HKB
from intellectual occupation with the sexual problem, the consequence of which in pronounced cases is a complete sexual ignorance, which is preserved till the age of sexual maturity is attained.[24]
This feature, so characteristic of hysteria, is not seldom concealed in crude observation by the existence of the second constitutional factor of hysteria, namely, the enormous development of the sexual craving. But the psychological analysis will always reveal it and solves the very contradictory enigma of hysteria by proving the existence of the contrasting pair, an immense sexual desire and a very exaggerated sexual rejection.
The provocation of the disease in hysterically predisposed persons is brought about if in consequence of their progressive maturity or external conditions of life they are earnestly confronted with the real sexual demand. Between the pressure of the craving and the opposition of the sexual rejection an outlet for the disease results, which does not remove the conflict but seeks to elude it by transforming the libidinous strivings into symptoms. It is an exception only in appearance if a hysterical person, say a man, becomes subject to some banal emotional disturbance, to a conflict in the center of which there is no sexual interest. Psychoanalysis will regularly show that it is the sexual components of the conflict which make the disease possible by withdrawing the psychic processes from normal adjustment.
Neurosis and Perversion.--A great part of the opposition to my assertion is explained by the fact that the sexuality from which I deduce the psychoneurotic symptoms is thought of as coincident with the normal sexual impulse. But psychoanalysis teaches us better than this. It shows that the symptoms do not by any means result at the expense only of the so called normal sexual impulse (at least not exclusively or preponderately), but they represent the converted expression of impulses which in a broader sense might be designated as perverse if they could manifest themselves directly in phantasies and acts without deviating from consciousness. The symptoms are therefore partially formed at the cost of abnormal sexuality. The neurosis is, so to say, the negative of the perversion.[25]
The sexual impulse of the psychoneurotic shows all the aberrations which we have studied as variations of the normal and as manifestations of morbid sexual life.
(a) In all the neurotics without exception we find feelings of inversion in the unconscious psychic life, fixation of libido on persons of the same sex. It is impossible, without a deep and searching discussion, adequately to appreciate the significance of this factor for the formation of the picture of the disease; I can only assert that the unconscious propensity to inversion is never wanting and is particularly of immense service in explaining male hysteria.[26]
(b) All the inclinations to anatomical transgression can be demonstrated in psychoneurotics in the unconscious and as symptom-creators. Of special frequency and intensity are those which impart to the mouth and the mucous membrane of the anus the role of genitals.
(c) The partial desires which usually appear in contrasting pairs play a very prominent role among the symptom-creators in the psychoneuroses. We have learned to know them as carriers of new sexual aims, such as peeping mania, exhibitionism, and the actively and passively formed impulses of cruelty. The contribution of the last is indispensable for the understanding of the morbid nature of the symptoms; it almost regularly controls some portion of the social behavior of the patient. The transformation of love into hatred, of tenderness into hostility, which is characteristic of a large number of neurotic cases and apparently of all cases of paranoia, takes place by means of the union of cruelty with the libido.
The interest in these deductions will be more heightened by certain peculiarities of the diagnosis of facts.
Alpha. There is nothing in the unconscious streams of thought of the neuroses which would correspond to an inclination towards fetichism; a circumstance which throws light on the psychological peculiarity of this well understood perversion.