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Everyday language possesses no counterpart to symptoms shingles cheap clopidogrel online visa the word hunger treatment of scabies buy clopidogrel no prescription, but science makes use of the word libido for that purpose symptoms vertigo order clopidogrel online now. It is generally understood to medications you cant take with grapefruit purchase clopidogrel once a day be absent in childhood, to set in at the time of puberty in connection with the process of coming to maturity and to be revealed in the manifestations of an irresistible attraction exercised by one sex upon the other; while its aim is presumed to be sexual union, or at all events actions leading in that direction. We have every reason to believe, however, that these views give a very false picture of the true situation. If we look into them more closely we shall find that they contain a number of errors, inaccuracies and hasty conclusions flaws. Let up call the person from whom sexual attraction proceeds the sexual object and the act towards which the instinct tends the sexual aim. Scientifically sifted observation, then, shows that numerous deviations occur in respect of both of these the sexual object and the sexual aim. The relation between these deviations and what is assumed to be normal requires thorough investigation. Since full bibliographies of the remaining literature of the subject will be found in the works of these writers, I have been able to spare myself the necessity for giving detailed references. It comes as a great surprise therefore to learn that there are men whose sexual object is a man and not a woman, and women whose sexual object is a woman and not a man. People of this kind are described as having contrary sexual feelings, or better, as being inverts, and the fact is described as inversion. The number of such people is very considerable, though there are difficulties in establishing it precisely. Persons of the opposite sex are never the object of their sexual desire, but leave them cold, or even arouse sexual aversion in them. As a consequence of this aversion, they are incapable, if they are men, of carrying out the sexual act, or else they derive no enjoyment from it. In that case their sexual objects may equally well be of their own or of the opposite sex. In that case, under certain external conditions of which inaccessibility of any normal sexual object and imitation are the chief they are capable of taking as their sexual object someone of their own sex and of deriving satisfaction from sexual intercourse with him. Three Essays On the Theory Of Sexuality 1466 Again, inverts vary in their views as to the peculiarity of their sexual instinct. Some of them accept their inversion as something in the natural course of things, just as a normal person accepts the direction of his libido, and insist energetically that inversion is as legitimate as the normal attitude; others rebel against their inversion and feel it as a pathological compulsion. The trait of inversion may either date back to the very beginning, as far back as the subjects memory reaches, or it may not have become noticeable till some particular time before or after puberty. It may even make its first appearance late in life after a long period of normal sexual activity. A periodic oscillation between a normal and an inverted sexual object has also sometimes been observed. Those cases are of particular interest in which the libido changes over to an inverted sexual object after a distressing experience with a normal one. As a rule these different kinds of variations are found side by side independently of one another. It is, however, safe to assume that the most extreme form of inversion will have been present from a very early age and that the person concerned will feel at one with his peculiarity. Many authorities would be unwilling to class together all the various cases which I have enumerated and would prefer to lay stress upon their differences rather than their resemblances, in accordance with their own preferred view of inversion. Nevertheless, though the distinctions cannot be disputed, it is impossible to overlook the existence of numerous intermediate examples of every type, so that we are driven to conclude that we are dealing with a connected series. This corresponded to the fact that medical observers first came across it in persons suffering, or appearing to suffer, from nervous diseases. This characterization of inversion involves two suppositions, which must be considered separately: that it is innate and that it is degenerate. It has become the fashion to regard any symptom which is not obviously due to trauma or infection as a sign of degeneracy. Magnans classification of degenerates is indeed of such a kind as not to exclude the possibility of the concept of degeneracy being applied to a nervous system whose general functioning is excellent. This being so, it may well be asked whether an attribution of degeneracy is of any value or adds anything to our knowledge. It seems wiser only to speak of it where (1) several serious deviations from the normal are found together, and (2) the capacity for efficient functioning and survival seem to be severely impaired. Bloch); and, even amongst the civilized peoples of Europe, climate and race exercise the most powerful influence on the prevalence of inversion and upon the attitude adopted towards it. The very existence of the two other classes, and especially the third, is difficult to reconcile with the hypothesis of the innateness of inversion. This explains why those who support this view tend to separate out the group of absolute inverts from all the rest, thus abandoning any attempt at giving an account of inversion which shall have universal application. In the view of these authorities inversion is innate in one group of cases, while in others it may have come about in other ways. The merit for bringing about this change is due to Bloch (1902-3), who has also laid stress on the occurrence of inversion among the civilizations of antiquity. Three Essays On the Theory Of Sexuality 1469 the reverse of this view is represented by the alternative one that inversion is an acquired character of the sexual instinct. This second view is based on the following considerations: (1) In the case of many inverts, even absolute ones, it is possible to show that very early in their lives a sexual impression occurred which left a permanent after-effect in the shape of a tendency to homosexuality. In view of these considerations it is even possible to doubt the very existence of such a thing as innate inversion. Havelock Ellis) that, if the cases of allegedly innate inversion were more closely examined, some experience of their early childhood would probably come to light which had a determining effect upon the direction taken by their libido. This experience would simply have passed out of the subjects conscious recollection, but could be recalled to his memory under