now that th...
In December there was a marked deterioration of her psychical condition. She once more became excited, gloomy and irritable. She had no more really good days even when it was impossible to detect anything that was remaining stuck inside her. To wards the end of December, at Christmas time, she was particularly restless...
She was carried back to the previous year with such intensity that in the new house she hallucinated her old room, so that when she wanted to go to the door she knocked up against the stove which stood in the same relation to the window as the door did in the old room. The change-over from one state to another occurred...
It was interesting here, too, to observe the way in which these revived psychical stimuli belonging to her secondary state made their way over into her first, more normal one. It happened, for instance, that one morning the patient said to me laughingly that she had no idea what was the matter but she was angry with me...
(Fortunately I had already relieved her at the time of the imaginative products of that year.) But in addition to all this the work that had to be done by the patient and her physician was immensely increased by a third group of separate disturbances which had to be disposed of in the same manner. These were the psychi...
This had lasted for some six weeks, when one day during hypnosis she grumbled about her English lady-companion whom she did not care for, and went on to describe, with every sign of disgust, how she had once gone into that ladys room and how her little dog - horrid creature! - had drunk out of a glass there. The patien...
Each individual symptom in this complicated case was taken separately in hand; all the occasions on which it had appeared were described in reverse order, starting before the time when the patient became bed-ridden and going back to the event which had led to its first appearance. When this had been described the sympt...
It turned out to be quite impracticable to shorten the work by trying to elicit in her memory straight away the first provoking cause of her symptoms. She was unable to find it, grew confused, and things proceeded even more slowly than if she was allowed quietly and steadily to follow back the thread of memories on whi...
During her subsequent evening hypnosis she would then, with the help of my notes, give me a fairly detailed account of these circumstances. An example will show the exhaustive manner in which she accomplished this. It was our regular experience that the patient did not hear when she was spoken to. It was possible to di...
Of course all these episodes were to a great extent identical in so far as they could be traced back to states of abstraction or absences or to fright. But in the patients memory they were so clearly differentiated, that if she happened to make a mistake in their sequence she would be obliged to correct herself and put...
While she was nursing her father she had seen him with a deaths head. She and the people with her remembered that once, while she still appeared to be in good health, she had paid a visit to one of her relatives. She had opened the door and all at once fallen down unconscious. In order to get over the obstruction to ou...
Thus when she woke up in the night she found herself in a strange room, for her family had moved house in the spring of 1881. Disagreeable events of this kind were avoided by my always (at her request) shutting her eyes in the evening and giving her a suggestion that she would not be able to open them till I did so mys...
right arm over the back of her chair. She fell into a waking dream and saw a black snake coming towards the sick man from the wall to bite him. (It is most likely that there were in fact snakes in the field behind the house and that these had previously given the girl a fright; they would thus have provided the materia...
Thenceforward the same thing invariably occurred whenever the hallucination was recalled by some object with a more or less snake-like appearance. This hallucination, however, as well as the contracture only appeared during the short absences which became more and more frequent from that night onwards. (The contracture...
Thus we were able to trace back all of her different disturbances of vision to different, more or less clearly determining causes. For instance, on one occasion, when she was sitting by her fathers bedside with tears in her eyes, he suddenly asked her what time it was. She could not see clearly; she made a great effort...
Thereafter, throughout the whole length of her illness she reacted to any markedly rhythmical music with a fussis nervosa. I cannot feel much regret that the incompleteness of my notes makes it impossible for me to enumerate all the occasions on which her various hysterical symptoms appeared. She herself told me them i...
40 Although I have suppressed a large number of quite interesting details, this case history of Anna O. has grown bulkier than would seem to be required for a hysterical illness that was not in itself of an unusual character. It was, however, impossible to describe the case without entering into details, and its featur...
Reveries and reflections during a more or less mechanical occupation do not in themselves imply a pathological splitting of consciousness, since if they are interrupted - if, for instance, the subject is spoken to - the normal unity of consciousness is restored; nor, presumably, is any amnesia present. In the case of A...
