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Finally medicine to prevent cold purchase generic meclizine line, the resolution of the whole tension by a communication of the correct name from an external quarter is itself a good example of the efficacy of psycho-analytic therapy medications used for depression cheap meclizine 25 mg mastercard, which aims at correcting the repressions and displacements and which removes the symptoms by re-instating the genuine psychical object treatment 101 cheap meclizine 25mg otc. The Psychical Mechanism Of Forgetfulness 483 Among the various factors treatment wax buy cheap meclizine 25 mg on-line, therefore, which contribute to a failure in recollection or a loss of memory, the part played by repression must not be overlooked; and it can be demonstrated not only in neurotics but (in a manner that is qualitatively the same) in normal people as well. It may be asserted quite generally that the ease (and ultimately the faithfulness, too) with which a given impression is awakened in the memory depends not only on the psychical constitution of the individual, the strength of the impression when it was fresh, the interest directed towards it at the time, the psychical constellation at the present time, the interest that is now devoted to its awakening, the connections into which the impression has been drawn, and so on not only on such things but also on the favourable or unfavourable attitude of a particular psychical factor which refuses to reproduce anything that might liberate unpleasure, or that might subsequently lead to the liberation of unpleasure. Thus the function of memory, which we like to regard as an archive open to anyone who is curious, is in this way subjected to restriction by a trend of the will, just as is any part of our activity directed to the external world. Half the secret of hysterical amnesia is uncovered when we say that hysterical people do not know what they do not want to know; and psycho-analytic treatment, which endeavours to fill up such gaps of memory in the course of its work, leads us to the discovery that the bringing back of those lost memories is opposed by a certain resistance which has to be counterbalanced by work proportionate to its magnitude. In the case of psychical processes which are on the whole normal, it cannot, of course, be claimed that the influence of this one-sided factor in the revival of memories in any way regularly overcomes all the other factors that must be taken into account. On one occasion, for instance, when I was meaning to describe the same small incident to a colleague of mine, the name of my authority for the stories about Bosnia suddenly escaped me. Moreover the two words were connected by an anecdote in which this same person pointed to himself and said: ‘I’m not called "Herz", but "Pick". The Psychical Mechanism Of Forgetfulness 484 In connection with the tendentious nature of our remembering and forgetting, I not long ago experienced an instructive example instructive because of what it betrayed of which I should like to add an account here. I was intending to pay a twenty-four-hour visit to a friend of mine who unfortunately lives very far away, and I was full of the things I was going to tell him. But before this I felt under an obligation to call on a family of my acquaintance in Vienna, one of whose members had moved to the town in question, so as to take their greetings and messages with me to the absent relative. They told me the name of the pension in which he lived, and also the name of the street and the number of the house, and, in view of my bad memory, wrote the address on a card, which I put in my wallet. The next day, when I had arrived at my friend’s, I began: ‘I’ve only one duty to carry out that may interfere with our being together; it’s a call, and it shall be the first thing I do. My memory for names is not particularly good, but it is incomparably better than for figures and numbers. I may have been paying medical visits at a certain house for a year on end, and yet, if I should have to be driven there by a cab driver, I should have difficulty in remembering the number of the house. But in this case I had taken special note of the house number; it was ultra-clear, as if to jeer at me for no trace remained in my recollection of the name of the pension or the street. I had forgotten all the data in the address which might have served as a starting point for discovering the pension; and, quite against my usual habit, I had retained the number of the house, which was useless for the purpose. When I was back again in Vienna and standing in front of my writing desk, I knew without a moment’s hesitation where it was that, in my ‘absent- mindedness’, I had put the card with the address on it. In my unconscious hiding of the thing the same intention had been operative as in my curiously modified act of forgetting. As I have shown elsewhere, great pathogenic importance must be attributed to the impressions of that time of life. But the subject of childhood memories is in any case bound to be of psychological interest, for they bring into striking relief a fundamental difference between the psychical functioning of children and of adults. No one calls in question the fact that the experiences of the earliest years of our childhood leave ineradicable traces in the depths of our minds. If, however, we seek in our memories to ascertain what were the impressions that were destined to influence us to the end of our lives, the outcome is either nothing at all or a relatively small number of isolated recollections which are often of dubious or enigmatic importance. It is only from the sixth or seventh year onwards in many cases only after the tenth year that our lives can be reproduced in memory as a connected chain of events. From that time on, however, there is also a direct relation between the psychical significance of an experience and its retention in the memory. Whatever seems important on account of its immediate or directly subsequent effects is recollected; whatever is judged to be inessential is forgotten. If I can remember an event a long time after its occurrence, I regard the fact of having retained it in my memory as evidence of its having made a deep impression on me at the time. I feel surprised at forgetting; and I feel even more surprised, perhaps, at remembering something apparently indifferent. Screen Memories 488 It is only in certain pathological mental conditions that the relation holding in normal adults between the psychical significance of an event and its retention in memory once more ceases to apply. For instance, a hysteric habitually shows amnesia for some or all of the experiences which led to the onset of his illness and which from that very fact have become important to him and, apart from that fact, may have been important on their own account. The analogy between pathological amnesia of this kind and the normal amnesia affecting our early years seems to me to give a valuable hint at the intimate connection that exists between the psychical content of neuroses and our infantile life. We are so much accustomed to this lack of memory of the impressions of childhood that we are apt to overlook the problem underlying it and are inclined to explain it as a self-evident consequence of the rudimentary character of the mental activities of children. Actually, however, a normally developed child of three or four already exhibits an enormous amount of highly organized mental functioning in the comparisons and inferences which he makes and in the expression of his feelings; and there is no obvious reason why amnesia should