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If it is true of the destructive instinct as well that the ego but what we have in mind here is rather the id virus 2014 symptoms buy zithromax 250mg, the whole person originally includes all the instinctual impulses antibiotic resistant germs order zithromax 250 mg on-line, we are led to bacteria images zithromax 250mg visa the view that masochism is older than sadism antibiotics for recurrent uti buy generic zithromax 250mg on line, and that sadism is the destructive instinct directed outwards, thus acquiring the characteristic of aggressiveness. A certain amount of the original destructive instinct may still remain in the interior. It seems that we can only perceive it under two conditions: if it is combined with erotic instincts into masochism or if with a greater or lesser erotic addition it is directed against the external world as aggressiveness. And now we are struck by the significance of the possibility that the aggressiveness may not be able to find satisfaction in the external world because it comes up against real obstacles. If this happens, it will perhaps retreat and increase the amount of self-destructiveness holding sway in the interior. We shall hear how this is in fact what occurs and how important a process this is. It really seems as though it is necessary for us to destroy some other thing or person in order not to destroy ourselves, in order to guard against the impulsion to self-destruction. New Introductory Lectures On Psycho-Analysis 4710 But the moralist will console himself for a long time to come with the improbability of our speculations. Poets, it is true, talk of such things; but poets are irresponsible people and enjoy the privilege of poetic licence. Incidentally, such ideas are not foreign even to physiology: consider the notion, for instance, of the mucous membrane of the stomach digesting itself. It must be admitted, however, that our self-destructive instinct calls for support on a wider basis. One cannot, after all, venture on a hypothesis of such a wide range merely because a few poor fools have linked their sexual satisfaction to a peculiar condition. The instincts rule not only mental but also vegetative life, and these organic instincts exhibit a characteristic which deserves our deepest interest. We may suppose that from the moment at which a state of things that has once been attained is upset, an instinct arises to create it afresh and brings about phenomena which we can describe as a ‘compulsion to repeat’. A power of regenerating lost organs extends far up into the animal kingdom, and the instinct for recovery to which, alongside of therapeutic assistance, our cures are due must be the residue of this capacity which is so enormously developed in the lower animals. The spawning migrations of fishes, the migratory flights of birds, and possibly all that we describe as manifestations of instinct in animals, take place under the orders of the compulsion to repeat, which expresses the conservative nature of the instincts. We have been struck by the fact that the forgotten and repressed experiences of childhood are reproduced during the work of analysis in dreams and reactions, particularly in those occurring in the transference, although their revival runs counter to the interest of the pleasure principle; and we have explained this by supposing that in these cases a compulsion to repeat is overcoming even the pleasure principle. There are people in whose lives the same reactions are perpetually being repeated uncorrected, to their own detriment, or others who seem to be pursued by a relentless fate, though closer investigation teaches us that they are unwittingly bringing this fate on themselves. New Introductory Lectures On Psycho-Analysis 4711 But how can this conservative characteristic of instincts help us to understand our self-destructivenessfi If it is true that at some immeasurably remote time and in a manner we cannot conceive life once proceeded out of inorganic matter, then, according to our presumption, an instinct must have arisen which sought to do away with life once more and to re-establish the inorganic state. If we recognize in this instinct the self-destructiveness of our hypothesis, we may regard the self- destructiveness as an expression of a ‘death instinct’ which cannot fail to be present in every vital process. And now the instincts that we believe in divide themselves into two groups the erotic instincts, which seek to combine more and more living substance into ever greater unities, and the death instincts, which oppose this effort and lead what is living back into an inorganic state. From the concurrent and opposing action of these two proceed the phenomena of life which are brought to an end by death. You may perhaps shrug your shoulders and say: ‘That isn’t natural science, it’s Schopenhauer’s philosophy! Moreover, there is nothing that has not been said already, and similar things had been said by many people before Schopenhauer. We are not asserting that death is the only aim of life; we are not overlooking the fact that there is life as well as death. How the two of them are mingled in the process of living, how the death instinct is made to serve the purposes of Eros, especially by being turned outwards as aggressiveness these are tasks which are left to future investigation. The question, too, of whether the conservative character may not belong to all instincts without exception, whether the erotic instincts as well may not be seeking to bring back an earlier state of things when they strive to bring about