appropriate influence. In the opinion of these writers inversion can only be described as a frequent variation of the sexual instinct, which can be determined by a number of external circumstances in the subjects life. The apparent certainty of this conclusion is, however, completely countered by the reflection that many people are subjected to the same sexual influences. We are therefore forced to a suspicion that the choice between innate and acquired is not an exclusive one or that it does not cover all the issues involved in inversion. In the former case we must ask in what respect it is innate, unless we are to accept the crude explanation that everyone is born with his sexual instinct attached to a particular sexual object. In the latter case it may be questioned whether the various accidental influences would be sufficient to explain the acquisition of inversion without the co-operation of something in the subject himself. Science, however, knows of cases in which the sexual characters are obscured, and in which it is consequently difficult to determine the sex. The genitals of the individuals concerned combine male and female characteristics. For it appears that a certain degree of anatomical hermaphroditism occurs normally. In every normal male or female individual, traces are found of the apparatus of the opposite sex. These either persist without function as rudimentary organs or become modified and take on other functions. These long-familiar facts of anatomy lead us to suppose that an originally bisexual physical disposition has, in the course of evolution, become modified into a unisexual one, leaving behind only a few traces of the sex that has become atrophied. It was tempting to extend this hypothesis to the mental sphere and to explain inversion in all its varieties as the expression of a psychical hermaphroditism. All that was required further in order to settle the question was that inversion should be regularly accompanied by the mental and somatic signs of hermaphroditism. Three Essays On the Theory Of Sexuality 1471 But this expectation was disappointed. It is impossible to demonstrate so close a connection between the hypothetical psychical hermaphroditism and the established anatomical one. A general lowering of the sexual instinct and a slight anatomical atrophy of the organs is found frequently in inverts (cf. The truth must therefore be recognized that inversion and somatic hermaphroditism are on the whole independent of each other. A great deal of importance, too, has been attached to what are called the secondary and tertiary sexual characters and to the great frequency of the occurrence of those of the opposite sex in inverts (cf. Much of this, again, is correct; but it should never be forgotten that in general the secondary and tertiary sexual characters of one sex occur very frequently in the opposite one. They are indications of hermaphroditism, but are not attended by any change of sexual object in the direction of inversion. Psychical hermaphroditism would gain substance if the inversion of the sexual object were at least accompanied by a parallel change-over of the subjects other mental qualities, instincts and character traits into those marking the opposite sex.
In short symptoms 8 months pregnant order clopidogrel 75mg with amex, the relation which we are examining now is not in any respect an exclusive one medications pictures buy clopidogrel 75 mg cheap. Nevertheless it remains true that it would be impossible for us to medications reactions buy generic clopidogrel imagine the dream-world without it medications with acetaminophen order clopidogrel american express. But in order to arrive at an understanding of it we must embark upon a discussion that will take us far afield. The Interpretation Of Dreams 969 As the starting-point for our enquiry, I should like to pick out one from among many remarks made upon the theory of dreaming by those who have written on the subject. In the course of a short discussion on the topic of dreams, the great Fechner (1889, 2, 520-1) puts forward the idea that the scene of action of dreams is different from that of waking ideational life. This is the only hypothesis that makes the special peculiarities of dream-life intelligible. I shall entirely disregard the fact that the mental apparatus with which we are here concerned is also known to us in the form of an anatomical preparation, and I shall carefully avoid the temptation to determine psychical locality in any anatomical fashion. I shall remain upon psychological ground, and I propose simply to follow the suggestion that we should picture the instrument which carries out our mental functions as resembling a compound microscope or a photographic apparatus, or something of the kind. On that basis, psychical locality will correspond to a point inside the apparatus at which one of the preliminary stages of an image comes into being. In the microscope and telescope, as we know, these occur in part at ideal points, regions in which no tangible component of the apparatus is situated. I see no necessity to apologize for the imperfections of this or of any similar imagery. Analogies of this kind are only intended to assist us in our attempt to make the complications of mental functioning intelligible by dissecting the function and assigning its different constituents to different component parts of the apparatus. So far as I know, the experiment has not hitherto been made of using this method of dissection in order to investigate the way in which the mental instrument is put together, and I can see no harm in it. We are justified, in my view, in giving free rein to our speculations so long as we retain the coolness of our judgement and do not mistake the scaffolding for the building. And since at our first approach to something unknown all that we need is the assistance of provisional ideas, I shall give preference in the first instance to hypotheses of the crudest and most concrete description. The Interpretation Of Dreams 970 Accordingly, we will picture the mental apparatus as a compound instrument, to the components of which we will give the name of agencies, or (for the sake of greater clarity) systems. Strictly speaking there is no need for the hypothesis that the psychical systems are actually arranged in a spatial order. It would be sufficient if a fixed order were established by the fact that in a given psychical process the excitation passes through the systems in a particular temporal sequence. In other processes the sequence may perhaps be a different one; that is a possibility that we shall leave open. For the sake of brevity we will in future speak of the components of the apparatus as fi-systems. All our psychical activity starts from stimuli (whether internal or external) and ends in innervations. At the sensory end there lies a system which receives perceptions; at the motor end there lies another, which opens the gateway to motor activity. Thus the most general schematic picture of the psychical