overtake these psychical acts, which carry no less weight than those of a later age. Before dealing with the psychological problems attaching to the earliest memories of childhood, it would of course be essential to make a collection of material by circularizing a fairly large number of normal adults and discovering what kind of recollections they are able to produce from these early years. The highly suggestive results of their questionnaire, which brought in replies from 123 persons, were published by the two authors in 1897. I have no intention at present of discussing the subject as a whole, and I shall therefore content myself with emphasizing the few points which will enable me to introduce the notion of what I have termed ‘screen memories’. The age to which the content of the earliest memories of childhood is usually referred back is the period between the ages of two and four. There is nothing at the moment to show what else is related to these individual differences; is to be noticed, say the Henris, that a person whose earliest recollection goes back to a very tender age to the first year of his life, perhaps will also have at his disposal further detached memories from the following years, and that he will be able to reproduce his experiences as a continuous chain from an earlier point of time from about his fifth year than is possible for other people, whose first recollection dates from a later time. Thus not only the date of the appearance of the first recollection but the whole function of memory may, in the case of some people, be advanced or retarded. Screen Memories 489 Quite special interest attaches to the question of what is the usual content of these earliest memories of childhood. The psychology of adults would necessarily lead us to expect that those experiences would be selected as worth remembering which had aroused some powerful emotion or which, owing to their consequences, had been recognized as important soon after their occurrence. And some indeed of the observations collected by the Henris appear to fulfil this expectation. They report that the most frequent content of the first memories of childhood are on the one hand occasions of fear, shame, physical pain, etc. We might therefore be inclined to assume that the principle governing the choice of memories is the same in the case of children as in that of adults. It is intelligible though the fact deserves to be explicitly mentioned that the memories retained from childhood should necessarily show evidence of the difference between what attracts the interest of a child and of an adult. This easily explains why, for instance, one woman reports that she remembers a number of accidents that occurred to her dolls when she was two years old but has no recollection of the serious and tragic events she might have observed at the same period. Now, however, we are met by a fact that is diametrically opposed to our expectations and cannot fail to astonish us. We hear that there are some people whose earliest recollections of childhood are concerned with everyday and indifferent events which could not produce any emotional effect even in children, but which are recollected (too clearly, one is inclined to say) in every detail, while approximately contemporary events, even if, on the evidence of their parents, they moved them intensely at the time, have not been retained in their memory. Thus the Henris mention a professor of philology whose earliest memory, dating back to between the ages of three and four, showed him a table laid for a meal and on it a basin of ice. At the same period there occurred the death of his grandmother which, according to his parents, was a severe blow to the child. But the professor of philology, as he now is, has no recollection of this bereavement; all that he remembers of those days is the basin of ice. Another man reports that his earliest memory is an episode upon a walk in which he broke off a branch from a tree. In my experience, based for the most part, it is true, on neurotics, they are quite frequent. One of the subjects of the Henris’ investigation made an attempt at explaining the occurrence of these mnemic images, whose innocence makes them so mysterious, and his explanation seems to me very much to the point. He thinks that in such cases the relevant scene may perhaps have been only incompletely retained in the memory, and that that may be why it seems so unenlightening: the parts that have been forgotten probably contained everything that made the experience noteworthy. I am able to confirm the truth of this view, though I should prefer to speak of these elements of the experience being omitted rather than forgotten. I have often succeeded, by means of psycho-analytic treatment, in uncovering the missing portions of a childhood experience and in thus proving that when the impression, of which no more than a torso was retained in the memory, had been restored to completeness, it did in fact agree with the presumption that it is the most important things that are recollected. This, however, provides no explanation of the remarkable choice which memory has made among the elements of the experience.

The criticism had been written by a very youthful reviewer who possessed small judgement medicine quotes doctor buy meclizine 25mg free shipping. He expressed lively regret at having published the criticism but would not undertake to symptoms zoning out cheap 25 mg meclizine with amex offer any redress symptoms after embryo transfer discount 25mg meclizine mastercard. I therefore severed my connection with the journal medicine that makes you poop purchase meclizine australia, but in my letter of resignation expressed a hope that our personal relations would not be affected by the event. The third source of the dream was an account I had just heard from a woman patient of her brother’s mental illness, and of how he had broken out in a frenzy with cries of ‘Nature! I myself preferred to think of the sexual sense in which the word is used even by the less educated people here. The Interpretation Of Dreams 887 I may add that my friend’s book which had been so severely criticized (‘one wonders whether it is the author or oneself who is crazy’, another reviewer had said) dealt with the chronological data of life and showed that the length of Goethe’s life was a multiple of a number that has a significance in biology. Thus the dream-thoughts were saying ironically: ‘Naturally, it’s he who is the crazy fool, and it’s you who are the men of genius and know better. For instance, Goethe attacked the young man, which is absurd, whereas it is still easy for quite a young man to attack Goethe, who is immortal. And again, I calculated from the year of Goethe’s death, whereas I had made the paralytic calculate from the year of his birth. But I have also undertaken to show that no dream is prompted by motives other than egoistic ones. So I must explain away the fact that in the present dream I made my friend’s cause my own and put myself in his place. The strength of my critical conviction in waking life is not enough to account for this. The story of the eighteen-year-old patient, however, and the different interpretations of his exclaiming ‘Nature! I could say to myself: ‘The kind of criticism that has been applied to your friend will be applied to you indeed, to some extent it already has been. Here is the missing main dream, which introduces an absurd and unintelligible verbal form which requires an explanation. On account of certain events which had occurred in the city of Rome, it had become necessary to remove the children to safety, and this was done. The scene was then