41 But whereas the paralysis experimentally provoked by Charcot in his patients became stabilized immediately, and whereas the paralysis caused in sufferers from traumatic neuroses by a severe traumatic shock sets in at once, the nervous system of this girl put up a successful resistance for four months. Her contractur...
affect would have the same result as an absence (though, indeed, it is possible that such affects actually caused a temporary absence in every case); chance coincidences set up pathological associations and sensory or motor disturbances, which thenceforward appeared along with the affect. But hitherto this only occurre...
It cannot be disputed, however, that precisely her consistency may have led her (in perfectly good faith) to assign to some of her symptoms a precipitating cause which they did not in fact possess. But this suspicion, too, I consider unjustified. The very insignificance of so many of those causes, the irrational charac...
I may advance in support of this view the fact that in the present case, too, the story of the development of the illness would have remained completely unknown alike to the patient and the physician if it had not been for her peculiarity of remembering things in hypnosis, as I have described, and of relating what she ...
Provisionally we can only express the view that trains of events similar to those here described occur more commonly than our ignorance of the pathogenic mechanism concerned has led us to suppose. When the patient had become confined to her bed, and her consciousness was constantly oscillating between her normal and he...
44 Throughout the entire illness her two states of consciousness persisted side by side: the primary one in which she was quite normal psychically, and the secondary one which may well be likened to a dream in view of its wealth of imaginative products and hallucinations, its large gaps of memory and the lack of inhibi...
what has given rise to a number of unexplained problems in many other hysterical patients. It was especially noticeable in Anna O. how much the products of her bad self, as she herself called it, affected her moral habit of mind. If these products had not been continually disposed of, we should have been faced by a hys...
Similar observations, as we know, have frequently been made. When a disorder of this kind has cleared up and the two states of consciousness have once more become merged into one, the patients, looking back to the past, see themselves as the single undivided personality which was aware of all the nonsense; they think t...
I had a very strong impression that the numerous products of her secondary state which had been quiescent were now forcing their way into consciousness; and though in the first instance they were being remembered only in her secondary state, they were nevertheless burdening and disturbing her normal one. It remains to ...
I was still far from having mastered it; in fact I did not carry the analysis of the symptoms far enough nor pursue it systematically enough. I shall perhaps be able best to give a picture of the patients condition and my medical procedure by reproducing the notes which I made each evening during the first three weeks ...
This clacking was made up of a number of sounds. Colleagues of mine with sporting experience told me, on hearing it, that its final notes resembled the call of a capercaillie. 47 What she told me was perfectly coherent and revealed an unusual degree of education and intelligence. This made it seem all the more strange ...
explaining or apologizing for her behaviour - probably, therefore, without herself having noticed the interpolation. I learned what follows of her circumstances. Her family came from Central Germany, but had been settled for two generations in the Baltic Provinces of Russia, where it possessed large estates. She was on...
For several months she has once more been very ill, suffering from depression and insomnia, and tormented with pains; she went to Abbazia in the vain hope of improvement, and for the last six weeks has been in Vienna, up till now in the care of a physician of outstanding merit. I suggested that she should separate from...
But even so, she still made a grimace and gave a jump every time anyone entered. Her chief complaint to-day was of sensations of cold and pain in her left leg which proceeded from her back above the iliac crest. I ordered her to be given warm baths and I shall massage her whole body twice a day. She is an excellent sub...
This treatment by warm baths, massage twice a day and hypnotic suggestion was continued for the next few days. She slept well, got visibly better, and passed most of the day lying quietly in bed. She was not forbidden to see her children, to read, or to deal with her correspondence. Every time she woke from hypnosis sh...
Dr. K. had told her that he had sent a whole case of white rats to Tiflis. As she told me this she demonstrated every sign of horror. She clenched and unclenched her hand several times. Keep still! - Dont say anything! - Dont touch me! - Supposing a creature like that was in the bed! (She shuddered.) Only think, when i...
her. On the occasion when I first visited her I asked her how old she was and she answered quite seriously: I am a woman dating from last century. Some weeks later she explained to me she had been thinking at the time in her delirium of a beautiful old cupboard which, as a connoisseur of old furniture, she had bought i...