a synthesis of living things into greater unities this question, too, we must leave unanswered. New Introductory Lectures On Psycho-Analysis 4712 We have travelled somewhat far from our basis. I will tell you in retrospect the starting-point of these reflections on the theory of the instincts. It was the same as that which led us to revise the relation between the ego and the unconscious the impression derived from the work of analysis that the patient who puts up a resistance is so often unaware of that resistance. Not only the fact of the resistance is unconscious to him, however, but its motives as well. We were obliged to search out these motives or motive, and to our surprise we found them in a powerful need for punishment which we could only class with masochistic wishes. The practical significance of this discovery is not less than its theoretical one, for the need for punishment is the worst enemy of our therapeutic efforts. It is satisfied by the suffering which is linked to the neurosis, and for that reason holds fast to being ill. It seems that this factor, an unconscious need for punishment, has a share in every neurotic illness. And here those cases in which the neurotic suffering can be replaced by suffering of another kind are wholly convincing. I once succeeded in freeing an unmarried woman, no longer young, from the complex of symptoms which had condemned her for some fifteen years to an existence of torment and had excluded her from any participation in life. She now felt she was well, and she plunged into eager activity, in order to develop her by no means small talent and to snatch a little recognition, enjoyment, and success, late though the moment was. But every one of her attempts ended either with people letting her know or with herself recognizing that she was too old to accomplish anything in that field. After each outcome of this kind a relapse into illness would have been the obvious thing, but she was no longer able to bring that about. Instead, she met each time with an accident which put her out of action for a time and caused her suffering. She fell down and sprained her ankle or hurt her knee, or she injured her hand in something she was doing. When she was made aware of how great her own share might be in these apparent accidents, she, so to say, changed her technique. Instead of accidents, indispositions appeared on the same provocations catarrhs, sore throats, influenzal conditions, rheumatic swellings till at last she made up her mind to resign her attempts and the whole agitation came to an end. New Introductory Lectures On Psycho-Analysis 4713 There is, as we think, no doubt about the origin of this unconscious need for punishment. It behaves like a piece of conscience, like a prolongation of our conscience into the unconscious; and it must have the same origin as conscience and correspond, therefore, to a piece of aggressiveness that has been internalized and taken over by the super-ego. If only the words went together better, we should be justified for all practical purposes in calling it an ‘unconscious sense of guilt’. Theoretically we are in fact in doubt whether we should suppose that all the aggressiveness that has returned from the external world is bound by the super-ego and accordingly turned against the ego, or that a part of it is carrying on its mute and uncanny activity as a free destructive instinct in the ego and the id. A distribution of the latter kind is the more probable; but we know nothing more about it. There is no doubt that, when the super-ego was first instituted, in equipping that agency use was made of the piece of the child’s aggressiveness towards his parents for which he was unable to effect a discharge outwards on account of his erotic fixation as well as of external difficulties; and for that reason the severity of the super-ego need not simply correspond to the strictness of the upbringing. It is very possible that, when there are later occasions for suppressing aggressiveness, the instinct may take the same path that was opened to it at that decisive point of time. New Introductory Lectures On Psycho-Analysis 4714 People in whom this unconscious sense of guilt is excessively strong betray themselves in analytic treatment by the negative therapeutic reaction which is so disagreeable from the prognostic point of view. When one has given them the solution of a symptom, which should normally be followed by at least its temporary disappearance, what they produce instead is a momentary exacerbation of the symptom and of the illness. It is often enough to praise them for their behaviour in the treatment or to say a few hopeful words about the progress of the analysis in order to bring about an unmistakable worsening of their condition. If you follow the analytic way of thinking, you will see in this behaviour a manifestation of the unconscious sense of guilt, for which being ill, with its sufferings and impediments, is just what is wanted. The problems which the unconscious sense of guilt has opened up, its connections with morality, education, crime and delinquency, are at present the preferred field of work for psycho-analysts. And here, at an unexpected point, we have emerged from the psychical underworld into the open market- place. I cannot lead you any further, but before I take leave of you for to-day I must detain you with one more train of thought. It has become our habit to say that our civilization has been built up at the cost of sexual trends which, being inhibited by society, are partly, it is true, repressed but have partly been made usable for other aims.

