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The final transformation which the fear of the super-ego undergoes is blood pressure good average buy generic esidrix on-line, it seems to arrhythmia echocardiogram buy esidrix 25mg on line me pulse pressure definition medical cheap esidrix 12.5mg with mastercard, the fear of death (or fear for life) which is a fear of the super-ego projected on to blood pressure medication for young adults buy generic esidrix 25mg the powers of destiny. Inhibitions, Symptoms And Anxiety 4295 At one time I attached some importance to the view that what was used as a discharge of anxiety was the cathexis which had been withdrawn in the process of repression. The reason for this is that whereas I formerly believed that anxiety invariably arose automatically by an economic process, my present conception of anxiety as a signal given by the ego in order to affect the pleasure-unpleasure agency does away with the necessity of considering the economic factor. Of course there is nothing to be said against the idea that it is precisely the energy that has been liberated by being withdrawn through repression which is used by the ego to arouse the affect; but it is no longer of any importance which portion of energy is employed for this purpose. This new view of things calls for an examination of another assertion of mine namely, that the ego is the actual seat of anxiety. There is no reason to assign any manifestation of anxiety to the super-ego; while the expression ‘anxiety of the id’ would stand in need of correction, though rather as to its form than its substance. Anxiety is an affective state and as such can, of course, only be felt by the ego. The id cannot have anxiety as the ego can; for it is not an organization and cannot make a judgement about situations of danger. On the other hand it very often happens that processes take place or begin to take place in the id which cause the ego to produce anxiety. Indeed, it is probable that the earliest repressions as well as most of the later ones are motivated by an ego-anxiety of this sort in regard to particular processes in the id. Here again we are rightly distinguishing between two cases: the case in which something occurs in the id which activates one of the danger-situations for the ego and induces the latter to give the anxiety-signal for inhibition to take place, and the case in which a situation analogous to the trauma of birth is established in the id and an automatic reaction of anxiety ensues. The two cases may be brought closer together if it is pointed out that the second case corresponds to the earliest and original danger-situation, while the first case corresponds to any one of the later determinants of anxiety that have been derived from it; or, as applied to the disorders which we in fact come across, that the second case is operative in the aetiology of the ‘actual’ neuroses, while the first remains typical for that of the psychoneuroses. Inhibitions, Symptoms And Anxiety 4296 We see, then, that it is not so much a question of taking back our earlier findings as of bringing them into line with more recent discoveries. It is still an undeniable fact that in sexual abstinence, in improper interference with the course of sexual excitation or if the latter is diverted from being worked over psychically, anxiety arises directly out of libido; in other words, that the ego is reduced to a state of helplessness in the face of an excessive tension due to need, as it was in the situation of birth, and that anxiety is then generated. Here once more, though the matter is of little importance, it is very possible that what finds discharge in the generating of anxiety is precisely the surplus of unutilized libido. As we know, a psychoneurosis is especially liable to develop on the basis of an ‘actual’ neurosis. This looks as though the ego were attempting to save itself from anxiety, which it has learned to keep in suspension for a while, and to bind it by the formation of symptoms. Analysis of the traumatic war neuroses a term which, incidentally, covers a great variety of disorders would probably have shown that a number of them possess some characteristics of the ‘actual’ neuroses. Inhibitions, Symptoms And Anxiety 4297 In describing the evolution of the various danger-situations from their prototype, the act of birth, I have had no intention of asserting that every later determinant of anxiety completely invalidates the preceding one. It is true that, as the development of the ego goes on, the earlier danger-situations tend to lose their force and to be set aside, so that we might say that each period of the individual’s life has its appropriate determinant of anxiety. Thus the danger of psychical helplessness is appropriate to the period of life when his ego is immature; the danger of loss of object, to early childhood when he is still dependent on others; the danger of castration, to the phallic phase; and the fear of his super-ego, to the latency period. Nevertheless, all these danger-situations and determinants of anxiety can persist side by side and cause the ego to react to them with anxiety at a period later than the appropriate one; or, again, several of them can come into operation at the same time. It is possible, moreover, that there is a fairly close relationship between the danger-situation that