in front of a gateway, double doors in the ancient style (the ‘Porta Romana’ at Siena, as I was aware during the dream itself). I was sitting on the edge of a fountain and was greatly depressed and almost in tears. A female figure an attendant or nun brought two boys out and handed them over to their father, who was not myself. The Jewish problem, concern about the future of one’s children, to whom one cannot give a country of their own, concern about educating them in such a way that they can move freely across frontiers all of this was easily recognizable among the relevant dream-thoughts. If Rome occurred in one of my dreams, it was necessary for me to find a substitute for it from some locality known to me (see p. Shortly before I had the dream I had heard that a man of the same religious persuasion as myself had been obliged to resign the position which he had painfully achieved in a State asylum. Our interest is aroused by the phrase ‘Auf geseres’ (at a point at which the situation in the dream would have led one to expect ‘Auf Wiedersehen’) as well as its quite meaningless opposite ‘Auf Ungeseres. But the short remark at the end of the dream to the effect that ‘Ungeseres’ denoted a preference over ‘Geseres’ opened the door to associations and at the same time to an elucidation of the word. An analogous relationship occurs in the case of caviare; unsalted [‘ungesalzen’] caviare is esteemed more highly that salted [‘gesalzen’]. This tallied with the fact that another member of my household, our excellent nurse, was recognizably portrayed in the female attendant or nun in the dream. There was still, however, no transitional idea between ‘salted unsalted’ and ‘Geseres Ungeseres. In their flight out of Egypt the Children of Israel had not time to allow their dough to rise and, in memory of this, they eat unleavened bread to this day at Easter. At this point I may insert a sudden association that occurred to me during this portion of the analysis. I remembered how, during the previous Easter, my Berlin friend and I had been walking through the streets of Breslau, a town in which we were strangers. A little girl asked me the way to a particular street, and I was obliged to confess that I did not know; and I remarked to my friend: ‘It is to be hoped that when she grows up that little girl will show more discrimination in her choice of the people whom she gets to direct her. He explained that so long as it remained on one side it was of no importance, but that if it passed over to the other eye it would be a serious matter. The affection cleared up completely in the one eye; but shortly afterwards signs in fact appeared of the other one being affected. The boy’s mother, terrified, at once sent for the doctor to the remote spot in the country where they were staying. But the construction of the desk was also intended to save the child from being short-sighted and one-sided. Hence the appearance in the dream of ‘Myops’ (and, behind it, ‘Cyclops’) and the reference to bilaterality. My concern about one-sidedness had more than one meaning: it would refer not only to physical one-sidedness but also to one sidedness of intellectual development. May it not even be that it was precisely this concern which, in its crazy way, the scene in the dream was contradictingfi After the child had turned to one side to say farewell words, he turned to the other side to say the contrary, as though to restore the balance. In every epoch of history those who have had something to say but could not say it without peril have eagerly assumed a fool’s cap. The audience at whom their forbidden speech was aimed tolerated it more easily if they could at the same time laugh and flatter themselves with the reflection that the unwelcome words were clearly nonsensical. The Prince in the play, who had to disguise himself as a madman, was behaving just as dreams do in reality; so that we can say of dreams what Hamlet said of himself, concealing the true circumstances under a cloak of wit and unintelligibility: ‘I am but mad north-north-west: when the wind is southerly, I know a hawk from a hand-saw! Incidentally, the situation in the dream of my removing my children to safety from the City of Rome was distorted by being related back to an analogous event that occurred in my own childhood: I was envying some relatives who, many years earlier, had had an opportunity of removing their children to another country. The Interpretation Of Dreams 891 My next task is to show that the dream-work consists in nothing more than a combination of the three factors I have mentioned and of a fourth which I have still to mention; that it carries out no other function than the translation of dream-thoughts in accordance with the four conditions to which it is subject; and that the question whether the mind operates in dreams with all its intellectual faculties or with only a part of them is wrongly framed and disregards the facts. Since, however, there are plenty of dreams in whose content judgements are passed, criticisms made, and appreciations expressed, in which surprise is felt at some particular element of the dream, in which explanations are attempted and argumentations embarked upon, I must now proceed to meet the objections arising from facts of this kind by producing some chosen examples. My reply is as follows: Everything that appears in dreams as the ostensible activity of the function of judgement is to be regarded not as an intellectual achievement of the dream-work but as belonging to the material of the dream-thoughts and as having been lifted from them into the manifest content of the dream as a ready-made structure. Even the judgements made after waking upon a dream that has been remembered, and the feelings called up in us by the reproduction of such a dream, form part, to a great extent, of the latent content of the dream and are to be included in its interpretation. The Interpretation Of Dreams 892 I I have already quoted a striking example of this. A woman patient refused to tell me a dream of hers because ‘it was not clear enough. There then followed a second piece of dream in which a dust-bin [Misttrugerl] appeared, and this gave rise to the following recollection. When she had first set up house she had jokingly remarked on one occasion in the presence of a young relative who was visiting in the house that her next job was to get hold of a new dust-bin. The next morning one arrived for her, but it was filled with lilies of the valley. This piece of the dream served to represent a common phrase ‘not grown on my own manure’. Here, then, the dream-representation had overflowed into the waking thoughts: one of the elements of the dream-thoughts had found representation in a waking judgement passed upon the dream as a whole. One of my patients had a dream which struck him as interesting, for immediately after waking he said to himself: ‘I must tell the doctor that. At the same time I had a notion that I had often seen this district before in dreams. He showed me a road that led round the corner to a restaurant (indoors, not a garden). There I asked for Frau Doni and was told that she lived at the back in a small room with three children. I went towards it, but before I got there met an indistinct figure with my two little girls; I took them with me after I had stood with them for a little while. When I woke up I had a feeling of great satisfaction, the reason for which I explained to myself as being that I was going to discover from this analysis the meaning of ‘I’ve dreamt of that before. The two events which occasioned the dream will serve, instead of a complete analysis, to indicate its meaning.