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They are put forward as the epitomized result of a longer process of thought based on observation and certainly also on inferences antibiotic resistance rates discount 250mg zithromax overnight delivery. If anyone wants to access virus buy cheap zithromax 500 mg on-line go through this process himself instead of accepting its result antibiotic gastritis buy zithromax 500 mg, they show him how to bacteria 3 types order zithromax 500 mg with mastercard set about it. Moreover, we are always in addition given the source of the knowledge conveyed by them, where that source is not self-evident, as it is in the case of geographical assertions. For instance, the earth is shaped like a sphere; the proofs adduced for this are Foucault’s pendulum experiment, the behaviour of the horizon and the possibility of circumnavigating the earth. Since it is impracticable, as everyone concerned realizes, to send every schoolchild on a voyage round the world, we are satisfied with letting what is taught at school be taken on trust; but we know that the path to acquiring a personal conviction remains open. When we ask on what their claim to be believed is founded, we are met with three answers, which harmonize remarkably badly with one another. Firstly, these teachings deserve to be believed because they were already believed by our primal ancestors; secondly, we possess proofs which have been handed down to us from those same primaeval times; and thirdly, it is forbidden to raise the question of their authentication at all. In former days anything so presumptuous was visited with the severest penalties, and even to-day society looks askance at any attempt to raise the question again. After all, a prohibition like this can only be for one reason that society is very well aware of the insecurity of the claim it makes on behalf of its religious doctrines. Otherwise it would certainly be very ready to put the necessary data at the disposal of anyone who wanted to arrive at conviction. This being so, it is with a feeling of mistrust which it is hard to allay that we pass on to an examination of the other two grounds of proof. They believed in things we could not possibly accept to-day; and the possibility occurs to us that the doctrines of religion may belong to that class too. The proofs they have left us are set down in writings which themselves bear every mark of untrustworthiness. They are full of contradictions, revisions and falsifications, and where they speak of factual confirmations they are themselves unconfirmed. It does not help much to have it asserted that their wording, or even their content only, originates from divine revelation; for this assertion is itself one of the doctrines whose authenticity is under examination, and no proposition can be a proof of itself. The Future Of An Illusion 4439 Thus we arrive at the singular conclusion that of all the information provided by our cultural assets it is precisely the elements which might be of the greatest importance to us and which have the task of solving the riddles of the universe and of reconciling us to the sufferings of life it is precisely those elements that are the least well authenticated of any. We should not be able to bring ourselves to accept anything of so little concern to us as the fact that whales bear young instead of laying eggs, if it were not capable of better proof than this. And let no one suppose that what I have said about the impossibility of proving the truth of religious doctrines contains anything new. It has been felt at all times undoubtedly, too, by the ancestors who bequeathed us this legacy. Many of them probably nourished the same doubts as ours, but the pressure imposed on them was too strong for them to have dared to utter them. And since then countless people have been tormented by similar doubts, and have striven to suppress them, because they thought it was their duty to believe; many brilliant intellects have broken down over this conflict, and many characters have been impaired by the compromises with which they have tried to find a way out of it. If all the evidence put forward for the authenticity of religious teachings originates in the past, it is natural to look round and see whether the present, about which it is easier to form judgements, may not also be able to furnish evidence of the sort. If by this means we could succeed in clearing even a single portion of the religious system from doubt, the whole of it would gain enormously in credibility. The proceedings of the spiritualists meet us at this point; they are convinced of the survival of the individual soul and they seek to demonstrate to us beyond doubt the truth of this one religious doctrine. Unfortunately they cannot succeed in refuting the fact that the appearance and utterances of their spirits are merely the products of their own mental activity. They have called up the spirits of the greatest men and of the most eminent thinkers, but all the pronouncements and information which they have received from them have been so foolish and so wretchedly meaningless that one can find nothing credible in them but the capacity of the spirits to adapt themselves to the circle of people who have conjured them up. The Future Of An Illusion 4440 I must now mention two attempts that have been made both of which convey the impression of being desperate efforts to evade the problem. It maintains that religious doctrines are outside the jurisdiction of reason are above