apparatus may be represented thus (Fig. The Interpretation Of Dreams 971 This, however, does no more than fulfil a requirement with which we have long been familiar, namely that the psychical apparatus must be constructed like a reflex apparatus. A trace is left in our psychical apparatus of the perceptions which impinge upon it. This we may describe as a memory-trace; and to the function relating to it we give the name of memory. But, as has already been pointed out elsewhere, there are obvious difficulties involved in supposing that one and the same system can accurately retain modifications of its elements and yet remain perpetually open to the reception of fresh occasions for modification. In accordance, therefore, with the principle which governs our experiment, we shall distribute these two functions on to different systems. We shall suppose that a system in the very front of the apparatus receives the perceptual stimuli but retains no trace of them and thus has no memory, while behind it there lies a second system which transforms the momentary excitations of the first system into permanent traces. The Interpretation Of Dreams 972 It is a familiar fact that we retain permanently something more than the mere content of the perceptions which impinge upon the system Pcpt. Our perceptions are linked with one another in our memory first and foremost according to simultaneity of occurrence. Association would thus consist in the fact that, as a result of a diminution in resistances and of the laying down of facilitating paths, an excitation is transmitted from a given Mnem. Closer consideration will show the necessity for supposing the existence not of one but of several such Mnem. It would of course be a waste of time to try to put the psychical significance of a system of this kind into words. Its character would lie in the intimate details of its relations to the different elements of the raw material of memory, that is if we may hint at a theory of a more radical kind in the degrees of conductive resistance which it offered to the passage of excitation from those elements. At this point I will interpolate a remark of a general nature which may perhaps have important implications. On the other hand, our memories not excepting those which are most deeply stamped on our minds are in themselves unconscious. They can be made conscious; but there can be no doubt that they can produce all their effects while in an unconscious condition. What we describe as our character is based on the memory- traces of our impressions; and, moreover, the impressions which have had the greatest effect on us those of our earliest youth are precisely the ones which scarcely ever become conscious. But if memories become conscious once more they exhibit no sensory quality or a very slight one in comparison with perceptions. A most promising light would be thrown on the conditions governing the excitation of neurone if it could be confirmed that the fi-systems of memory and the quality that characterizes consciousness are mutually exclusive. The Interpretation Of Dreams 973 the assumptions we have so far put forward as to the construction of the psychical apparatus at its sensory end have been made without reference to dreams or to the psychological information that we have been able to infer from them. Evidence afforded by dreams will, however, help us towards understanding another portion of the apparatus. We have seen that we were only able to explain the formation of dreams by venturing upon the hypothesis of there being two psychical agencies, one of which submitted the activity of the other to a criticism which involved its exclusion from consciousness. The critical agency, we concluded, stands in a closer relation to consciousness than the agency criticized: it stands like a screen between the latter and consciousness. Further we found reasons for identifying the critical agency with the agency which directs our waking life and determines our voluntary, conscious actions. If, in accordance with our assumptions, we replace these agencies by systems, then our last conclusion must lead us to locate the critical system at the motor end of the apparatus. We will now introduce the two system into our schematic picture and give them names to express their relation to consciousness (Fig. The Interpretation Of Dreams 974 We will describe the last of the systems at the motor end as the preconscious, to indicate that the excitatory processes occurring in it can enter consciousness without further impediment provided that certain other conditions are fulfilled: for instance, that they reach a certain degree of intensity, that the function which can only be described as attention is distributed in a particular way, and so on. We will describe the system that lies behind it as the unconscious, because it has no access to consciousness except via the preconscious, in passing through which its excitatory process is obliged to submit to modifications. It is true that in the course of our future discussion we shall learn that this is not entirely accurate, and that the process of forming dreams is obliged to attach itself to dream- thoughts belonging to the preconscious system. But when we consider the dream-wish, we shall find that the motive force for producing dreams is supplied by the Ucs. Like all other thought structures, this dream-instigator will make an effort to advance into the Pcs. The Interpretation Of Dreams 975 Experience shows us that this path leading through the preconscious to consciousness is barred to the dream-thoughts during the daytime by the censorship imposed by resistance. During the night they are able to obtain access to consciousness; but the question arises as to how they do so and thanks to what modification. If what enabled the dream-thoughts to achieve this were the fact that at night there is a lowering of the resistance which guards the frontier between the unconscious and the preconscious, we should have dreams which were in the nature of ideas and which were without the hallucinatory quality in which we are at the moment interested. The only way in which we can describe what happens in hallucinatory dreams is by saying that the excitation moves in a backward direction. Instead of being transmitted towards the motor end of the apparatus it moves towards the sensory end and finally reaches the perceptual system. If we describe as progressive the direction taken by psychical processes arising from the unconscious during waking life, then we may speak of dreams as having a regressive character. The imaginatio, he tells us, constructs dreams out of the stored-up images of sensory objects; and the process is carried out in a reverse direction to that in waking life. I, Chapter 2): In sum, our dreams are the reverse of our waking imaginations, the motion, when we are awake, beginning at one end, and when we dream at another.
