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The origin and development of psychoanaysis

restored to her normal mental life. This state of health would last for several hours, and then give
place on the next day to a new "absence," which was removed in the same way by relating the
newly-created fancies. It was impossible not to get the impression that the psychic alteration
which was expressed in the "absence" was a consequence of the excitations originating from
these intensely emotional fancy-images. The patient herself, who at this time of her illness
strangely enough understood and spoke only English, gave this new kind of treatment the name "
talking care," or jokingly designated it as "chimney sweeping."
The doctor soon hit upon the fact that through such cleansing of the soul more could be
accomplished than a temporary removal of the constantly recurring mental "clouds." Symptoms
of the disease would disappear when in hypnosis the patient could be made to remember the
situation and the associative connections under which they first appeared, provided free vent was
given to the emotions which they aroused. "There was in the summer a time of intense heat, and
the patient had suffered very much from thirst; for, without any apparent reason, she had
suddenly become unable to drink. She would take a glass of water in her hand, but as soon as it
touched her lips she would push it away as though suffering from hydrophobia. Obviously for
these few seconds she was in her absent state. She ate only fruit, melons and the like, in order to
relieve this tormenting thirst. When this had been going on about six weeks, she was talking one
day in hypnosis about her English governess, whom she disliked, and finally told, with every sign
of disgust, how she had come into the room of the governess, and how that lady's little dog, that
she abhorred, had drunk out of a glass. Out of respect for the conventions the patient had
remained silent. Now, after she had given energetic expression to her restrained anger, she asked
for a drink, drank a large quantity of water without trouble, and woke from hypnosis with the
glass at her lips. The symptom thereupon vanished permanently.[5]
Permit me to dwell for a moment on this experience. No one had ever cured an hysterical
symptom by such means before, or had come so near understanding its cause. This would be a
pregnant discovery if the expectation could be confirmed that still other, perhaps the majority of
symptoms, originated in this way and could be removed by the same method. Breuer spared no
pains to convince himself of this and investigated the pathogenesis of the other more serious
symptoms in a more orderly way. Such was indeed the case; almost all the symptoms originated
in exactly this way, as remnants, as precipitates, if you like, of affectively-toned experiences,
which for that reason we later called "psychic traumata." The nature of the symptoms became
clear through their relation to the scene which caused them. They were, to use the technical term,
"determined" (determiniert) by the scene whose memory traces they embodied, and so could no
longer be described as arbitrary or enigmatical functions of the neurosis.
Only one variation from what might be expected must be mentioned. It was not always a single
experience which occasioned the symptom, but usually several, perhaps many similar, repeated
traumata cooperated in this effect. It was necessary to repeat the whole series of pathogenic
memories in chronological sequence, and of course in reverse order, the last first and the first
last. It was quite impossible to reach the first and often most essential trauma directly, without
first clearing away those coming later.
You will of course want to hear me speak of other examples of the causation of hysterical
symptoms beside this of inability to drink on account of the disgust caused by the dog drinking
from the glass. I must, however, if I hold to my programme, limit myself to very few examples.
Breuer relates, for instance, that his patient's visual disturbances could be traced back to external
causes, in the following way. "The patient, with tears in her eyes, was sitting by the sick-bed
when her father suddenly asked her what time it was. She could not see distinctly, strained her
eyes to see, brought the watch near her eyes so that the dial seemed very large (macropia and
strabismus conv.), or else she tried hard to suppress her tears, so that the sick man might not see
them."[6]
All the pathogenic impressions sprang from the time when she shared in the care of her sick
 
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