Then I was frightened again when I was seven and I unexpectedly saw my sister in her coffin; and again when I was eight and my brother terrified me so often by dressing up in sheets like a ghost; and again when I was nine and I saw my aunt in her coffin and her jaw suddenly dropped. This series of traumatic precipitati...
them before her. To give support to my suggestion I stroked her several times over the eyes. May 9. - Without my having given her any further suggestion, she had slept well. But she had gastric pains in the morning. They came on yesterday in the garden where, she stayed out too long with her children. She agreed to my ...
I then asked her whether she had always spoken with a stammer and how long she had had her fic (the peculiar clacking sound). Her stammering, she said, had come on while she was ill; she had had the fic for the last five years, ever since a time when she this was sitting by the bedside of her younger daughter who was v...
For the first time she was cheerful and talkative and gave evidence of a sense of humour that I should not have expected in such a serious woman; and, among other things, in the strong feeling that she was better, she made fun of her treatment by my medical predecessor. She had long intended, she said, to give up that ...
One of them was of how she saw a female cousin taken off to an insane asylum (when she was fifteen). She tried to call for help but was unable to, and lost her power of speech till the evening of the same day. Since she talked so often about asylums in her waking state, I interrupted her and asked on what other occasio...
- Another memory was how, at nineteen, she lifted up a stone and found a toad under it, which made her lose her power of speech for hours afterwards. During this hypnosis I convinced myself that she knew everything that happened in the last hypnosis, whereas in waking life she knows nothing of it. A special kind of sym...
So each time even while I am massaging her, my influence has already begun to affect her; she grows quieter and clearer in the head, and even without questioning under hypnosis can discover the cause of her ill-humour on that day. Nor is her conversation during the massage so aimless as would appear. On the contrary, i...
Under hypnosis I repeated my question as to what it was that had made her upset and I got the same answers but in the reverse order: (1) her indiscreet talk yesterday, and (2) her pains caused by her being so uncomfortable in the bath. - I asked her to-day the meaning of her phrase Keep still!, etc. She explained that ...
Incidentally, all the accounts she gave of traumas arranged like these in groups began with a how, the component traumas being separated by an and. Since I noticed that the protective formula was designed to safeguard her against a recurrence of such experiences, I removed this fear by suggestion, and in fact I never h...
Under hypnosis, I also asked her whether she remembered the last thing she told me; in asking this what I had in mind was a task which had been left over from yesterday evening; but she began quite correctly with the dont touch me from this mornings hypnosis. So I took her back to yesterdays topic. I had asked her the ...
She appeared to try to do this and remained quiet as she did so; and from now on she spoke in the hypnosis without any spastic impediment.* A suggestion which was carried out. ? It is possible that this answer, I dont know, was correct; but it may quite as well have indicated reluctance to talk about the causes of the ...
visiting a Frenchwoman who was a friend of hers, and had been sent into the next room with another girl to fetch a dictionary, and had then seen someone sit up in the bed who looked exactly like the woman she had just left behind in the other room. She went stiff all over and was rooted to the spot. She learnt afterwar...
How they had a friend staying at her home who liked slipping into the room very softly so that all of a sudden he was there; how she had been so ill after her mothers death and had gone to a health resort and a lunatic had walked into her room several times at night by mistake and come right up to her bed; and lastly, ...
She did not know, she said; she was just afraid. Under hypnosis, which I induced before my colleague arrived, she declared that she was afraid she had offended me by something she had said during the massage yesterday which seemed to her to have been impolite. She was frightened of anything new, too, and consequently o...
I got her to describe this event to me in full detail, and this she did with every sign of deepest emotion but without any clacking or stammering: - How, she began, they had been at a place on the Riviera of which they were both very fond, and while they were crossing a bridge he had suddenly sunk to the ground and lai...
This child, she said, had been very queer for a long time; it had screamed all the time and did not sleep, and it had developed a paralysis of the left leg which there had seemed very little hope of curing. When it was four it had had visions; it had been late in learning to walk and to talk, so that for a long time it...
When, as much as eighteen months later, I saw Frau Emmy again in a relatively good state of health, she complained that there were a number of most important moments in her life of which she had only the vaguest memory. She regarded this as evidence of a weakening of her memory, and I had to be careful not to tell her ...

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