Thus the form of dreams is far from being without significance and itself calls for interpretation treatment 9mm kidney stones cheap 75 mg clopidogrel with visa. When several dreams occur during the same night symptoms ulcer stomach buy cheapest clopidogrel, they often have the same meaning and indicate that an attempt is being made to treatment norovirus order clopidogrel 75 mg overnight delivery deal more and more efficiently with a stimulus of increasing insistence symptoms pregnancy clopidogrel 75 mg line. In individual dreams a particularly difficult element may be represented by several symbols by doublets. Introductory Lectures On Psycho-Analysis 3269 If we make a series of comparisons between the dream-thoughts and the manifest dreams which replace them, we shall come upon all kinds of things for which we are unprepared: for instance, that nonsense and absurdity in dreams have their meaning. At this point, indeed, the contrast between the medical and the psycho-analytic view of dreams reaches a pitch of acuteness not met with elsewhere. According to the former, dreams are senseless because mental activity in dreams has abandoned all its powers of criticism; according to our view, on the contrary, dreams become senseless when a piece of criticism included in the dream-thoughts a judgement that this is absurd has to be represented. There is as a rule nothing in the latent dream-thoughts corresponding to these doubts and uncertainties; they are entirely due to the activity of the dream-censorship and are to be equated with an attempt at elimination which has not quite succeeded. Among the most surprising findings is the way in which the dream-work treats contraries that occur in the latent dream. We know already that conformities in the latent material are replaced by condensations in the manifest dream. Well, contraries are treated in the same way as conformities, and there is a special preference for expressing them by the same manifest element. Thus an element in the manifest dream which is capable of having a contrary may equally well be expressing either itself or its contrary or both together: only the sense can decide which translation is to be chosen. This connects with the further fact that a representation of no or at any rate an unambiguous one is not to be found in dreams. Introductory Lectures On Psycho-Analysis 3270 A welcome analogy to this strange behaviour of the dream-work is provided for us in the development of language. Some philologists have maintained that in the most ancient languages contraries such as strong-weak, light-dark, big-small are expressed by the same verbal roots. In speaking, misunderstanding from the use of such ambivalent words was avoided by differences of intonation and by the accompanying gesture, and in writing, by the addition of what is termed a determinative a picture which is not itself intended to be spoken. For instance, ken meaning strong was written with a picture of a little upright man after the alphabetic signs; when ken stood for weak, what followed was the picture of a man squatting down limply. It was only later, by means of slight modifications of the original homologous word, that two distinct representations were arrived at of the contraries included in it. The remains of this ancient antithetical meaning seem to have been preserved not only in the latest developments of the oldest languages but also in far younger ones and even in some that are still living. In Latin, words that remained ambivalent in this way are altus (high and deep) and sacer (sacred and accursed). As instances of modifications of the same root I may mention clamare (to cry), clam (softly, quietly, secretly); siccus (dry), succus (juice). The English word without (which is really with-without) is used to-day for without alone. Introductory Lectures On Psycho-Analysis 3271 Another characteristic of the dream-work also has its counterpart in the development of language. In Ancient Egyptian, as well as in other, later languages, the order of the sounds in a word can be reversed, while keeping the same meaning. Examples of this in English and German are: Topf [pot]-pot; boat- tub; hurry-Ruhe [rest]; Balken [beam]-Kloben [log] and club; wait-tauwen [tarry]. Similarly in Latin and German: capere-packen [to seize]; ren-Niere [kidney]. Reversals like this, which occur here with individual words, take place in various ways in the dream-work. Besides this we find in dreams reversals of situation, of the relation between two people a topsy-turvy world. Or again we find a reversal in the order of events, so that what precedes an event causally comes after it in the dream like a theatrical production by a third-rate touring company, in which the hero falls down dead and the shot that killed him is not fired in the wings till afterwards. Or there are dreams where the whole order of the elements is reversed, so that to make sense in interpreting it we must take the last one first and the first one last. You will remember too from our study of dream symbolism that going or falling into the water means the same as coming out of it that is, giving birth or being born, and that climbing up a staircase or a ladder is the same thing as coming down it. It is not hard to see the advantage that dream-distortion can derive from this freedom of representation. They are equally characteristic of ancient systems of expression by speech and writing and they involve the same difficulties, which we shall have to discuss again later in a critical sense. In the case of the dream-work it is clearly a matter of transforming the latent thoughts which are expressed in words into sensory images, mostly of a visual sort. Now our thoughts originally arose from sensory images of that kind: their first material and their preliminary stages were sense impressions, or, more properly, mnemic images of such impressions. Only later were words attached to them and the words in turn linked up into thoughts. The dream-work thus submits thoughts to a regressive treatment and undoes their development; and in the course of the regression everything has to be dropped that had been added as a new acquisition in the course of the development of the mnemic images into thoughts. Introductory Lectures On Psycho-Analysis 3272 Such then, it seems, is the dream-work. As compared with the processes we have come to know in it, interest in the manifest dream must pale into insignificance. But I will devote a few more remarks to the latter, since it is of it alone that we have immediate knowledge. It is bound to be a matter of indifference to us whether it is well put together, or is broken up into a series of disconnected separate pictures. Even if it has an apparently sensible exterior, we know that this has only come about through dream-distortion and can have as little organic relation to the internal content of the dream as the facade of an Italian church has to its structure and plan. There are other occasions when this facade of the dream has its meaning, and reproduces an important component of the latent dream-thoughts with little or no distortion. But