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It is precisely the typical hysterical symptoms which fall into this class medications john frew order meclizine 25 mg without a prescription, such as hemi-anaesthesia world medicine generic 25 mg meclizine, contraction of the field of vision z pak medications buy discount meclizine online, epileptiform convulsions symptoms bone cancer cheap 25mg meclizine, and so on. An explanation of our views on this group must be reserved for a fuller discussion of the subject. Observations such as these seem to us to establish an analogy between the pathogenesis of common hysteria and that of the traumatic neuroses, and to justify an extension of the concept of traumatic hysteria. In traumatic neuroses the operative cause of the illness is not the trifling physical injury but the affect of fright the psychical trauma. In an analogous manner, our investigations reveal, for many, if not for most, hysterical symptoms, precipitating causes which can only be described as psychical traumas. 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 the case of common hysteria it not infrequently happens that, instead of a single, major trauma, we find a number of partial traumas forming a group of provoking causes. These have only been able to exercise a traumatic effect by summation and they belong together in so far as they are in part components of a single story of suffering. There are other cases in which an apparently trivial circumstance combines with the actually operative event or occurs at a time of peculiar susceptibility to stimulation and in this way attains the dignity of a trauma which it would not otherwise have possessed but which thenceforward persists. Studies On Hysteria 9 But the causal relation between the determining psychical trauma and the hysterical phenomenon is not of a kind implying that the trauma merely acts like an agent provocateur in releasing the symptom, which thereafter leads an independent existence. 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 important practical interest to our findings. For we found, to our great surprise at first, that each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying affect, and when the patient had described that event in the greatest possible detail and had put the affect into words. The psychical process which originally took place must be repeated as vividly as possible; it must be brought back to its status nascendi and then given verbal utterance. Where what we are dealing with are phenomena involving stimuli (spasms, neuralgias and hallucinations) these re-appear once again with the fullest intensity and then vanish for ever. Failures of function, such as paralyses and anaesthesias, vanish in the same way, though, of course, without the temporary intensification being discernible. Il remet le sujet dans l’etat ou le mal s’est manifeste et combat par la parole le meme mal, mais renaissant. He puts the subject back into the state in which his trouble first appeared and uses words to combat that trouble, as it now makes a fresh emergence. Studies On Hysteria 10 It is plausible to suppose that it is a question here of unconscious suggestion: the patient expects to be relieved of his sufferings by this procedure, and it is this expectation, and not the verbal utterance, which is the operative factor. 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 auto-hypnoses on the part of the patient, and came as a great surprise to the observer. We may reverse the dictum ‘cessante causa cessat effectuss’ [‘when the cause ceases the effect ceases’] and conclude from these observations that the determining process continues to operate in some way or other for years not indirectly, through a chain of intermediate causal links, but as a directly releasing cause just as a psychical pain that is remembered in waking consciousness still provokes a lachrymal secretion long after the event. 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. The most important of these is whether there has been an energetic reaction to the event that provokes the affect. By ‘reaction’ we here understand the whole class of voluntary and involuntary reflexes from tears to acts of revenge in which, as experience shows us, the affects are discharged. If this reaction takes place to a sufficient amount a large part of the affect disappears as a result. Linguistic usage bears witness to this fact of daily observation by such phrases as ‘to cry oneself out’ [‘sich ausweinen’], and to ‘blow off steam’ [‘sich austoben’, literally ‘to rage oneself out’]. 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 an injury that has been suffered in silence as ‘a mortification’ [‘Krankung’, literally ‘making ill’]. But language serves as a substitute for action; by its help, an affect can be ‘abreacted’ almost as effectively. In other cases speaking is itself the adequate reflex, when, for instance, it is a lamentation or giving utterance to a tormenting secret. If there is no such reaction, whether in deeds or words, or in the mildest cases in tears, any recollection of the event retains its affective tone to begin with. A memory of such a trauma, even if it has not been abreacted, enters the great complex of associations, it comes alongside other experiences, which may contradict it, and is subjected to rectification by other ideas. After an accident, for instance, the memory of the danger and the (mitigated) repetition of the fright becomes associated with the memory of what happened afterwards rescue and the consciousness of present safety. Again, a person’s memory of a humiliation is corrected by his putting the facts right, by considering his own worth, etc. In this way a normal person is able to bring about the disappearance of the accompanying affect through the process of association. To this we must add the general effacement of impressions, the fading of memories which we name ‘forgetting’ and which wears away those ideas in particular that are no longer affectively operative. Our observations have shown, on the other hand, that the memories which have become the determinants of hysterical phenomena persist for a long time with astonishing freshness and with the whole of their affective colouring. We must, however, mention another remarkable fact, which we shall later be able to turn to account, namely, that these memories, unlike other memories of their past lives, are not at the patients’ disposal. On the contrary, these experiences are completely absent from the patient’s memory when they are in a normal psychical state, or are only present in highly summary form. Not until they have been questioned under hypnosis do these memories emerge with the undiminished vividness of a recent event. Thus, for six whole months, one of our patients reproduced under hypnosis with hallucinatory vividness everything that had excited her on the same day of the previous year (during an attack of acute hysteria). A diary kept by her mother with out her knowledge proved the completeness of the reproduction. Another patient, partly under hypnosis and partly during spontaneous attacks, re-lived