'Studies in Hysteria' by Sigmund Freud and Joseph Breuer; 'The Unconcious' by Sigmund Freud

The Studies in Hysteria contains several of Freud's earliest case histories, and would be worth reading for that alone (their tentative and evolving format can be contrasted with the later case histories collected in the Penguin volume named after The Wolfman). The Studies are also the earliest attempt to theorise the 'talking cure' that Freud developed in collaboration with Joseph Breuer. This book is therefore the foundational text of psychoanalysis, although many of its ideas were later abandoned (for example, Freud is still using hypnosis for the earlier cases, and also ... massage!)

The collection of essays on The Unconscious includes later elaborations of some of the ideas introduced in the Studies. These essays are more concise and focused than the Studies; but they are also more abstract.

Freudian theory is often presumed to validate the concept of a fugue state: that is a split consciousness, which was a common symptom of hysteria. In fact, Freud's work opposed the prevailing view that Hysteria is a form of mental disintegration characterized by the tendency to to a permanent and complete split of the personality (this formulation is from Pierre Janet, The Mental State of Hystericals, 1894).

Even so, in the Studies, Freud and Breuer do repeat the then-accepted dictum that hypnosis is artificial hysteria (SiH, p. 15); and that, during a hysterical attack, a hypnoid consciousness has taken hold of the subject’s entire existence (SiH, p. 18). The therapeutic value of hypnosis was therefore due to a principle of resemblance between illness and cure. With the patient under hypnosis, the psychologist could communicate directly with her illness.

After 1900, as Freud developed both his theory of the unconscious and the therapeutic method of free association, he grew increasingly sceptical, not only of hypnosis, but of the whole concept of a double conscience. What we have within us, he argued, is not a second consciousness, but psychic acts that are devoid of consciousness (TU, p. 54). Thus the known cases of ‘double conscience’ (split consciousness) can most accurately be described as cases of a splitting of psychic activity into two groups, with the same consciousness alternating between the two sites (TU, p. 54). Similarly, in 'A Note on the Unconscious in Psychoanalysis' (1912), Freud again asserted that:

If philosophers find difficulties in accepting the existence of unconscious ideas, the existence of an unconscious consciousness seems to me even more objectionable. The cases described as splitting of consciousness ... might better be described as shifting of consciousness, - that function – or whatever it be – oscillating between the two psychical complexes which become conscious and unconscious in alternation.

Even in the Studies, while Breuer is confident that hypnoid states are the cause and condition of many, indeed most, of the major and complex hysterias, Freud is reluctant to concede full agency (that is, a truly independent existence) to unconscious ideas, which do not, therefore, 'belong' to an independent consciousness, but rather are removed from consciousness, as in this account of the influence of such ideas on Fräulein Elisabeth von R. (p. 168):

the love for her brother-in-law was present as a kind of foreign body in her consciousness, which had not entered into any relation with the rest of her ideational life. What presented itself, as regards this inclination, was the peculiar state of at once knowing and not knowing, that is, the state of the detached psychical group. This is all that is meant when we assert that this inclination was not ‘clearly conscious’ to her; it is not meant to indicate an inferior quality or a lesser degree of consciousness, but rather a detachment from any free associative traffic of thought with the ideational content.

The question of fugue states remains important in medicine today because of multiple personality disorder, a diagnosis that dates back to the heyday of hysteria, but has increased greatly in frequency in recent years, especially in America. In the Studies, Freud was exploring the idea that hysteria derives from repressed memories of sexual abuse. This is now thought to be an essential precondition for multiple personality disorder too. The later Freud seems to have abandoned (or at least ceased to emphasise) this presumed connection between sexual abuse and dissociation.

My new novel Reciprocity Failure features several actions carried out in a fugue state, although in the novel, these states are chemically-induced: that is, they are blackouts caused by alcohol and / or Stilnox / Ambien (which is in fact classified as a ‘hypnotic’ drug). In a blackout, the affected person performs actions of which they later retain no memory. In cases of extreme intoxication, there also may be considerable impairment of motor functions and perception, and observable personality changes. Oddly, there is very little theoretical discussion of such chemical blackouts (even though they are a well-attested phenomenon). In particular, the available discussion rarely relates blackouts to psychoanalytic theory. Perhaps this is because blackouts are treated as examples of short-term memory loss rather than dissociation; or perhaps it is because they have an identifiable physiological cause, and are always temporary. They therefore require no theoretical explanation.

Interestingly, the foundational literary account of multiple personality disorder - that is, Robert Louis Stevenson's Strange Case of Dr Jekyll and Mr Hyde (on which, more soon) - also attributes the protagonist's transformation to chemical manipulation rather than hysterical dissociation.