we cannot know this before we have submitted the dream to interpretation and have been able to form a judgement from it as to the amount of distortion that has taken place. A similar doubt arises when two elements in a dream appear to have been brought into a close relation to each other. This may give us a valuable hint that we may bring together what corresponds to these elements in the latent dream as well; but on other occasions we can convince ourselves that what belongs together in the dream- thoughts has been torn apart in the dream. In general one must avoid seeking to explain one part of the manifest dream by another, as though the dream had been coherently conceived and was a logically arranged narrative. On the contrary, it is as a rule like a piece of breccia, composed of various fragments of rock held together by a binding medium, so that the designs that appear on it do not belong to the original rocks imbedded in it. And there is in fact one part of the dream-work, known as secondary revision, whose business it is to make something whole and more or less coherent out of the first products of the dream-work. In the course of this, the material is arranged in what is often a completely misleading sense and, where it seems necessary, interpolations are made in it. Introductory Lectures On Psycho-Analysis 3273 On the other hand, we must not over-estimate the dream-work and attribute too much to it. The achievements I have enumerated exhaust its activity; it can do no more than condense, displace, represent in plastic form and subject the whole to a secondary revision. What appear in the dream as expressions of judgement, of criticism, of astonishment or of inference none of these are achievements of the dream- work and they are very rarely expressions of afterthoughts about the dream; they are for the most part portions of the latent dream-thoughts which have passed over into the manifest dream with a greater or less amount of modification and adaptation to the context. With a few assignable exceptions, speeches in dreams are copies and combinations of speeches which one has heard or spoken one self on the day before the dream and which have been included in the latent thoughts either as material or as the instigator of the dream. Such of them as appear in the manifest dream are mostly combinations of numbers, sham calculations which are quite senseless qua calculations and are once again only copies of calculations in the latent dream-thoughts. In these circumstances it is not to be wondered at that the interest which had turned to the dream-work soon tends to move away from it to the latent dream-thoughts, which are revealed, distorted to a greater or less degree, by the manifest dream. But there is no justification for carrying this shift of interest so far that, in looking at the matter theoretically, one replaces the dream entirely by the latent dream-thoughts and makes some assertion about the former which only applies to the latter. It is strange that the findings of psycho-analysis could be misused to bring about this confusion. One cannot give the name of dream to anything other than the product of the dream-work that is to say, the form into which the latent thoughts have been transmuted by the dream-work. Introductory Lectures On Psycho-Analysis 3274 the dream-work is a process of quite a singular kind, of which the like has not yet become known in mental life. Condensations, displacements, regressive transformations of thoughts into images such things are novelties whose discovery has already richly rewarded the labours of psycho-analysis. And you can see once more, from the parallels to the dream-work, the connections which have been revealed between psycho-analytic studies and other fields especially those concerned in the development of speech and thought. You will only be able to form an idea of the further significance of these discoveries when you learn that the mechanism of dream-construction is the model of the manner in which neurotic symptoms arise.
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The lessening amount of affection he receives medications quinapril buy generic clopidogrel, the increasing demands of education medications names and uses buy clopidogrel 75 mg with visa, hard words and an occasional punishment these show him at last the full extent to treatment plan for anxiety purchase cheap clopidogrel which he has been scorned medicine q10 buy clopidogrel with mastercard. These are a few typical and constantly recurring instances of the ways in which the love characteristic of the age of childhood is brought to a conclusion. Patients repeat all of these unwanted situations and painful emotions in the transference and revive them with the greatest ingenuity. They seek to bring about the interruption of the treatment while it is still incomplete; they contrive once more to feel themselves scorned, to oblige the physician to speak severely to them and treat them coldly; they discover appropriate objects for their jealousy; instead of the passionately desired baby of their childhood, they produce a plan or a promise of some grand present which turns out as a rule to be no less unreal. None of these things can have produced pleasure in the past, and it might be supposed that they would cause less unpleasure to-day if they emerged as memories or dreams instead of taking the form of fresh experiences. They are of course the activities of instincts intended to lead to satisfaction; but no lesson has been learnt from the old experience of these activities having led instead only to unpleasure. Beyond the Pleasure Principle 3726 What psycho-analysis reveals in the transference phenomena of neurotics can also be observed in the lives of some normal people. The impression they give is of being pursued by a malignant fate or possessed by some daemonic power; but psycho-analysis has always taken the view that their fate is for the most part arranged by themselves and determined by early infantile influences. The compulsion which is here in evidence differs in no way from the compulsion to repeat which we have found in neurotics, even though the people we are now considering have never shown any signs of dealing with a neurotic conflict by producing symptoms. Thus we have come across people all of whose human relationships have the same outcome: such as the benefactor who is abandoned in anger after a time by each of his proteges, however much they may otherwise differ from one another, and who thus seems doomed to taste all the bitterness of ingratitude; or the man whose friendships all end in betrayal by his friend; or the man who time after time in the course of his life raises someone else into a position of great private or public authority and then, after a certain interval, himself upsets that authority and replaces him by a new one; or, again, the lover each of whose love affairs with a woman passes through the same phases and reaches the same conclusion. This perpetual recurrence