reason. If the truth of religious doctrines is dependent on an inner experience which bears witness to that truth, what is one to do about the many people who do not have this rare experiencefi One may require every man to use the gift of reason which he possesses, but one cannot erect, on the basis of a motive that exists only for a very few, an obligation that shall apply to everyone. If one man has gained an unshakable conviction of the true reality of religious doctrines from a state of ecstasy which has deeply moved him, of what significance is that to othersfi This asserts that our thought-activity includes a great number of hypotheses whose groundlessness and even absurdity we fully realize. They are called ‘fictions’, but for a variety of practical reasons we have to behave ‘as if’ we believed in these fictions. This is the case with religious doctrines because of their incomparable importance for the maintenance of human society. But I think the demand made by the ‘As if’ argument is one that only a philosopher could put forward. A man whose thinking is not influenced by the artifices of philosophy will never be able to accept it; in such a man’s view, the admission that something is absurd or contrary to reason leaves no more to be said. It cannot be expected of him that precisely in treating his most important interests he shall forgo the guarantees he requires for all his ordinary activities. I am reminded of one of my children who was distinguished at an early age by a peculiarly marked matter-of-factness. When the children were being told a fairy story and were listening to it with rapt attention, he would come up and ask: ‘Is that a true storyfi We may expect that people will soon behave in the same way towards the fairy tales of religion, in spite of the advocacy of ‘As if’. But at present they still behave quite differently; and in past times religious ideas, in spite of their incontrovertible lack of authentication, have exercised the strongest possible influence on mankind. We must ask where the inner force of those doctrines lies and to what it is that they owe their efficacy, independent as it is of recognition by reason. Nor is it our object so to deprive them for as practical fictions we leave them all intact; they perish only as theoretical truths. It will be found if we turn our attention to the psychical origin of religious ideas. These, which are given out as teachings, are not precipitates of experience or end-results of thinking: they are illusions, fulfilments of the oldest, strongest and most urgent wishes of mankind. As we already know, the terrifying impression of helplessness in childhood arouses the need for protection for protection through love which was provided by the father; and the recognition that this helplessness lasts throughout life made it necessary to cling to the existence of a father, but this time a more powerful one. Thus the benevolent rule of a divine Providence allays our fear of the dangers of life; the establishment of a moral world-order ensures the fulfilment of the demands of justice, which have so often remained unfulfilled in human civilization; and the prolongation of earthly existence in a future life provides the local and temporal framework in which these wish-fulfilments shall take place. Answers to the riddles that tempt the curiosity of man, such as how the universe began or what the relation is between body and mind, are developed in conformity with the underlying assumptions of this system. It is an enormous relief to the individual psyche if the conflicts of its childhood arising from the father-complex conflicts which it has never wholly overcome are removed from it and brought to a solution which is universally accepted. When I say that these things are all illusions, I must define the meaning of the word. Aristotle’s belief that vermin are developed out of dung (a belief to which ignorant people still cling) was an error; so was the belief of a former generation of doctors that tabes dorsalis is the result of sexual excess. On the other hand, it was an illusion of Columbus’s that he had discovered a new sea-route to the Indies. One may describe as an illusion the assertion made by certain nationalists that the Indo-Germanic race is the only one capable of civilization; or the belief, which was only destroyed by psycho-analysis, that children are creatures without sexuality. But they differ from them, too, apart from the more complicated structure of delusions. In the case of delusions, we emphasize as essential their being in contradiction with reality. Illusions need not necessarily be false that is to say, unrealizable or in contradiction to reality. For instance, a middle-class girl may have the illusion that a prince will come and marry her. Whether one classifies this belief as an illusion or as something analogous to a delusion will depend on one’s personal attitude. Examples of illusions which have proved true are not easy to find, but the illusion of the alchemists that all metals can be turned into gold might be one of them. The wish to have a great deal of gold, as much gold as possible, has, it is true, been a good deal damped by our present-day knowledge of the determinants of wealth, but chemistry no longer regards the transmutation of metals into gold as impossible. Thus we call a belief an illusion when a wish-fulfilment is a prominent factor in its motivation, and in doing so we disregard its relations to reality, just as the illusion itself sets no store by verification.

