Mental Causation in Neurosis and Hysteria

The split subject

The split subject

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The origin of psychoanalysis is often taken to occur with the introduction of Freud’s The Interpretation of Dreams (1900) where he posits the nature of the dream as an unconscious wish fulfilment. However, before this publication Freud was busy at work with two strange categories of mental-psychic phenomena which had pulled his attention due to the type of causal explanation they seemed to require. These two strange categories of mental-psychic phenomena included neurosis (specifically “obsessional” neurosis) and hysteria.

The type of causal explanation they seemed to require was a reverse causality where the mind affected the body, as opposed to the body affecting the mind. Mental causation had been perceived by the medical establishment as an illusory pseudo-scientific explanation for what needed specific understanding on the level of biological cause. Freud, on the other hand, sought to investigate in a concrete form, the way in which the psychic-ideational life of the mind could produce very real biological effects. In one of his first papers titled “Psychical Treatment” he writes (1890):

In the course of this investigation it was found that in some at least of these [neurotic] patients the signs of their illness originate from nothing other than a change in the action of their minds upon their bodies and that the immediate cause of their disorder is to be looked for in their minds.

Freud’s original patients were mostly middle-to-upper class Viennese women (although not exclusively). Due to this distribution of patients, he happened to come into contact with many intensely repressed adults who suffered from symptoms of hysteria. He quickly recognised that hysteria disproportionately pathologized the female subject; whereas neurosis happened to more commonly pathologize the male subject. In any case, the hysterical subject was marked by an irreducible split internal to their own consciousness: the emergence of a quite fierce dual personality. Strangely enough this split into dual personality had been willed by the subject’s own consciousness, although the original intention of this will had been for integration (and not splitting). Thus, the emergence of hysteria had been caused due to an ill-informed mental action, leading to the opposite of the subject’s egoic desires. The subject wanted integration of consciousness, but what the subject received was the splitting of consciousness. Here Freud writes (1894a):

“Splitting of consciousness is a primary feature of the mental change in hysteria […] The splitting in the content of consciousness is the result of an act of will on the part of the patient; that is to say, it is initiated by an effort of will whose motive can be specified.  […] I do not, of course, mean that the patient intends to bring about a spitting of his consciousness.  His intention is a different one; but, instead of attaining its aim, it produces a splitting of consciousness.

What was going on? What seemed to be going on was not causally on the level of the body but on the level of the mind, specifically the psychical life of language and ideas. What preceded the splitting of consciousness due to the mental action of the subject’s will was a confrontation with an incompatible or contradictory idea. The subject, in the course of development, had become aware of an idea that could not be properly integrated by their ego, thus producing an emotionally distressing affect, and thus necessitating a type of mental action to repress or defend against the persistent internal incompatibility or contradiction. The result was a type of mental action Freud described as a “pushing the thing away” or “forgetting”. This is the origin of the identification of repression as an egoic defense, an ultimately reactionary and futile mechanism to solve the ideational incompatibility or contradiction appearing to consciousness.

The hysteric thus built an identity on a split of consciousness, with one form of consciousness seemingly acceptable to the world: a weak egoic appearance; and the other form of consciousness seemingly unacceptable to the world: a strong id-like underground. These two personalities would do battle inside the (increasingly tormented) subject, with the weak egoic appearance conforming to the morals and standards of the society (marriage, children, and so forth); and the strong id-like underground revealing all sorts of strange pathological desires in the secret speech of the analyst’s office (wanting to kill her children, wanting to throw her self out of a window, etc.). In this way Freud got the first glimpse of “civilisation’s discontents”.

In contrast to hysteria, Freud also identified another strong mental symptom, which disproportionately affected men: obsessional neurosis. Whereas hysteria was based on a splitting of consciousness, obsessional neurosis was based on a “non-arrival” of a certain consciousness which demanded a substitute form. Thus for the obsessional neurotic an incompatible or contradictory idea was encountered by the subject, but the reaction to this incompatible or contradictory idea was of a different egoic formation in relation to the hysteric. Instead of splitting into two forms of consciousness, the obsessional neurotic’s consciousness became “fixed” on a substitute form of satisfaction or fulfilment (1894a):

The task which the ego, in its defensive attitude, sets itself of treating the incompatible idea as ‘non arivee [non-arrival;] simply cannot be fulfilled by it.

The similarity with hysteria is that the subject’s egoic desire in terms of mental action had been to free itself from incompatibility or contradiction. The hysteric wanted to banish the incompatibility through repression, and the obsessional neurotic wanted to banish the incompatibility through alternative actualisation. However, in this egoic motion the opposite occurs: the hysteric seems to become split from a true idea, the neurotic seems to become obsessed with a false idea. The true idea split from the hysteric is the underground desires unacceptable to society, and the false idea of the neurotic is the attachment to a false desire through a form of sublimation of the original impossible energy that is recognised as “non-arrival” (not satisfiable).

What is more than this clear identification of an emergent oppositional determination in the psychical life of human consciousness, is the clear identification of the origin of this oppositional determination, which seemed to be demarcated along (what we would call today) “gendered lines”. Freud was, from the beginning, convinced that the origin of this oppositional determination was sexual (although he had yet to identify its infantile sexual origin). Here in regards to the origin of hysteria (1894a):

[hysterical] incompatible ideas […] arise chiefly on the soil of sexual experience and sensation; and the patients can recollect as precisely as could be desired their efforts at defence

And the origin of neurosis (1894a):

we have evidence that the [neurotic] obsession represents a substitute or surrogate for the incompatible sexual idea and has taken its place in consciousness

At this stage of understanding Freud had come to classify two symptomal forms of consciousness as originating in the psychical life of an incompatibility, and an incompatibility that is chiefly of a sexual nature, which then becomes transferred into problems of a non-sexual nature (coping with the day-to-day of modern civilization, and so forth). Consequently, Freud had clearly identified the problem, which was that the spontaneous egoic formation, although well-intended, was not an adequate solution to the becoming of a form of human consciousness. What the action of the ego produced was merely a prolongation of incompatibility where the repressed idea remained hidden or buried in another unknown form of consciousness (1894a):

In both the instances considered so far, defence against the incompatible idea was effected by separating it from its affect; the idea itself remained in consciousness, even though weakened and isolated.