is operative and the form taken by the ensuing neurosis. Up till then we had been content to confine our interest to those aspects of repression which concerned the ego the keeping away from consciousness and from motility, and the formation of substitutes (symptoms). With regard to the repressed instinctual impulses themselves, we assumed that they remained unaltered in the unconscious for an indefinite length of time. But now our interest is turned to the vicissitudes of the repressed and we begin to suspect that it is not self-evident, perhaps not even usual, that those impulses should remain unaltered and unalterable in this way. There is no doubt that the original impulses have been inhibited and deflected from their aim through repression. But has the portion of them in the unconscious maintained itself and been proof against the influences of life that tend to alter and depreciate themfi In other words, do the old wishes, about whose former existence analysis tells us, still existfi It is that the old, repressed wishes must still be present in the unconscious since we still find their derivatives, the symptoms, in operation. It does not enable us to decide between two possibilities: either that the old wish is now operating only through its derivatives, having transferred the whole of its cathectic energy to them, or that it is itself still in existence too. If its fate has been to exhaust itself in cathecting its derivatives, there is yet a third possibility. In the course of the neurosis it may have become re-animated by regression, anachronistic though it may now be. There are many things about mental life, both normal and pathological, which seem to call for the raising of such questions. In my paper, ‘The Dissolution of the Oedipus Complex’ (1924d), I had occasion to notice the difference between the mere repression and the real removal of an old wishful impulse. Inhibitions, Symptoms And Anxiety 4298 When, in an earlier part of this discussion, we found that the danger of castration was of importance in more than one neurotic illness, we put ourselves on guard against overestimating that factor, since it could not be a decisive one for the female sex, who are undoubtedly more subject to neuroses than men. We now see that there is no danger of our regarding castration anxiety as the sole motive force of the defensive processes which lead to neurosis. I have shown elsewhere how little girls, in the course of their development, are led into making a tender object-cathexis by their castration complex. It is precisely in women that the danger situation of loss of object seems to have remained the most effective. All we need to do is to make a slight modification in our description of their determinant of anxiety, in the sense that it is no longer a matter of feeling the want of, or actually losing the object itself, but of losing the object’s love. Since there is no doubt that hysteria has a strong affinity with femininity, just as obsessional neurosis has with masculinity, it appears probable that, as a determinant of anxiety, loss of love plays much the same part in hysteria as the threat of castration does in phobias and fear of the super-ego in obsessional neurosis. According to the second opinion, symptoms are only formed in order to avoid anxiety: they bind the psychical energy which would otherwise be discharged as anxiety. That this latter opinion is at least in part true is shown by some striking examples. If an agoraphobic patient who has been accompanied into the street is left alone there, he will produce an anxiety attack. Or if an obsessional neurotic is prevented from washing his hands after having touched something, he will become a prey to almost unbearable anxiety. It is plain, then, that the purpose and the result of the imposed condition of being accompanied in the street and the obsessional act of washing the hands were to obviate outbreaks of anxiety of this kind. In this sense every inhibition which the ego imposes on itself can be called a symptom. Since we have traced back the generating of anxiety to a situation of danger, we shall prefer to say that symptoms are created in order to remove the ego from a situation of danger. If the symptoms are prevented from being formed, the danger does in fact materialize; that is, a situation analogous to birth is established in which the ego is helpless in the face of a constantly increasing instinctual demand the earliest and original determinant of anxiety. Thus in our view the relation between anxiety and symptom is less close than was supposed, for we have inserted the factor of the danger-situation between them. We can also add that the generating of anxiety sets symptom formation going and is, indeed, a necessary prerequisite of it. For if the ego did not arouse the pleasure-unpleasure agency by generating anxiety, it would not obtain the power to arrest the process which is preparing in the id and which threatens danger. There is in all this an evident inclination to limit to a minimum the amount of anxiety generated and to employ it only as a signal; for to do otherwise would only result in feeling in another place the unpleasure which the instinctual process was threatening to produce, and that would not be a success from the standpoint of the pleasure principle, although it is one that occurs often enough in the