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The French words “balance” and “balcon” (meaning “balance” and “balcony”) begin with different syllables (“ba” in “balance” and “bal” in “balcon”) antibiotics for urine/kidney infection buy 250mg zithromax otc. Native French speakers find it easy detect “ba” in “balance” and “bal” in “balcon” antibiotics for recurrent uti trusted 500mg zithromax. On the other hand bacteria 2 game generic zithromax 500 mg on-line, they take longer to antibiotic resistance how does it occur effective zithromax 500 mg find the “bal” in “balance” and “ba” in “balcon” because although these sounds are present, they do not correspond to the syllables. The syllable structure of the English word “balance” is far less clear; people are uncertain to which syllable the “1” sound belongs. Hence the time it takes English speakers to detect “ba” and “bal” does not vary with the syllable structure of the word they hear (“balance” or “balcony”). It is as though the segmentation strategy is fixed at an early age, and only that strategy is developed further. This is not as big a disadvantage as it might seem: efficient bilinguals are able to discard ineffective segmentation processes and use other, more general, analytical processes instead (Cutler et al, 1986, 1992). Categorical perception Even though there is all this variation in the way in which phonemes can sound, we rarely, if ever, notice these differences. This phenomenon is known as the categorical perception of phonemes (first demonstrated by Liberman, Harris, Hoffman & Griffith, 1957). In spite of the continuum, participants placed these syllables into three quite distinct categories beginning with /b/, /d/, and /g/. The pairs /p/ and /b/, and /t/ and /d/ differ only in this minimal feature of voicing. Although this is midway between the two extremes, we actually categorize such sounds as being either simply voiced or unvoiced —exactly which may differ from time to time and person to person, and people can actually be biased towards one end of the continuum or the other. It is possible to fatigue the feature detectors hypothesized to be responsible for categorical perception by repeated exposure to a sound, and to shift perception towards the other end of the continuum (Eimas & Corbit, 1973). For example, repeated presentation of the syllable “ba” makes people less sensitive to the voicing feature of the /b/. This means that immediately afterwards the boundary between /b/ and /p/ shifts towards the /p/ end of the continuum. Hence even though speech stimuli may be physically continuous, perception is categorical. The boundaries between categories are not fixed, but are sensitive to contextual factors such as the rate of speech. In effect, an absolutely short interval can be treated as a relatively long one if the surrounding speech is rapid enough (Summerfield, 1981). They are able to interpret the relative duration of different frequency components of speech depending on the rate of speech (Eimas & Miller, 1980; Miller & Jusczyk, 1989; see Altmann, 1997, for more detail). It is possible that many phenomena in speech perception are better described in terms of continuous rather than categorical perception, and although our phenomenal experience of speech identification is that sounds fall into distinct categories, the evidence that early sensory processing is really categorical is much weaker (Massaro, 1987, 1994). Massaro argued that the apparent poor discrimination within categories does not result from early perceptual processing, but instead just arises from a bias of participants to say that items from the same category are identical. Nevertheless, the idea of categorical perception remains popular in psycholinguistics. Savin and Bever (1970) asked participants to respond as soon as they heard a particular unit, which was either a single phoneme or a syllable. They found that participants responded more slowly to phoneme targets than to syllable targets, and concluded that phoneme identification is subsequent to the perception of syllables. They proposed that phonemes are not perceptually real in the sense that syllables are: we do not recognize words through perceiving their individual phonemes, but instead can only recognize them through perceiving some more fundamental unit, such as the syllable. Foss and Swinney (1973) queried this conclusion, arguing that the phoneme and syllable monitoring task used by Savin and Bever did not directly tap into the perception process. That is, just because we can become consciously aware of a higher unit first does not mean that it is processed perceptually earlier. Foss and Blank (1980) proposed a dual-code theory where speech processing employs both a prelexical (or phonetic) code and a postlexical (or phonemic) code. The prelexical