of the same thing causes us no astonishment when it relates to active behaviour on the part of the person concerned and when we can discern in him an essential character-trait which always remains the same and which is compelled to find expression in a repetition of the same experiences. We are much more impressed by cases where the subject appears to have a passive experience, over which he has no influence, but in which he meets with a repetition of the same fatality. There is the case, for instance, of the woman who married three successive husbands each of whom fell ill soon afterwards and had to be nursed by her on their death-beds. Its hero, Tancred, unwittingly kills his beloved Clorinda in a duel while she is disguised in the armour of an enemy knight. After her burial he makes his way into a strange magic forest which strikes the Crusaders army with terror. He slashes with his sword at a tall tree; but blood streams from the cut and the voice of Clorinda, whose soul is imprisoned in the tree, is heard complaining that he has wounded his beloved once again. If we take into account observations such as these, based upon behaviour in the transference and upon the life-histories of men and women, we shall find courage to assume that there really does exist in the mind a compulsion to repeat which overrides the pleasure principle. Now too we shall be inclined to relate to this compulsion the dreams which occur in traumatic neuroses and the impulse which leads children to play. Beyond the Pleasure Principle 3727 But it is to be noted that only in rare instances can we observe the pure effects of the compulsion to repeat, unsupported by other motives. In the case of childrens play we have already laid stress on the other ways in which the emergence of the compulsion may be interpreted; the compulsion to repeat and instinctual satisfaction which is immediately pleasurable seem to converge here into an intimate partnership. The phenomena of transference are obviously exploited by the resistance which the ego maintains in its pertinacious insistence upon repression; the compulsion to repeat, which the treatment tries to bring into its service is, as it were, drawn over by the ego to its side (clinging as the ego does to the pleasure principle). A great deal of what might be described as the compulsion of destiny seems intelligible on a rational basis; so that we are under no necessity to call in a new and mysterious motive force to explain it. But on maturer reflection we shall be forced to admit that even in the other instances the whole ground is not covered by the operation of the familiar motive forces. Enough is left unexplained to justify the hypothesis of a compulsion to repeat something that seems more primitive, more elementary, more instinctual than the pleasure principle which it overrides. But if a compulsion to repeat does operate in the mind, we should be glad to know something about it, to learn what function it corresponds to, under what conditions it can emerge and what its relation is to the pleasure principle to which, after all, we have hitherto ascribed dominance over the course of the processes of excitation in mental life. It is further an attempt to follow out an idea consistently, out of curiosity to see where it will lead. Psycho-analytic speculation takes as its point of departure the impression, derived from examining unconscious processes, that consciousness may be, not the most universal attribute of mental processes, but only a particular function of them. Speaking in metapsychological terms, it asserts that consciousness is a function of a particular system which it describes as Cs. What consciousness yields consists essentially of perceptions of excitations coming from the external world and of feelings of pleasure and unpleasure which can only arise from within the mental apparatus; it is therefore possible to assign to the system Pcpt. It must lie on the borderline between outside and inside; it must be turned towards the external world and must envelop the other psychical systems. It will be seen that there is nothing daringly new in these assumptions; we have merely adopted the views on localization held by cerebral anatomy, which locates the seat of consciousness in the cerebral cortex the outermost, enveloping layer of the central organ. Cerebral anatomy has no need to consider why, speaking anatomically, consciousness should be lodged on the surface of the brain instead of being safely housed somewhere in its inmost interior. Perhaps we shall be more successful in accounting for this situation in the case of our system Pcpt. Beyond the Pleasure Principle 3729 Consciousness is not the only distinctive character which we ascribe to the processes in that system. On the basis of impressions derived from our psycho-analytic experience, we assume that all excitatory processes that occur in the other systems leave permanent traces behind in them which form the foundation of memory. Such memory-traces, then, have nothing to do with the fact of becoming conscious; indeed they are often most powerful and most enduring when the process which left them behind was one which never entered consciousness. We find it hard to believe, however, that permanent traces of excitation such as these are also left in the system Pcpt. If they remained constantly conscious, they would very soon set limits to the systems aptitude for receiving fresh excitations. We should, so to say, have altered nothing and gained nothing by our hypothesis relegating the process of becoming conscious to a special system. Though this consideration is not absolutely conclusive, it nevertheless leads us to suspect that becoming conscious and leaving behind a memory- trace are processes incompatible with each other within one and the same system. Thus we should be able to say that the excitatory process becomes conscious in the system Cs. I followed these same lines in the schematic picture which I included in the speculative section of my Interpretation of Dreams. It must be borne in mind that little enough is known from other sources of the origin of consciousness; when, therefore, we lay down the proposition that consciousness arises instead of a memory-trace, the assertion deserves consideration, at all events on the ground of its being framed in fairly precise terms. An exception of this sort to the general rule requires to be explained by some factor that applies exclusively to that one system. Such a factor, which is absent in the other systems, might well be the exposed situation of the system Cs. Beyond the Pleasure Principle 3730 Let us picture a living organism in its most simplified possible form as an undifferentiated vesicle of a substance that is susceptible to stimulation. Then the surface turned towards the external world will from its very situation be differentiated and will serve as an organ for receiving stimuli. Indeed embryology, in its capacity as a recapitulation of developmental history, actually shows us that