neuroses. Inhibitions, Symptoms And Anxiety 4300 Symptom-formation, then, does in fact put an end to the danger-situation. It has two aspects: one, hidden from view, brings about the alteration in the id in virtue of which the ego is removed from danger; the other, presented openly, shows what has been created in place of the instinctual process that has been affected namely, the substitutive formation. It would, however, be more correct to ascribe to the defensive process what we have just said about symptom-formation and to use the latter term as synonymous with substitute-formation. It will then be clear that the defensive process is analogous to the flight by means of which the ego removes itself from a danger that threatens it from outside. One objection to it is that loss of an object (or loss of love on the part of the object) and the threat of castration are just as much dangers coming from outside as, let us say, a ferocious animal would be; they are not instinctual dangers. A wolf would probably attack us irrespectively of our behaviour towards it; but the loved person would not cease to love us nor should we be threatened with castration if we did not entertain certain feelings and intentions within us. Thus such instinctual impulses are determinants of external dangers and so become dangerous in themselves; and we can now proceed against the external danger by taking measures against the internal ones. In phobias of animals the danger seems to be still felt entirely as an external one, just as it has undergone an external displacement in the symptom. That portion of anxiety in regard to the super-ego which constitutes social anxiety still represents an internal substitute for an external danger, while the other portion- moral anxiety is already completely endopsychic.
On the contrary blood pressure bracelet purchase esidrix, such an event would blood pressure level chart buy esidrix 25mg with amex, I think blood pressure medication excessive sweating order esidrix, be something entirely commonplace and banal; and even the position in which we have inferred that the coitus took place cannot in the least alter this judgement especially as the evidence does not require that the intercourse should have been performed from behind each time blood pressure chart heart rate purchase esidrix now. A single time would have been enough to give the spectator an opportunity for making observations which would have been rendered difficult or impossible by any other attitude of the lovers. The content of the scene cannot therefore in itself be an argument against its credibility. Doubts as to its probability will turn upon three other points: whether a child at the tender age of one and a half could be in a position to take in the perceptions of such a complicated process and to preserve them so accurately in his unconscious; secondly, whether it is possible at the age of four for a deferred revision of the impressions so received to penetrate the understanding; and finally, whether any procedure could succeed in bringing into consciousness coherently and convincingly the details of a scene of this kind which had been experienced and understood in such circumstances. All the minor details of my patient’s case almost excluded the possibility of shifting the date in this way. Moreover, the fact should be taken into account that these scenes of observing parental intercourse are by no means rarely brought to light in analysis. The condition of their occurrence, however, is precisely that it should be in the earliest period of childhood. The older the child is, the more carefully, with parents above a certain social level, will the child be deprived of the opportunity for this kind of observation. From the History Of An Infantile Neurosis 3529 Later on I shall carefully examine these and other doubts; but I can assure the reader that I am no less critically inclined than he towards an acceptance of this observation of the child’s, and I will only ask him to join me in adopting a provisional belief in the reality of the scene. We will first proceed with the study of the relations between this ‘primal scene’ and the patient’s dream, his symptoms, and the history of his life; and we will trace separately the effects that followed from the essential content of the scene and from one of its visual impressions. By the latter I mean the postures which he saw his parents adopt the man upright, and the woman bent down like an animal. We have already heard that during his anxiety period his sister used to terrify him with a picture from the fairy-book, in which the wolf was shown standing upright, with one foot forward, with its claws stretched out and its ears pricked. He devoted himself with tireless perseverance during the treatment to the task of hunting in the second-hand book shops till he had found the illustrated fairy-book of his childhood, and had recognized his bogy in an illustration to the story of ‘The Wolf and the Seven Little Goats’. He thought that the posture of the wolf in this picture might have reminded him of that of his father during the constructed primal scene. At all events the picture became the point of departure for further manifestations of anxiety. Once when he was in his seventh or eighth year he was informed that next day a new tutor was coming for him. That night he dreamt of