code is computed directly from the perceptual analysis of the input acoustic information, whereas the postlexical code is derived from information derived from higher-level units such as words. In the phoneme-monitoring task, participants have to press a button as soon as they hear a particular sound. Foss and Blank showed that phoneme- monitoring times to target phonemes in words and nonwords were approximately the same. In this case, the participants must have been responding to the phonetic code, as nonwords cannot have phonological codes. Foss and Blank also found that the frequency of the target word does not affect phoneme-monitoring times. On the other hand, manipulating the semantic context of a word leads to people responding on the basis of the postlexical code. Subsequently Foss and Gernsbacher (1983) failed to find experimental support for the dual-code model. They concluded that people generally respond in the phoneme-monitoring task on the basis of the prelexical code, and only in exceptional circumstances make use of a postlexical code. Nonwords that are constructed from words are more difficult to reject in an auditory lexical decision task than nonwords constructed from nonwords. In each case you then take off the final consonant and splice on a new one, “b”, to give you a new nonword, “smob”. Although they might initially sound the same, the version made from “smog” is more difficult to reject as a nonword because the coarticulation information from the vowel is consistent with a word. If the phonetic representation of the vowel had been translated into a phoneme before lexical access, then the coarticulation information would have been lost and the two types of nonword would have been equally difficult. Marslen- Wilson and Warren argued that lexical representations are directly accessed from featural information in the sound signal. Co-articulation information from vowels is used early to identify the following consonant and therefore a word. In summary, there is controversy about whether or not we need to identify phonemes before recognizing a word. Most data suggest that while phonemes might be computed during word recognition, we do not need to complete phoneme identification before word recognition can begin. The research on phonological awareness described in Chapter 7 suggests that we seem to be less aware of phonemes than other phonological constituents of speech, such as syllables. Morais and Kolinsky (1994) proposed that there are two quite distinct representations of phonemes: an unconscious system operating in speech recognition and production, and a conscious system developed in the context of the development of literacy (reading and writing). The effect of context on speech recognition is of central importance, and has been hotly debated. Is speech recognition a purely bottom-up process, or can top-down information influence its outcomefi If we can show that the word in which a sound occurs, or indeed the meaning of the whole sentence, can influence the recognition of that particular sound, then we will have shown a topdown influence on sound perception. In this case, we will have shown that speech perception is in part at least an interactive process; knowledge about whole words is influencing our perception of their component sounds. Of course, different types of context could have an effect at every level of phonological processing, and in principle the effects might be different at each level. The first piece of relevant evidence is based on the categorical perception of sounds varying along a continuum. That is, participants are willing to put a sound into a category they would not otherwise choose if the result makes a word: “kiss” is a word, “giss” is not, and this influences our categorical perception of the ambiguous phoneme. Findings using this technique, developed by Connine and Clifton (1987), further strengthen the argument that lexical knowledge (information about words) is available to the categorical perception of ambiguous stimuli. They showed that other processing advantages accrue to the ambiguous stimuli when this lexical knowledge is invoked, but not at the ends of the continuum, where perceptual information alone is sufficient to make a decision. Signal detection theory provides a means of describing the identification of imperfectly discriminable stimuli. Lexical context is not sensitive to manipulations (primarily the extent to which correct responses are rewarded and incorrect ones punished) known to influence postperceptual processes (Pitt, 1995a,b; but see Massaro & Oden, 1995, for a reply). Connine (1990) found that sentential context (provided by the meaning of the whole sentence) behaves differently from lexical context (the context provided by the word in which the ambiguous phoneme occurs).

