Freud, S. A General Introduction to Psychoanalysis, Lecture 17 on The Sense of Symptoms- (OCD), and Lecture 18(PTSD)

A summary of Freud’s Lecture 17 The Sense of Symptoms(1915-1917)

Freud’s essential declaration, in his paper/lecture the sense of symptoms, is that symptoms in general and obsessional neurosis in particular have a sense and a symbolic representation of the individuals experiential past. Neurotic symptoms represent, repeat, and contain, the individuals past experience, like parapraxes and dreams, which represent something of the individuals past and unconscious mind.

Freud defines obsessional neurosis as a preoccupation with thoughts and impulses that feel alien and strange to the patient. Although the obsessions appear silly, alien, and indifferent, they exhaust the patient’s well-being, and antagonize him until he surrenders to their overpowering persistency. The obsessions facilitate impulses which cause him to act and perform ceremonies which provide no enjoyment; on the contrary they’re repetitive and bring anxiety.

Although the obsessions and compulsions are related, they are not equally distributed in equal proportion.

The only way the patient can rid themselves from the obsessions is by using displacement. He is able to exchange one foolish idea with another, which is somewhat milder, however the general obsessions persist.

Another key feature in obsessional neurosis is doubt. Doubt in the intellectual arena. Although the individual may have achieved a high degree of intellect, he/she is unable to find certainty and decisiveness. Uncertainty is evident in areas which were once most certain, and an ever increasing inconclusiveness and loss of freedom become apparent.

Psychiatry views these symptoms as degeneration, however psychoanalysis proves otherwise. The fact that psychoanalysis can rid one from these symptoms proves that there is no degeneration; rather there is a specific expression that these symptoms communicate.

Freud goes on to present two cases which show how obsessional symptoms are actually a manifestation of a past scene. The obsessions can also be a form of identification with a particulate figure from the forgotten scene. Freud ads, in addition to its representation of the past scene, there is a specific motivation and kernel that propels the past incident into an obsessional act, which is the desire to undo, to correct, to rectify the past event.
The ceremonial process that’s manifest in the obsessional neurosis can be differentiated from the standard ceremonies with that that they are unyielding, irrational, and carried out with apprehension.

In both cases the symptoms reveal a strong sexual conflict in the patient’s past.
The more individualized the symptoms are the easier it is to find the connection. Difficulty arises with ‘typical’ and ‘historical’ symptoms, which are common among all individuals with a specific pathology, because of their commonality.

A summary of Lecture XVIII

In both cases there appeared to be a fixation which caused them to alienate the present and future. The past experience kept the patients in a particular attachment to its event, and didn’t allow them to move forward. The symptoms carried the individuals back to a past episode and kept them hostage and stagnated to that particular occasion.

Freud compares obsessional neurosis to traumatic neurosis (ptsd). In traumatic neurosis we can clearly see how the trauma keeps the patient from moving forward, and how the trauma is repeated and replicated. It is as if the patient is still in the ‘traumatic situation’ and needs to resolve the dangers and overwhelming stimulus which the situation once entailed. Obsessional neurosis can be seen as another form of traumatic neurosis.

However from our second case study where the girl had an erotic attachment to her father there needs additional explanation. The erotic attachment to fathers is so common that trauma is unsuitable and after the erotic attachment she went on for several years with no apparent symptoms, only after a long period of time did the symptoms appear.

There is another important observation which needs to made, and that is, both patients had no idea what was forcing them to perform these acts. They had no awareness as to why these obsessions and compulsions were happening. The connections to the past were totally hidden. The whence, whither, and predetermination were totally unmindful to the patient. This observation directs us to a specific region in the mind, the unconscious. We need to make another observation and that’s the alien features and estrangement, which color these symptoms. This also indicate to their unconscious origin. They’re like aliens from the immortals intruding on a mortal’s life, which again directs us to an unconscious region in the mind that is disconnected from the rest of the conscious mind. And although the obsessions themselves are conscious their predeterminations are unconscious.

In order for the symptoms to sustain their origin they need to stay away from consciousness. The minute the unconscious origin becomes conscious the symptoms cease. This is the key to the psychoanalytic therapeutic process. Symptoms arrived because the unconscious processes weren’t allowed to become fully developed, thus symptoms replaced these processes. The therapeutic mission is to reverse that which had taken place and to allow the unconscious processes to become fully develop, thus the symptoms cease. This is the foundation of psychoanalysis cure.
One may think that having the analyst tell the patient about unconscious origin will help, no, this is erroneous. The patient needs to become aware and acknowledge his desires from the inside. Although the analyst’s information can help put the analytic process into motion it cannot remove the symptoms. The knowledge of the fact is not enough. The knowledge needs to come from within the psychical structure of his internal ego.