with hallucinatory clarity all the events of a hysterical psychosis which she had passed through ten years earlier and which she had for the most part forgotten till the moment at which it re-emerged. Moreover, certain memories of aetiological importance which dated back from fifteen to twenty-five years were found to be astonishingly intact and to possess remarkable sensory force, and when they returned they acted with all the affective strength of new experiences. Studies On Hysteria 13 this can only be explained on the view that these memories constitute an exception in their relation to all the wearing-away processes which we have discussed above. It appears, that is to say, that these memories correspond to traumas that have not been sufficiently abreacted; and if we enter more closely into the reasons which have prevented this, we find at least two sets of conditions under which the reaction to the trauma fails to occur. In the first group are those cases in which the patients have not reacted to a psychical trauma because the nature of the trauma excluded a reaction, as in the case of the apparently irreparable loss of a loved person or because social circumstance made a reaction impossible or because it was a question of things which the patient wished to forget, and therefore intentionally repressed from his conscious thought and inhibited and suppressed. It is precisely distressing things of this kind that, under hypnosis, we find are the basis of hysterical phenomena. The second group of conditions are determined, not by the content of the memories but by the psychical states in which the patient received the experiences in question. For we find, under hypnosis, among the causes of hysterical symptoms ideas which are not in themselves significant, but whose persistence is due to the fact that they originated during the prevalence of severely paralysing affects, such as fright, or during positively abnormal psychical states, such as the semi-hypnotic twilight state of day-dreaming, auto- hypnoses, and so on. In such cases it is the nature of the states which makes a reaction to the event impossible. Both kinds of conditions may, of course, be simultaneously present, and this, in fact, often occurs. It is so when a trauma which is operative in itself takes place while a severely paralysing affect prevails or during a modified state of consciousness. But it also seems to be true that in many people a psychical trauma produces one of these abnormal states, which, in turn, makes reaction impossible. Both of these groups of conditions, however, have in common the fact that the psychical traumas which have not been disposed of by reaction cannot be disposed of either by being worked over by means of association. In the first group the patient is determined to forget the distressing experiences and accordingly excludes them so far as possible from association; while in the second group the associative working-over fails to occur because there is no extensive associative connection between the normal state of consciousness and the pathological ones in which the ideas made their appearance. It may therefore be said that the ideas which have become pathological have persisted with such freshness and affective strength because they have been denied the normal wearing-away process by means of abreaction and reproduction in states of uninhibited association. In 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 patient’s normal memory but in his memory when he is hypnotized. The longer we have been occupied with these phenomena the more we have become convinced that the splitting of consciousness which is so striking in the well-known classical cases under the form of ‘double conscience’ is present to a rudimentary degree in every hysteria, and that a tendency to such dissociation, and with it the emergence of abnormal states of consciousness (which we shall bring together under the term ‘hypnoid’) is the basic phenomenon of this neurosis. In these views we concur with Binet and the two Janets, though we have had no experience of the remarkable findings they have made on anaesthetic patients. We should like to balance the familiar thesis that hypnosis is an artificial hysteria by another the basis and sine qua non of hysteria is the existence of hypnoid states.

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On the contrary medicine x xtreme pastillas buy generic meclizine 25mg line, it appears that for them medicine man gallery meclizine 25 mg visa, too medicine list trusted meclizine 25mg, defloration is a significant act; but it has become the subject of a taboo of a prohibition which may be described as religious treatment yeast infection men order meclizine 25mg on-line. Instead of reserving it for the girl’s bridegroom and future partner in marriage, custom demands that he shall shun the performance of it. I shall content myself, therefore, with stating the fact that the practice of rupturing the hymen in this way outside the subsequent marriage is very widespread among primitive races living to-day. As Crawley says ‘This marriage ceremony consists in perforation of the hymen by some appointed person other than the husband; it is most common in the lowest stages of culture, especially in Australia. The Taboo Of Virginity 2351 If, however, defloration is not to result from the first act of marital intercourse, then it must have been carried out beforehand whatever the way and whoever the agent may have been. I shall quote a few passages from Crawley’s book, mentioned above, which provide information on these points but also give grounds for some critical observations. In the Portland and Glenelg tribes this is done to the bride by an old woman; and sometimes white men are asked for this reason to deflower maidens (Brough Smith, 2, 319). This defloration is performed by the father of the bride amongst the Sakais (Malay), Battas (Sumatra), and Alfoers of Celebes (Ploss and Bartels, 2, 490). In the Philippines there were certain men whose profession it was to deflower brides, in case the hymen had not been ruptured in childhood by an old woman who was sometimes employed for this (Featherman, 2, 474). The defloration of the bride was amongst some Eskimo tribes entrusted to the angekok, or priest (ibid. Firstly, it is a pity that in these reports a more careful distinction is not made between simple rupture of the hymen without intercourse, and intercourse for the purpose of effecting this rupture. There is only one passage in which we are told expressly that the procedure falls into two actions: defloration (carried out by hand or with some instrument) and the act of intercourse which follows it. The material in Ploss and Bartels (1891), in other respects so rich, is almost useless for our purpose, because in their presentation of it the psychological importance of the act of defloration is completely displaced in favour of its anatomical results. Secondly, we should be glad to be informed how the ‘ceremonial’ (purely formal, ritual, or official) coitus, which takes place on these occasions, differs from ordinary sexual intercourse. The authors