the central nervous system originates from the ectoderm; the grey matter of the cortex remains a derivative of the primitive superficial layer of the organism and may have inherited some of its essential properties. It would be easy to suppose, then, that as a result of the ceaseless impact of external stimuli on the surface of the vesicle, its substance to a certain depth may have become permanently modified, so that excitatory processes run a different course in it from what they run in the deeper layers. A crust would thus be formed which would at last have been so thoroughly baked through by stimulation that it would present the most favourable possible conditions for the reception of stimuli and become incapable of any further modification. Various ideas may be formed which cannot at present be verified as to the nature of this modification of the substance and of the excitatory process. It may be supposed that, in passing from one element to another, an excitation has to overcome a resistance, and that the diminution of resistance thus effected is what lays down a permanent trace of the excitation, that is, a facilitation. This picture can be brought into relation with Breuers distinction between quiescent (or bound) and mobile cathectic energy in the elements of the psychical systems;fi the elements of the system Cs. It seems best, however, to express oneself as cautiously as possible on these points. None the less, this speculation will have enabled us to bring the origin of consciousness into some sort of connection with the situation of the system Cs. Beyond the Pleasure Principle 3731 But we have more to say of the living vesicle with its receptive cortical layer. This little fragment of living substance is suspended in the middle of an external world charged with the most powerful energies; and it would be killed by the stimulation emanating from these if it were not provided with a protective shield against stimuli. It acquires the shield in this way: its outermost surface ceases to have the structure proper to living matter, becomes to some degree inorganic and thenceforward functions as a special envelope or membrane resistant to stimuli. In consequence, the energies of the external world are able to pass into the next underlying layers, which have remained living, with only a fragment of their original intensity; and these layers can devote themselves, behind the protective shield, to the reception of the amounts of stimulus which have been allowed through it. By its death, the outer layer has saved all the deeper ones from a similar fate unless, that is to say, stimuli reach it which are so strong that they break through the protective shield.
Our patient had never acquired the emotional relation to treatment wpw 75 mg clopidogrel with amex women which would have corresponded to medicine 852 purchase online clopidogrel his age and his attractive personality symptoms bronchitis buy 75 mg clopidogrel fast delivery. He had once been engaged to symptoms vaginal cancer purchase clopidogrel once a day a beautiful young girl of good social position; but she had broken off the engagement because she found that her fiance was without any affection. Years later, his illness broke out just at the moment when he had succeeded for the first time in satisfying a woman completely. When this woman embraced him in gratitude and devotion, he suddenly had a mysterious pain that went round the top of his head like a sharp cut. Later on he interpreted this sensation as though an incision were being made at an autopsy for exposing the brain. And as his friend had become a pathological anatomist, it slowly dawned on him that he alone could have sent this last woman to him to seduce him- From that point onwards his eyes were opened to the other persecutions to which he believed he had been made a victim by the machinations of his one-time friend. Introductory Lectures On Psycho-Analysis 3470 But what about the cases in which the persecutor is not of the same sex as the patient and which appear, therefore, to contradict our explanation of their being a defence against homosexual libidofi A little time ago I had an opportunity of examining such a case and was able to derive a confirmation from the apparent contradiction. A girl, who believed she was being persecuted by a man with whom she had had affectionate assignations on two occasions, had in fact first had a delusion that was directed against a woman who could be looked on as a substitute for her mother. It was only after her second assignation that she took the step of detaching the delusion from the woman and transferring it to the man. To begin with, therefore, the precondition of the persecutor being of the same sex as the patient was fulfilled in this case too. In making a complaint to a lawyer and to a doctor, the patient made no mention of this preliminary stage of her delusion and thus gave rise to an appearance of there being a contradiction of our explanation of paranoia. Homosexual object-choice originally lies closer to narcissism than does the heterosexual kind. When it is a question, therefore, of repelling an undesirably strong homosexual impulse, the path back to narcissism is made particularly easy. Hitherto I have had very little opportunity of talking to you about the foundations of erotic life so far as we have discovered them, and it is too late now to catch up on the omission. Object-choice, the step forward in the development of the libido which is made after the narcissistic stage, can take place according to two different types: either according to the narcissistic type, where the subjects own ego is replaced by another one that is as similar as possible, or according to the attachment type, where people who have become precious through satisfying the other vital needs are chosen as objects by the libido as well. A strong libidinal fixation to the narcissistic type of object-choice is to be included in the predisposition to manifest homosexuality. Introductory Lectures On Psycho-Analysis 3471 You will recall that at our first meeting of the present academic year I described a case to you of a woman suffering from delusions of jealousy. Now that we are so near its end you would no doubt like to hear how delusions are explained by psycho-analysis. The fact that a delusion cannot be shaken by logical arguments or real experiences is explained in the same way as in the case of an obsession by its relation to the unconscious, which is represented and held down by the delusion or by the obsession. The difference between the two is based on the difference between the topography and dynamics of the two illnesses. As with paranoia, so also with melancholia (of which, incidentally, many different clinical forms have been described) we have found a point at which it has become possible to obtain some insight into the internal structure of the disease. We have discovered that the self-reproaches, with which these melancholic patients torment themselves in the most