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Her behaviour must have seemed as incomprehensible to antibiotic z pack buy zithromax 250mg with amex the man after she had left him as to virus nyc cheap zithromax 250 mg on line us antibiotic lotion for acne generic 100mg zithromax visa, for he must long before have gathered from innumerable small signs that he was secure of the girl’s affections antimicrobial 24-7 purchase 250 mg zithromax free shipping. In our discussion of Dora’s second dream we shall come upon the solution of this riddle as well as upon the self-reproach which we have hitherto failed to discover. As she kept on repeating her complaints against her father with a wearisome monotony, and as at the same time her cough continued, I was led to think that this symptom might have some meaning in connection with her father. And apart from this, the explanation of the symptom which I had hitherto obtained was far from fulfilling the requirements which I am accustomed to make of such explanations. According to a rule which I had found confirmed over and over again by experience, though I had not yet ventured to erect it into a general principle, a symptom signifies the representation the realization of a phantasy with a sexual content, that is to say, it signifies a sexual situation. It would be better to say that at least one of the meanings of a symptom is the representation of a sexual phantasy, but that no such limitation is imposed upon the content of its other meanings. Any one who takes up psycho-analytic work will quickly discover that a symptom has more than one meaning and serves to represent several unconscious mental processes simultaneously. And I should like to add that in my estimation a single unconscious mental process or phantasy will scarcely ever suffice for the production of a symptom. Fragment Of An Analysis Of A Case Of Hysteria 1384 An opportunity very soon occurred for interpreting Dora’s nervous cough in this way by means of an imagined sexual situation. Certain details of the way in which she expressed herself (which I pass over here, like most other purely technical parts of the analysis) led me to see that behind this phrase its opposite lay concealed, namely, that her father was ‘ein unvermogender Mann’ [‘a man without means’]. This could only be meant in a sexual sense that her father, as a man, was without means, was impotent. She knew very well, she said, that there was more than one way of obtaining sexual gratification. I could then go on to say that in that case she must be thinking of precisely those parts of the body which in her case were in a state of irritation, the throat and the oral cavity. To be sure, she would not hear of going so far as this in recognizing her own thoughts; and indeed, if the occurrence of the symptom was to be made possible at all, it was essential that she should not be completely clear on the subject. But the conclusion was inevitable that with her spasmodic cough, which, as is usual, was referred for its exciting stimulus to a tickling in her throat, she pictured to herself a scene of sexual gratification per os between the two people whose love-affair occupied her mind so incessantly. A very short time after she had tacitly accepted this explanation her cough vanished which fitted in very well with my view; but I do not wish to lay too much stress upon this development, since her cough had so often before disappeared spontaneously. The astonishment is probably caused by my daring to talk about such delicate and unpleasant subjects to a young girl or, for that matter, to any woman who is sexually active. The horror is aroused, no doubt, by the possibility that an inexperienced girl could know about practices of such a kind and could occupy her imagination with them. It is possible for a man to talk to girls and women upon sexual matters of every kind without doing them harm and without bringing suspicion upon himself, so long as, in the first place, he adopts a particular way of doing it, and, in the second place, can make them feel convinced that it is unavoidable. A gynaecologist, after all, under the same conditions, does not hesitate to make them submit to uncovering every possible part of their body. The best way of speaking about such things is to be dry and direct; and that is at the same time the method furthest removed from the prurience with which the same subjects are handled in ‘society’, and to which girls and women alike are so thoroughly accustomed. I call bodily organs and processes by their technical names, and I tell these to the patient if they the names, I mean happen to be unknown to her. I have certainly heard of some people doctors and laymen who are scandalized by a therapeutic method in which conversations of this sort occur, and who appear to envy either me or my patients the titillation which, according to their notions, such a method must afford. But I am too well acquainted with the respectability of these gentry to excite myself over them. But there is one thing that I will mention: often, after I have for some time treated a patient who had not at first found it easy to be open about sexual matters, I have had the satisfaction of hearing her exclaim: ‘Why, after all, your treatment is far more respectable than Mr. There is no necessity for feeling any compunction at discussing the facts of normal or abnormal sexual life with them. With the exercise of a little caution all that is done is to translate into conscious ideas what was already known in the unconscious; and, after all, the whole effectiveness of the treatment is based upon our knowledge that the affect attached to an unconscious idea operates more strongly and, since it cannot be inhibited, more injuriously than the affect attached to a conscious one. For where there is no knowledge of sexual processes even in the unconscious, no hysterical symptom will arise; and where hysteria is found there can no longer be any question of ‘innocence of mind’ in the sense in which parents and educators use the phrase. With children of ten, of twelve, or of fourteen, with boys and girls alike, I have satisfied myself that the truth of this statement can invariably be relied upon. Fragment Of An Analysis Of A Case Of Hysteria 1387 As regards the second kind of emotional reaction, which is not directed against me this time, but against my patient supposing