to whom I have had access either have been too embarrassed to discuss the matter or have once again underestimated the psychological importance of such sexual details. It is to be hoped that the first-hand accounts of travellers and missionaries may be more complete and less ambiguous, but since this literature, which is for the most part foreign, is for the time being inaccessible I cannot say anything definite on the subject. Besides, we may get round the problem arising over this second point if we bear in mind the fact that a ceremonial mock-coitus would after all only represent a substitute for, and perhaps replace altogether, an act that in earlier times would have been carried out completely. When a virgin is deflowered, her blood is as a rule shed; the first attempt at explanation, then, is based on the horror of blood among primitive races who consider blood as the seat of life. This blood taboo is seen in numerous kinds of observances which have nothing to do with sexuality; it is obviously connected with the prohibition against murder and forms a protective measure against the primal thirst for blood, primaeval man’s pleasure in killing. According to this view the taboo of virginity is connected with the taboo of menstruation which is almost universally maintained. Primitive people cannot dissociate the puzzling phenomenon of this monthly flow of blood from sadistic ideas. Menstruation, especially its first appearance, is interpreted as the bite of some spirit-animal, perhaps as a sign of sexual intercourse with this spirit. Occasionally some report gives grounds for recognizing the spirit as that of an ancestor and then, supported by other findings,fi we understand that the menstruating girl is taboo because she is the property of this ancestral spirit. The Taboo Of Virginity 2353 Other considerations, however, warn us not to over-estimate the influence of a factor such as the horror of blood. It has not, after all, been strong enough to suppress practices like the circumcision of boys and the still more cruel equivalent with girls (excision of the clitoris and labia minora) which are to some extent the custom in these same races, nor to abolish the prevalence of other ceremonies involving bloodshed. It would not therefore be surprising, either, if this horror were overcome for the benefit of the husband on the occasion of the first cohabitation. There is a second explanation, also unconcerned with sexuality, which has, however, a much more general scope than the first. It suggests that primitive man is prey to a perpetual lurking apprehensiveness, just as in the psycho-analytic theory of the neuroses we claim to be the case with people suffering from anxiety neurosis. This apprehensiveness will appear most strongly on all occasions which differ in any way from the usual, which involve something new or unexpected, something not understood or uncanny. This is also the origin of the ceremonial practices, widely adopted in later religions, which are connected with the beginning of every new undertaking, the start of every new period of time, the first-fruits of human, animal and plant life. The dangers which the anxious man believes to be threatening him never appear more vivid in his expectation than on the threshold of a dangerous situation, and then, too, is the only time when protecting himself against them is of any use. The first act of intercourse in marriage can certainly claim, on grounds of importance, to be preceded by such precautionary measures. These two attempts at explanation, based on horror of blood and on fear of first occurrences, do not contradict but rather reinforce each other. The first occasion of sexual intercourse is certainly a critical action, all the more so if it is to involve a flow of blood. The Taboo Of Virginity 2354 A third explanation the one which Crawley prefers draws attention to the fact that the taboo of virginity is part of a large totality which embraces the whole of sexual life. It is not only the first coitus with a woman which is taboo but sexual intercourse in general; one might almost say that women are altogether taboo. A woman is not only taboo in particular situations arising from her sexual life such as menstruation, pregnancy, childbirth and lying-in; apart from these situations, intercourse with women is subject to such solemn and numerous restrictions that we have every reason to doubt the reputed sexual freedom of savages. It is true that, on particular occasions, primitive man’s sexuality will override all inhibitions; but for the most part it seems to be more strongly held in check by prohibitions than it is at higher levels of civilization. Whenever the man undertakes some special enterprise, like setting out on an expedition, a hunt or a campaign, he is obliged to keep away from his wife and especially from sexual intercourse with her; otherwise she will paralyse his strength and bring him bad luck. In the usages of daily life as well there is an unmistakable tendency to keep the sexes apart. Women live with women, men with men; family life, in our sense, seems scarcely to exist in many primitive tribes. This separation sometimes goes so far that one sex is not allowed to say aloud the personal names of members of the other sex, and that the women develop a language with a special vocabulary. Sexual needs will from time to time break through these barriers of separation afresh, but in some tribes even the encounters of husband and wife have to take place outside the house and in secret. Wherever primitive man has set up a taboo he fears some danger and it cannot be disputed that a generalized dread of women is expressed in all these rules of avoidance. Perhaps this dread is based on the fact that woman is different from man, forever incomprehensible and mysterious, strange and therefore apparently hostile. The man is afraid of being weakened by the woman, infected with her femininity and of then showing himself incapable. The effect which coitus has on discharging tensions and causing flaccidity may be the prototype of what the man fears; and realization of the influence which the woman gains over him through sexual intercourse, the consideration she thereby forces from him, may justify the extension of this fear. In all this there is nothing obsolete, nothing which is not still alive among ourselves. The Taboo Of Virginity 2355 Many observers of primitive races living to-day have put forward the view that their impulsions in love are relatively weak and never reach the degree of intensity which we are accustomed to meet with in civilized men. Other observers have contradicted this opinion, but in any case the practice of the taboos we have described testifies to the existence of a force which opposes love by rejecting women as strange and hostile. Crawley, in language which differs only slightly from the current terminology of psycho-analysis, declares that each individual is separated from the others by a ‘taboo of personal isolation’, and that it is precisely the minor differences in people who are otherwise alike that form the basis of feelings of strangeness and hostility between