Moreover, in focusing on these mental phenomena, Freud had also clearly identified the way in which such mental phenomena have real bodily affects on human beings. In symptomal states of hysteria and neurosis the subject may experience disturbances of heart action, respiration, sweating, tremors and shivering, ravenous hunger, diarrhoea, vertigo, congestions or night frights (1894b). Such bodily reactions to mental symptoms led Freud further down the rabbit hole of the mind and the origin of these problems.

The more Freud investigated the origins of hysteria and neurosis the more it became clear to him of the common linkage between the two symptoms. The formation of both symptoms, he hypothesised, was not just in an incompatible idea, but in the deeper form of a psychical trauma, and specifically a psychical trauma related to infantile sexuality (1896):

Symptoms […] can only be understood if traced back to experiences which have a ‘traumatic’ effect, and that these psychical traumas refer to the patient’s sexual life […] it is not enough that [they] should occur at some period of the subject’s life an event which touches his sexual existence and becomes pathogenic through the release and suppression of a distressing affect.  On the contrary, these sexual traumas must have occurred in early childhood (before puberty)

However, at the common causal linkage between hysteria and neurosis now being pushed back to a deeper origin (more deeply problematising the issue), Freud also identified that the type of relation to the psychical sexual trauma once again bifurcated, with hysteria being formed as a result of passive sexual trauma and obsessional neurosis being formed as a result of active sexual trauma. Once again we can see that such divergences fall along classical metaphysical categories often associated with gender (passive = female; action = male). Here on the emergence of hysteria (1896):

I have found this specific determinant of hysteria — sexual passivity during the pre-sexual period […] A path is laid open to an understanding of why hysteria is far more frequent in members of the female sex

And on the emergence of obsessional neurosis (1896):

Obsessions similarly presuppose a sexual experience in childhood (though one of a different nature from that found in hysteria).  […] However, it is not longer a question of sexual passivity, but of acts of aggression carried out with pleasure and of pleasurable participation in sexual acts — that is to say, of sexual activity.  This difference in the aetiological circumstances is bound up with the fact that obsessional neurosis shows a viable preference for the male sex.

Of course Freud was not “reifying” or ‘essentializing” the genders or the symptoms. Male subjects could become hysterical, and female subjects could become obsessional neurotics. The core difference was in the motion of the sexual energy and the affect on the human subject. The fact that there was a more-or-less clear demarcation between female hysterics and male neurotics was more a probabilistic distribution which may have reflected social morals and rules of the time, and perhaps the effects of being in a certain biological body with different energetic flows emerging in development, and so forth.

The larger point is that all of these observations were made before Freud published The Interpretation of Dreams (1900) with the idea that a dream was an unconscious wish fulfilment. What preceded this hypothesis was a crucial development in what came to be known as psychoanalysis, namely the emphasis on mental causation (mind affecting the body), and the emergence of two forms of symptoms (hysteria and neurosis), which had a common infantile sexual origin, and which could not be handled by the subject’s ego (despite its best efforts).

In this way the birth of psychoanalysis is really in the identification that these symptoms required us to develop a way, a “talking cure”, to discuss these “unconscious” dimensions of our minds (1896):

Psychoanalysis: [the] purpose of making conscious what has so far been unconscious

This closed a certain early chapter in Freud’s thinking, a closure leading to a new opening (to the formalization of dreams, desires and so forth). From the very beginning Freud had been captured by the problem of mental causation, the ideational life of human beings, and the “magic” of language to transform the subject’s reality. The logic was straightforward, if humans could fearlessly open up the spaces to confront the incompatible ideas, the unconscious traumas, the taboos of sexuality, then perhaps a new type of human could emerge, a type of human that breaks from the unconscious shackles of hysterical “splitting of consciousness”, or a neurotic “obsessional attachment to false goals”. Here Freud is clear (1898):

Above all, a place must be created in public opinion for the discussion of the problems of sexual life.  It will have to become possible to talk about these things without being stamped as a trouble-maker or as a person who makes capital out of the lower instincts.  And so here, too, there is enough work left to do for the next hundred years — in which our civilization will have to learn to come to terms with the claims of sexuality.

Well, one thing we can say is that Freud underestimated the degree of the problem. It is clearly going to take more than a hundred years to approach and reconcile these problems. Hysteria and obsessional neurosis are still very much with us. Egoic defences against their underlying sexual contradiction and trauma are still very much with us. And the failure to open up the symbolic spaces to discuss these realities are still very much with us.

That is why I want to dedicate my full attention to better understanding the nature of the unconscious, the way in which it intersects with the physical world, and what a deeper knowledge of this realm can tell us about the truth of reality. Want to join? REGISTER NOW.


Freud, S. 1890. Psychical Treatment.

Freud, S. 1894a. The Neuro-Psychoses of Defence (An Attempt at a Psychological Theory of Acquired Hysteria, of Many Phobias, and Obsessions and of Certain Hallucinatory Psychoses)

Freud, S. 1894b. On the Grounds for Detaching a Particular Syndrome from Neurasthenia Under the Description ‘Anxiety Neurosis’.

Freud, S. 1896. Further Remarks on the Neuro-Psychoses of Defence.

Freud, S. 1898. Sexuality in the Aetiology of the Neuroses.