The resistance to acknowledge the unconscious is because it causes a blow to the human ego, similar to the recognition that the earth is not the center of the universe, and that human are decedent from the animal kingdom.

2 thoughts on “Freud, S. A General Introduction to Psychoanalysis, Lecture 17 on The Sense of Symptoms- (OCD), and Lecture 18(PTSD)

  1. Psychoanalysis at the same time is underrated in this attempt to “reveal” and through that heal, and at the same time paradoxical problematic, since every therapeutic practice is also a creation, creation in a deleuzian sense, something not (only) revealing but reshaping. This becomes especially true in the age of chemical drugs and stressful life conditions.

    I claim most psychic problems contain serious physical origin from damaged nerve functions to imbalanced dopamine production (like in drug users, many hallucinations and irrational symptoms can often be a result of this imbalanced dopamine function, not necessarily too much of it, but rather brain’s difficulty to maintain healthy dopamine levels, which can be a result of stressful living conditions and lifestyle factors that body has to cope with).

    As the increase of serotonin through SSRI drugs or blocking of dopamine through antipsychotic treatment seems to “cut” certain processes in the body, they often lead to side effects. One could also just slightly increase the amount of tryptophan (through which serotonin is created) or phenylalanine and/or tyrosine (which are used for creation of dopamine, thyroid hormones etc.) and let body use them the way it needs. One can use them as pure amino acids or get them from food sources.

    It is true that tryptophan and phenylalanine can, in high amounts, block each other, but there has to be correct balance with active elements (striving for a goal, or whatever) and rest elements (serotonin, melatonin etc.). Too much serotonin simply makes one dull, unwilling and passive. Also certain studies prove that increase in dopamine level, and even in adrenaline or noradrenaline and such, can paradoxically provide a drop in cortisol level. In this sense, stress is not just this inability to relax, but inability to find proper (subjective, as it always is) balance with rest and action, a proper lifestyle and this is of course always related to our current social order, our collective reality.

    Sometimes an attempt to rise testosterone can result problems with dopamine function as testosterone is associated with fat, which can be problematic for dopamine function. Third element in this triangle would be processes related to blood flow. Again, this is too simple model (even in this purpose), but it proves the point that lifestyle is a question of a certain process, proper balance. And it leads us to a possibility that one could probably bind certain bodily processes together, to make it easier to locate physical origins for a problem (not just a physical decease, which is simply a result of processes or somewhat imbalanced processes). Scientific thinking is often interested in static “something”, not processes.

    To heal dopamine function one can also use some amount of NAC, which seems to heal dopamine pathways in a prolonged use through increased glutathione. I would suggest to use it regularly for a while (half a year for example) and after that use it depending of needs (maybe leave it out for a while and so on). Vitamin C is another basic vitamin that one can use. It should be divided in small portions, something like 250mg, maybe 3-4 times per day, or even more, if problems are serious. One can also use B vitamins as they are related to healthy nerve functions. These affect the processes through which hormones, neurotransmitters etc. are created, so one has to always ask, are the symptoms related to a lack of something or body’s inability to get certain processes done.

    One can also use zinc (and copper as it can go down with zinc supplementation), fish oil and vitamin D as lack of them is sometimes associated with mental, or mental type of problems. I would use them only depending of needs (vitamin D only if one is not spending time in sunlight regularly and so on). Daily food choices affect things as well. Again, it’s this question of balance…

    Often all problems are more or less related to increased and continually too high level of cortisol. Many things from mental practices to natural substances can be used to control cortisol level. Of course these are just a way to adapt and are not always enough.

    I’m not saying here that mental problems are only related to physical level (after all, this scientific level is rather new invention historically). They are related to combination of individual past, society (and collective demands) and physical imbalances. However, one should very carefully consider on which level different symptoms should be treated to result overall positive effects. In worst cases the physical imbalances of a mentally ill patient, if treated in general scientific field, would result in a long list of decease states or whatever. Sometimes we make decease states more chronic then they really should be.

    I claim we come from very different past experiences, from very different social groups, from very different linguistic systems. Yes, there are some collective elements, but in the end we all use language slightly different way. Understanding is misunderstanding, I claim. We understand the other only by this lack of understanding. We think we have some insight and yet again cannot never fully relate to it. And this is why I think we cannot never really “help” the other, not in this “do this or that” sense. It’s not just that his or her experiences are different, it’s also that his or her bodily systems contain slightly different type of balance.

    What we can, however, do, is to adapt or tune in just enough to be able to give some ideas to other, some small fragments or possibilities, something to get forward to, to progress. And in this sense, I believe in this combination of different systems to provide a better overall sense of things, or to create a tool box that has more tools to use.

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