them. It would be tempting to pursue this idea and to derive from this ‘narcissism of minor differences’ the hostility which in every human relation we see fighting successfully against feelings of fellowship and overpowering the commandment that all men should love one another. Psycho-analysis believes that it has discovered a large part of what underlies the narcissistic rejection of women by men, which is so much mixed up with despising them, in drawing attention to the castration complex and its influence on the opinion in which women are held. We can see, however, that these latter considerations have led us to range far beyond our subject. The general taboo of women throws no light on the particular rules concerning the first sexual act with a virgin. As far as they are concerned, we have not got beyond the first two explanations, based on horror of blood and fear of first occurrences, and even these, we must point out, do not touch the core of the taboo in question. It is quite clear that the intention underlying this taboo is that of denying or sparing precisely the future husband something which cannot be dissociated from the first sexual act, although according to our introductory observations this very relation would lead to the woman becoming specially bound to this one man. The Taboo Of Virginity 2356 It is not our task on this occasion to discuss the origin and ultimate significance of taboo observances. I have done this in my book Totem and Taboo, where I have given due consideration to the part played by primal ambivalence in determining the formation of taboo and have traced the genesis of the latter from the prehistoric events which led to the founding of the human family. We can no longer recognize an original meaning of this kind in taboos observed among primitive tribes to-day. We forget all too easily, in expecting to find any such thing, that even the most primitive peoples exist in a culture far removed from that of primaeval days, which is just as old as our own from the point of view of time and like ours corresponds to a later, if different, stage of development. To-day we find taboos among primitive peoples already elaborated into an intricate system of just the sort that neurotics among ourselves develop in their phobias, and we find old motifs replaced by new ones that fit together harmoniously.

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A great number of reminiscences now occur to symptoms ruptured spleen purchase generic meclizine him medicine 802 25 mg meclizine otc, without our having to symptoms 89 nissan pickup pcv valve bad buy meclizine 25 mg on line question him or set him tasks symptoms stomach flu meclizine 25 mg free shipping. What we have done is to make a path to an inner stratum within which the patient now has spontaneously at his disposal material that has an equal degree of resistance attaching to it. It is best to allow him for a time to reproduce such material without being influenced. It is true that he himself is not in a position to uncover important connections, but he may be left to clear up material lying within the same stratum. The things that he brings up in this way often seem disconnected, but they offer material which will be given point when a connection is discovered later on. If we interfere with the patient in his reproduction of the ideas that pour in on him, we may ‘bury’ things that have to be freed later with a great deal of trouble. On the other hand we must not over-estimate the patient’s unconscious ‘intelligence’ and leave the direction of the whole work to it. If I wanted to give a diagrammatic picture of our mode of operation, I might perhaps say that we ourselves undertake the opening up of inner strata, advancing radially, whereas the patient looks after the peripheral extension of the work. Advances are brought about, as we know, by overcoming resistance in the manner already indicated. We must get hold of a piece of the logical thread, by whose guidance alone we may hope to penetrate to the interior. We cannot expect that the free communications made by the patient, the material from the most superficial strata, will make it easy for the analyst to recognize at what points the path leads into the depths or where he is to find the starting-points of the connections of thought of which he is in search. On the contrary, this is precisely what is carefully concealed; the account given by the patient sounds as if it were complete and self-contained. It is at first as though we were standing before a wall which shut out every prospect and prevents us from having any idea whether there is anything behind it, and if so, what. Studies On Hysteria 258 But if we examine with a critical eye the account that the patient has given us without much trouble or resistance, we shall quite infallibly discover gaps and imperfections in it. At one point the train of thought will be visibly interrupted and patched up by the patient as best he may, with a turn of speech or an inadequate explanation; at another point we come upon a motive which would have to be described as a feeble one in a normal person. The patient will not recognize these deficiencies when his attention is drawn to them. But the physician will be right in looking behind the weak spots for an approach to the material in the deeper layers and in hoping that he will discover precisely there the connecting threads for which he is seeking with the pressure procedure. Accordingly, we say to the patient: ‘You are mistaken; what you are putting forward can have nothing to do with the present subject. We must expect to come upon something else here, and this will occur to you under the pressure of my hand. If the chains of ideas in neurotic and particularly in hysterical patients produce a different impression, if in them the relative intensity of different ideas seems inexplicable by psychological determinants alone, we have already found out the reason for this and can attribute it to the existence of hidden unconscious motives. We may thus suspect the presence of such secret motives wherever a breach of this kind in a train of thought is apparent or when the force ascribed by the patient to his motives goes far beyond the normal. Studies On Hysteria 259 In carrying out this work we must of course keep free from the theoretical prejudice that we are dealing with the abnormal brains of ‘degeneres’ and ‘desequilibres’,fi who are at liberty, owing to a stigma, to throw overboard the common psychological laws that govern the connection of ideas and in whom one chance idea may become exaggeratedly intense for no motive and another may remain indestructible for no psychological reason. Once we have discovered the concealed motives, which have often remained unconscious, and have taken them into account, nothing that is puzzling or contrary to rule remains in hysterical connections of thought, any more than in normal ones. In this way, then, by detecting lacunas in the patient’s first description, lacunas which are often covered by ‘false connections’, we get hold of a piece of the logical thread at the periphery, and from this point