merciless fashion, in fact apply to another person, the sexual object which they have lost or which has become valueless to them through its own fault. From this we can conclude that the melancholic has, it is true, withdrawn his libido from the object, but that, by a process which we must call narcissistic identification, the object has been set up in the ego itself, has been as it were, projected on to the ego. A melancholics propensity to suicide is also made more intelligible if we consider that the patients embitterment strikes with a single blow at his own ego and at the loved and hated object. In melancholia, as well as in other narcissistic disorders, a particular trait in the patients emotional life emerges with peculiar emphasis what, since Bleuler, we have been accustomed to describe as ambivalence. By this we mean the direction towards the same person of contrary affectionate and hostile feelings. Unluckily I have been unable in the course of these lectures to tell you more about this emotional ambivalence. Introductory Lectures On Psycho-Analysis 3472 In addition to narcissistic identification, there is a hysterical kind, which has been familiar to us very much longer. I wish it were possible to illustrate for you the differences between the two forms by a few clear specifications. There is something I can tell you about the periodic and cyclical forms of melancholia which I am sure you will be glad to hear. For in favourable circumstances I have experienced this twice it is possible by analytic treatment in the lucid intervals to prevent the return of the condition in the same or the opposite emotional mood. We learn from such cases that in melancholia and mania we are concerned once more with a special method of dealing with a conflict whose underlying determinants agree precisely with those of the other neuroses. You can imagine how much more there is for psycho-analysis to learn in this field of knowledge. I told you too that we hoped that the analysis of the narcissistic disorders would give us an insight into the way in which our ego is put together and built up out of different agencies. From the analysis of delusions of observation we have drawn the conclusion that there actually exists in the ego an agency which unceasingly observes, criticizes and compares, and in that way sets itself over against the other part of the ego. We believe, therefore, that the patient is betraying a truth to us which is not yet sufficiently appreciated when he complains that he is spied upon and observed at every step he takes and that every one of his thoughts is reported and criticized. His only mistake is in regarding this uncomfortable power as something alien to him and placing it outside himself. He senses an agency holding sway in his ego which measures his actual ego and each of its activities by an ideal ego that he has created for himself in the course of his development. We believe, too, that this creation was made with the intention of re-establishing the self-satisfaction which was attached to primary infantile narcissism but which since then has suffered so many disturbances and mortifications. We know the self- observing agency as the ego-censor, the conscience; it is this that exercises the dream-censorship during the night, from which the repressions of inadmissible wishful impulses proceed. When in delusions of observation it becomes split up, it reveals to us its origin from the influences of parents, educators and social environment from an identification with some of these model figures. Introductory Lectures On Psycho-Analysis 3473 these are a few of the findings which have hitherto been reached from the application of psycho-analysis to the narcissistic disorders. No doubt there are not yet enough of them and they still lack the precision which can only be attained from established familiarity with a new field. We owe all of them to a use of the concept of ego-libido or narcissistic libido, by whose help we can extend to the narcissistic neuroses the views which have proved their value with the transference neuroses. Now, however, you will ask whether it is possible that we shall succeed in subsuming all the disturbances of the narcissistic illnesses and of the psychoses under the libido theory, whether we look upon the libidinal factor in mental life as universally guilty of the causation of illness, and need never attribute the responsibility for it to changes in the functioning of the self-preservative instinct. Well, Ladies and Gentlemen, this question seems to me to call for no urgent reply, and, above all, not to be ripe for judgement. We can confidently leave it over in expectation of the progress of our scientific work. I should not be surprised if it turned out that the power to produce pathogenic effects was in fact a prerogative of the libidinal instincts, so that the libido theory could celebrate its triumph all along the line from the simplest actual neurosis to the most severe alienation of the personality. We after all know that it is a characteristic feature of the libido that it struggles against submitting to the reality of the universe to Ananke. But I regard it as extremely probable that the ego- instincts are carried along secondarily by the pathogenic instigation of the libido and forced into functional disturbances. Nor can I think that it would be a disaster to the trend of our researches, if what lies before us is the discovery that in severe psychoses the ego-instincts themselves have gone astray as a primary fact. Introductory Lectures On Psycho-Analysis 3474 Let me once more, however, return for a moment to anxiety, to throw light on a last obscurity that we left there. I have said that there is something that does not tally with the relation (so thoroughly recognized apart from this) between anxiety and libido: the fact, namely, that realistic anxiety in face of a danger seems to be a manifestation of the self-preservative instinct which, after all, can scarcely be disputed. How would it be, though, if what was responsible for the affect of anxiety was not the egoistic ego-instincts but the ego- libidofi After all, the state of anxiety is in every instance inexpedient, and its inexpedience becomes obvious if it reaches a fairly high pitch. In such cases it interferes with action, whether flight or defence, which alone is expedient and alone serves the cause of self-preservation. If, therefore, we attribute the affective portion of realistic anxiety to ego-libido and the accompanying action to the self-preservative instinct, we shall have got rid of the theoretical difficulty. After all, you do not seriously believe that one runs away because one feels anxietyfi One feels anxiety and one runs away for a common motive, which is roused by the perception of danger. People who have been through a great mortal danger tell us that they were not at all afraid but merely acted for instance, that they aimed their rifle at the wild beast and that is unquestionably what was most expedient.