IT WAS A MISTAKE to try to confine the all too wide theme of the exogenous origin of character formations and neuroses within a Congress paper. I shall, therefore, content myself with a short extract from what I would have had to say on that subject. Perhaps it will be best if I start by telling you how I have come to the problem expressed in the title of this paper. In the address given to the Viennese Psycho-Analytic Society on the occasion of Professor Freud's seventy-fifth birthday, I reported on a regression in technique (and partly also in the theory) of the neuroses to which I was forced by certain bad or incomplete results with my patients. By that I mean the recent, more emphatic stress on the traumatic factors in the pathogenesis of the neuroses which had been unjustly neglected in recent years. Insufficiently deep exploration of the exogenous factor leads to the danger of resorting prematurely to explanations—often too facile explanations—in terms of “disposition” and “constitution.”
The — I should like to say imposing - phenomena, the almost hallucinatory repetitions of traumatic experiences which began to accumulate in my daily practice, seemed to justify the hope that by this abreaction large quantities of repressed affects might obtain acceptance by the conscious mind and that the formation of new symptoms, especially when the superstructure of the affects had been sufficiently loosened by the analytic work, might be ended. This hope, unfortunately, was only very imperfectly fulfilled and some of my patients caused me a great deal of worry and embarrassment. The repetition, encouraged by the analysis, turned out to be too good. It is true that there was a marked improvement in some of the symptoms; on the other hand, however, these patients began to suffer from nocturnal attacks of anxiety, even from severe nightmares, and the analytic session degenerated time and again into an attack of anxiety hysteria. Although we were able to analyse conscientiously the threatening symptoms of such an attack, which seemed to convince and reassure the patient, the expected permanent success failed to materialize and the next morning brought the same complaints about the dreadful night, while in the analytic session, repetition of the trauma occurred. In this embarrassing position I tried to console myself in the usual way—that the patient had a much too forceful resistance or that he suffered from such severe repressions that abreaction and emergence into consciousness could only occur piecemeal. However, as the state of the patient, even after a considerable time, did not change in essentials, I had to give free rein to self-criticism. I started to listen to my patients when, in their attacks, they called me insensitive, cold, even hard and cruel, when they reproached me with being selfish, heartless, conceited, when they shouted at me: “Help! Quick! Don't let me perish helplessly!” Then I began to test my conscience in order to discover whether, despite all my conscious good intentions, there might after all be some truth in these accusations. I wish to add that such periods of anger and hatred occurred only exceptionally; very often the sessions ended with a striking, almost helpless compliance and willingness to accept my interpretations. This, however, was so transitory that I came to realize that even these apparently willing patients felt hatred and rage, and I began to encourage them not to spare me in any way. This encouragement, too, failed to achieve much, for most of my patients energetically refused to accept such an interpretative demand although it was well supported by analytic material.