on we clear a further path by the pressure technique. In doing this, we very seldom succeed in making our way right into the interior along one and the same thread. As a rule it breaks off half-way: the pressure fails and either produces no result or one that cannot be clarified or carried further in spite of every effort. The patient’s facial expression must decide whether we have really come to an end, or whether this is an instance which requires no psychical elucidation, or whether what has brought the work to a standstill is excessive resistance. In the last case, if we cannot promptly overcome the resistance we may assume that we have followed the thread into a stratum which is for the time being still impenetrable. When we have arrived at this stratum along all the threads and have discovered the entanglements on account of which the separate threads could not be followed any further in isolation, we can think of attacking the resistance before us afresh. We force our way into the internal strata, overcoming resistances all the time; we get to know the themes accumulated in one of these strata and the threads running through it, and we experiment how far we can advance with our present means and the knowledge we have acquired; we obtain preliminary information about the contents of the next strata by means of the pressure technique; we drop threads and pick them up again; we follow them as far as nodal points; we are constantly making up arrears; and every time that we pursue a file of memories we are led to some side-path, which nevertheless eventually joins up again. By this method we at last reach a point at which we can stop working in strata and can penetrate by a main path straight to the nucleus of the pathogenic organization. In these later stages of the work it is of use if we can guess the way in which things are connected up and tell the patient before we have uncovered it. If we have guessed right, the course of the analysis will be accelerated; but even a wrong hypothesis helps us on, by compelling the patient to take sides and by enticing him into energetic denials which betray his undoubted better knowledge. We learn with astonishment from this that we are not in a position to force anything on the patient about the things of which he is ostensibly ignorant or to influence the products of the analysis by arousing an expectation. I have never once succeeded, by foretelling something, in altering or falsifying the reproduction of memories or the connection of events; for if I had, it would inevitably have been betrayed in the end by some contradiction in the material. If something turned out as I had foretold, it was invariably proved by a great number of unimpeachable reminiscences that I had done no more than guess right. We need not be afraid, therefore, of telling the patient what we think his next connection of thought is going to be. Another observation, which is constantly repeated, relates to the patient’s spontaneous reproductions. It may be asserted that every single reminiscence which emerges during an analysis of this kind has significance. An intrusion of irrelevant mnemic images (which happen in some way or other to be associated with the important ones) in fact never occurs. An exception which does not contradict this rule may be postulated for memories which, unimportant in themselves, are nevertheless indispensable as a bridge, in the sense that the association between two important memories can only be made through them. Studies On Hysteria 261 the length of time during which a memory remains in the narrow defile in front of the patient’s consciousness is, as has already been explained, in direct proportion to its importance. A picture which refuses to disappear is one which still calls for consideration, a thought which cannot be dismissed is one that needs to be pursued further. Moreover, a recollection never returns a second time once it has been dealt with; an image that has been ‘talked away’ is not seen again. If nevertheless this does happen we can confidently assume that the second time the image will be accompanied by a new set of thoughts, or the idea will have new implications. Again, it frequently happens that an image or thought will re-appear in different degrees of intensity, first as a hint and later with complete clarity. Among the tasks presented by analysis is that of getting rid of symptoms which are capable of increasing in intensity or of returning: pains, symptoms (such as vomiting) which are due to stimuli, sensations or contractures. While we are working at one of these symptoms we come across the interesting and not undesired phenomenon of ‘joining in the conversation’. The problematical symptom re-appears, or appears with greater intensity, as soon as we reach the region of the pathogenic organization which contains the symptom’s aetiology, and thenceforward it accompanies the work with characteristic oscillations which are instructive to the physician. The intensity of the symptom (let us take for instance a desire to vomit) increases the deeper we penetrate into one of the relevant pathogenic memories; it reaches its climax shortly before the patient gives utterance to that memory; and when he has finished doing so it suddenly diminishes or even vanishes completely for a time. If, owing to resistance, the patient delays his telling for a long time, the tension of the sensation of the desire to vomit becomes unbearable, and if we cannot force him to speak he actually begins to vomit. In this way we obtain a plastic impression of the fact that ‘vomiting’ takes the place of a psychical act (in this instance, the act of utterance), exactly as the conversion theory of hysteria maintains. Studies On Hysteria 262 this oscillation in intensity on the part of the hysterical symptom is then repeated every time we approach a fresh memory which is pathogenic in respect of it. If we are obliged temporarily to drop the thread to which this symptom is attached, the symptom, too, retires into obscurity, to emerge once more at a later period of the analysis. This performance goes on until the working-over of the pathogenic material disposes of the symptom once and for all. In all this, strictly speaking, the hysterical symptom is not behaving in any way differently from the memory-picture or the reproduced thought which we conjure up under the pressure of our hand. In both cases we find the same obsessionally obstinate recurrence in the patient’s memory, which has to be disposed of. The difference lies only in the apparently spontaneous emergence of the hysterical symptoms, while, as we very well remember, we ourselves provoked the scenes and ideas. In fact, however, there is an uninterrupted series, extending from the unmodified mnemic residues of affective experiences and acts of thought to the hysterical symptoms, which are the mnemic symbols of those experiences and thoughts. The phenomenon of hysterical symptoms joining in the conversation during the analysis involves a practical drawback, to which we ought to be able to reconcile the patient.

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