this tutor in the shape of a lion that came towards his bed roaring loudly and in the posture of the wolf in the picture; and once again he awoke in a state of anxiety. The wolf phobia had been overcome by that time, so he was free to choose himself a new anxiety- animal, and in this late dream he was recognizing the tutor as a father-surrogate. In the later years of his childhood each of his tutors and masters played the part of his father, and was endowed with his father’s influence both for good and for evil. From the History Of An Infantile Neurosis 3530 While he was at his secondary school the Fates provided him with a remarkable opportunity of reviving his wolf phobia, and of using the relation which lay behind it as an occasion for severe inhibitions. From the very first he felt cowed by him, and he was once taken severely to task by him for having made a stupid mistake in a piece of Latin translation. From that time on he could not get free from a paralysing fear of this master, and it was soon extended to other masters besides. But the occasion on which he made his blunder in the translation was also to the purpose. He had to translate the Latin word ‘filius’, and he did it with the French word ‘fils’ instead of with the corresponding word from his own language. In the room in which the first sessions were held there was a large grandfather clock opposite the patient, who lay on a sofa facing away from me. I was struck by the fact that from time to time he turned his face towards me, looked at me in a very friendly way as though to propitiate me, and then turned his look away from me to the clock. I thought at the time that he was in this way showing his eagerness for the end of the hour. A long time afterwards the patient reminded me of this piece of dumb show, and gave me an explanation of it; for he recalled that the youngest of the seven little goats hid himself in the case of the grandfather clock while his six brothers were eaten up by the wolf. But this is untenable; the chronological priority of the wolf phobia and its reference to the period of his childhood spent upon the first estate is far too securely attested. From the History Of An Infantile Neurosis 3531 the wolf that he was afraid of was undoubtedly his father; but his fear of the wolf was conditional upon the creature being in an upright posture. His recollection asserted most definitely that he had not been terrified by pictures of wolves going on all fours or, as in the story of ‘Little Red Riding-Hood’, lying in bed. The posture which, according to our construction of the primal scene, he had seen the woman assume, was of no less significance; though in this case the significance was limited to the sexual sphere. The most striking phenomenon of his erotic life after maturity was his liability to compulsive attacks of falling physically in love which came on and disappeared again in the most puzzling succession. These attacks released a tremendous energy in him even at times when he was otherwise inhibited, and they were quite beyond his control. I must, for a specially important reason, postpone a full consideration of this compulsive love; but I may mention here that it was subject to a definite condition, which was concealed from his consciousness and was discovered only during the treatment. It was necessary that the woman should have assumed the posture which we have ascribed to his mother in the primal scene. From his puberty he had felt large and conspicuous buttocks as the most powerful attraction in a woman; to copulate except from behind gave him scarcely any enjoyment. At this point a criticism may justly be raised: it may be objected that a sexual preference of this kind for the hind parts of the body is a general characteristic of people who are inclined to an obsessional neurosis, and that its presence does not justify us in referring it back to a special impression in childhood. It is part of the fabric of the anal-erotic disposition and is one of the archaic traits which distinguish that constitution. Indeed, copulation from behind more ferarum [in the fashion of animals] may, after all, be regarded as phylogenetically the older form. We shall return to this point too in a later discussion, when we have brought forward the supplementary material which showed the basis of the unconscious condition upon which his falling in love depended. From the History Of An Infantile Neurosis 3532 Let us now proceed with our discussion of the relations between his dream and the primal scene. We should so far have expected the dream to present the child (who was rejoicing at Christmas in the prospect of the fulfilment of his wishes) with this picture of sexual satisfaction afforded through his father’s agency, just as he had seen it in the primal scene, as a model of the satisfaction that he himself was longing to obtain from his father. Instead of this picture, however, there appeared the material of the story which he had been told by his grandfather shortly before: the tree, the wolves, and the taillessness (in the over- compensated form of the bushy tails of the putative wolves). At this point some connection is missing, some associative bridge to lead from the content of the primal scene to that of the wolf story. It was this detail that called up the recollection of the picture of the primal scene; and it was in