that my view of her is correct and which regards the perverse nature of her phantasies as horrible, I should like to say emphatically that a medical man has no business to indulge in such passionate condemnation. I may also remark in passing that it seems to me superfluous for a physician who is writing upon the aberrations of the sexual instincts to seize every opportunity of inserting into the text expressions of his personal repugnance at such revolting things. We are faced by a fact; and it is to be hoped that we shall grow accustomed to it, when we have put our own tastes on one side. We must learn to speak without indignation of what we call the sexual perversions instances in which the sexual function has extended its limits in respect either to the part of the body concerned or to the sexual object chosen. The uncertainty in regard to the boundaries of what is to be called normal sexual life, when we take different races and different epochs into account, should in itself be enough to cool the zealot’s ardour. We surely ought not to forget that the perversion which is the most repellent to us, the sensual love of a man for a man, was not only tolerated by a people so far our superiors in cultivation as were the Greeks, but was actually entrusted by them with important social functions. The sexual life of each one of us extends to a slight degree now in this direction, now in that beyond the narrow lines imposed as the standard of normality. The perversions are neither bestial nor degenerate in the emotional sense of the word. They are a development of germs all of which are contained in the undifferentiated sexual disposition of the child, and which, by being suppressed or by being diverted to higher, asexual aims by being ‘sublimated’ are destined to provide the energy for a great number of our cultural achievements. When, therefore, any one has become a gross and manifest pervert, it would be more correct to say that he has remained one, for he exhibits a certain stage of inhibited development. All psychoneurotics are persons with strongly marked perverse tendencies, which have been repressed in the course of their development and have become unconscious. Consequently their unconscious phantasies show precisely the same content as the documentarily recorded actions of perverts even though they have not read Krafft-Ebing’s Psychopathia Sexualis, to which simple-minded people attribute such a large share of the responsibility for the production of perverse tendencies. In neurotics their sexual constitution, under which the effects of heredity are included, operates in combination with any accidental influences in their life which may disturb the development of normal sexuality. A stream of water which meets with an obstacle in the river-bed is dammed up and flows back into old channels which had formerly seemed fated to run dry. The motive forces leading to the formation of hysterical symptoms draw their strength not only from repressed normal sexuality but also from unconscious perverse activities. Fragment Of An Analysis Of A Case Of Hysteria 1388 the less repellent of the so-called sexual perversions are very widely diffused among the whole population, as every one knows except medical writers upon the subject. Or, I should rather say, they know it too; only they take care to forget it at the moment when they take up their pens to write about it. So it is not to be wondered at that this hysterical girl of nearly nineteen, who had heard of the occurrence of such a method of sexual intercourse (sucking at the male organ), should have developed an unconscious phantasy of this sort and should have given it expression by an irritation in her throat and by coughing. Nor would it have been very extraordinary if she had arrived at such a phantasy even without having had any enlightenment from external sources an occurrence which I have quite certainly observed in other patients. For in her case a noteworthy fact afforded the necessary somatic prerequisite for this independent creation of a phantasy which would coincide with the practices of perverts. Her father, too recollected breaking her of the habit after it had persisted into her fourth or fifth year. Dora herself had a clear picture of a scene from her early childhood in which she was sitting on the floor in a corner sucking her left thumb and at the same time tugging with her right hand at the lobe of her brother’s ear as he sat quietly beside her. Here we have an instance of the complete form of self-gratification by sucking, as it has also been described to me by other patients, who had subsequently become anaesthetic and hysterical. Fragment Of An Analysis Of A Case Of Hysteria 1389 One of these patients gave me a piece of information which sheds a clear light on the origin of this curious habit. She retained a memory of her childhood, dating back, according to her, to the first half of her second year, in which she saw herself sucking at her nurse’s breast and at the same time pulling rhythmically at the lobe of her nurse’s ear. No one will feel inclined to dispute, I think, that the mucous membrane of the lips and mouth is to be regarded as a primary ‘erotogenic zone’, since it preserves this earlier significance in the act of kissing, which is looked upon as normal. An intense activity of this erotogenic zone at an early age thus determines the subsequent presence of a somatic compliance on the part of the tract of mucous membrane which begins at the lips. Thus, at a time when the sexual object proper, that is, the male organ, has already become known, circumstances may arise which once more increase the excitation of the oral zone, whose erotogenic character has, as we have seen, been retained. It then needs very little creative power to substitute the sexual object of the moment (the penis) for the original object (the nipple) or for the finger which does duty for it, and to place the current sexual object in the situation in which gratification was originally obtained. So we see that this excessively repulsive and perverted phantasy of sucking at a penis has the most innocent origin. It is a new version of what may be described as a prehistoric impression of sucking at the mother’s or nurse’s breast an impression which has usually been revived by contact with children who are being nursed.

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