this way that it became possible for the material of the primal scene to be represented by that of the wolf story, and at the same time for the two parents to be replaced, as was desirable, by several wolves. The content of the dream met with a further transformation, and the material of the wolf story was made to fit in with the content of the fairy tale of ‘The Seven Little Goats’, by borrowing from it the number seven. It is only at this point, I think, that we can regard the anxiety-dream of this four-year-old boy as being exhaustively explained. Six is the number of the children that were eaten; the seventh escaped into the clock-case. It is always a strict law of dream-interpretation that an explanation must be found for every detail. The remark, ‘I know it was winter when I had the dream, and night-time’, refers to the patient’s recollection of the dream and is not part of its content. It is correct, for it was one of the nights before his birthday, that is, Christmas Day. That is to be translated: ‘Suddenly I woke up of my own accord’, a recollection of the primal scene. The influence of the wolf story, in which the wolf leapt in through the window, is making itself felt as a modifying factor, and transforms a direct expression into a plastic one. At the same time the introduction of the window serves the purpose of providing a contemporary reference for the subsequent content of the dream. On Christmas Eve the door opens suddenly and one sees before one the tree with the presents. Here therefore the influence of the actual expectation of Christmas (which comprises the wish for sexual satisfaction) is making itself felt. The representative of the Christmas tree, and therefore belonging to the current situation.
By accepting the existence of these two (or three) psychical systems arrhythmia specialist esidrix 25 mg low cost, psycho-analysis has departed a step further from the descriptive ‘psychology of consciousness’ and has raised new problems and acquired a new content blood pressure zantac generic esidrix 25mg fast delivery. Up till now prehypertension lisinopril discount esidrix 25 mg line, it has differed from that psychology mainly by reason of its dynamic view of mental processes; now in addition it seems to arteria3d cartoon medieval pack generic esidrix 12.5 mg on line take account of psychical topography as well, and to indicate in respect of any given mental act within what system or between what systems it takes place. On account of this attempt, too, it has been given the name of ‘depth-psychology’. We shall hear that it can be further enriched by taking yet another point of view into account. The Unconscious 2998 If we are to take the topography of mental acts seriously we must direct our interest to a doubt which arises at this point. When a psychical act (let us confine ourselves here to one which is in the nature of an idea) is transposed from the system Ucs. Or are we rather to believe that the transposition consists in a change in the state of the idea, a change involving the same material and occurring in the same localityfi This question may appear abstruse, but it must be raised if we wish to form a more definite conception of psychical topography, of the dimension of depth in the mind. It is a difficult one because it goes beyond pure psychology and touches on the relations of the mental apparatus to anatomy. Research has given irrefutable proof that mental activity is bound up with the function of the brain as it is with no other organ. We are taken a step further we do not know how much by the discovery of the unequal importance of the different parts of the brain and their special relations to particular parts of the body and to particular mental activities. But every attempt to go on from there to discover a localization of mental processes, every endeavour to think of ideas as stored up in nerve-cells and of excitations as travelling along nerve-fibres, has miscarried completely. The same fate would await any theory which attempted to recognize, let us say, the anatomical position of the system Cs. There is a hiatus here which at present cannot be filled, nor is it one of the tasks of psychology to fill it. Our psychical topography has for the present nothing to do with anatomy; it has reference not to anatomical localities, but to regions in the mental apparatus, wherever they may be situated in the body. The Unconscious 2999 In this respect, then, our work is untrammelled and may proceed according to its own requirements. It will, however, be useful to remind ourselves that as things stand our hypotheses set out to be no more than graphic illustrations. The second hypothesis that of a merely functional change of state is a priori more probable, but it is less plastic, less easy to manipulate. With the first, or topographical, hypothesis is bound up that of a topographical separation of the systems Ucs. This view may seem odd, but it can be supported by observations from psycho-analytic practice. If we communicate to a patient some idea which he has at one time repressed but which we have discovered in him, our telling him makes at first no change in his mental condition. Above all, it does not remove the repression nor undo its effects, as might perhaps be expected from the fact that the previously unconscious idea has now become conscious. On the contrary, all that we shall achieve at first will be a fresh rejection of the repressed idea. But now the patient has in actual fact the same idea in two forms indifferent places in his mental apparatus: first, he has the conscious memory of the auditory trace of the idea, conveyed in what we told him; and secondly, he also has as we know for certain the unconscious memory of his experience as it was in its earlier form. Actually there is no lifting of the repression until the conscious idea, after the resistances have been overcome, has entered into connection with the unconscious memory- trace. It is only through the making conscious of the latter itself that success is achieved. On superficial consideration this would seem to show that conscious and unconscious ideas are distinct registrations, topographically separated, of the same content. But a moment’s reflection shows that the identity of the information given to the patient with his repressed memory is only apparent. To have heard something and to have experienced something are in their psychological nature two quite different things, even though the content of both is the same. So for the moment we are not in a position to decide between the two possibilities that we have discussed. Perhaps later on we shall come upon factors which may turn the balance in favour of one or the other. Perhaps we shall make the discovery that our question was inadequately framed and that the difference between an unconscious and a conscious idea has to be defined in quite another way. We have said that there are conscious and unconscious ideas; but are there also unconscious instinctual impulses, emotions and feelings, or is it in this instance meaningless to form combinations of the kindfi I am in fact of the opinion that the antithesis of conscious and unconscious is not applicable to instincts. An instinct can never become an object of consciousness only the idea that represents the instinct can. Even in the unconscious, moreover, an instinct cannot be represented otherwise than by an idea. If the instinct did not attach itself to an idea or manifest itself as an affective state, we could know nothing about it. When we nevertheless speak of an unconscious instinctual impulse or of a repressed instinctual impulse, the looseness of phraseology is a harmless one. We can only mean an instinctual impulse the ideational representative of which is unconscious, for nothing else comes into consideration. We should expect the answer to the question about unconscious feelings, emotions and affects to be just as easily given. Thus the possibility of the attribute of unconsciousness would be completely excluded as far as emotions, feelings and affects are concerned. But in psycho-analytic practice we are accustomed to speak of unconscious love, hate, anger, etc. Is there more meaning in the use of these terms than there is in speaking of ‘unconscious instincts’fi In the first place, it may happen that an affective or emotional impulse is perceived but misconstrued. Owing to the repression of its proper representative it has been forced to become connected with another idea, and is now regarded by consciousness as the manifestation of that idea. If we restore the true connection, we call the original affective impulse an ‘unconscious’ one. Yet its affect was never unconscious; all that had happened was that its idea had undergone repression. In general, the use of the terms ‘unconscious affect’ and ‘unconscious emotion’ has reference to the vicissitudes undergone, in consequence of repression, by the quantitative factor in the instinctual impulse. We know that three such vicissitudes are possible:fi either the affect remains, wholly or in part, as it is; or it is transformed into a qualitatively different quota of affect, above all into anxiety; or it is suppressed, i. In every instance where repression has succeeded in inhibiting the development of affects, we term those affects (which we restore when we undo the work of repression) ‘unconscious’. Thus it cannot be denied that the use of the terms in question is consistent; but in comparison with unconscious ideas there is the important difference that unconscious ideas continue to exist after repression as actual structures in the system Ucs. Strictly speaking, then, and although no fault can be found with the linguistic usage, there are no unconscious affects as there are unconscious ideas. The whole difference arises from the fact that ideas are cathexes basically of memory-traces whilst affects and feelings correspond to processes of discharge, the final manifestations of which are perceived as feelings. In the present state of our knowledge of affects and feelings we cannot express this difference more clearly. The Unconscious 3002 It is of especial interest to us to have established the fact that repression can succeed in inhibiting an instinctual impulse from being turned into a manifestation of affect. Nevertheless, there is an unmistakable difference in the relation of the controlling system to the two contiguous processes of discharge. Even within the limits of normal life we can recognize that a constant struggle for primacy over affectivity goes on between the two systems Cs. It is possible for the development of affect to proceed directly from the system Ucs.
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