Assault on Freud
- Freud: The Assault on Truth by Jeffrey Moussaieff Masson
Faber, 308 pp, £9.95, May 1984, ISBN 0 571 13240 5
A great deal of publicity has surrounded Jeffrey Masson and his book, some good, some bad, but all of it enveloped by an atmosphere which has helped to obscure the important historical issues about the origins of psychoanalysis that his book raises. Yet Masson himself is partially responsible for submerging these issues. The rhetorical structure of his book is an extended ad hominem argument: Freud and later psychoanalysts were liars and hypocrites, lacking in courage, and therefore psychoanalytic theory is useless. It is as if Masson had rehabilitated and adapted the old argument that since Luther had notorious difficulties with his toilet habits, his Commentary on Romans is worthless.
However, with some effort of will, one can disentangle an argumentative core from Masson’s rhetoric. The plot of The Assault on Truth is as follows. In April 1896 Freud gave a paper to the Vienna Society for Psychiatry and Neurology entitled ‘The Aetiology of Hysteria’. In this paper, and in the others published in 1896, Freud argued that infantile sexual trauma was always at the basis of the development of hysteria. As Freud put it, ‘at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood but which can be reproduced through the work of psychoanalysis in spite of the intervening decades’ (Standard Edition, III, 203: Freud’s italics). Freud divided his cases into three groups, according to the origin of the premature sexual experience. The first consisted of assaults by strangers; in the second an adult, while looking after the child, initiated sexual intercourse with her or him and maintained a regular love relationship, often lasting for years; the third group consisted of sexual relations between two children of different sexes, although Freud believed that children would not commit sexually aggressive acts unless they had been previously seduced. The theory that hysteria always led back to infantile sexual seduction, know as the seduction theory, was one that Freud would publicly give up less than ten years after he first elaborated it. He would come to believe that fantasy could play an important role in the genesis of hysteria and other neuroses, and that, from both a theoretical and a clinical point of view, he had over-estimated the importance of infantile seduction.
Masson’s book is the story of how Freud ‘suppressed’ the seduction theory, how, to use Masson’s description, ‘by shifting the emphasis from an actual world of sadness, misery and cruelty to an internal stage on which actors performed invented dramas for an invisible audience of their own invention, Freud began a trend away from the real world that, it seems to me, is at the root of the present-day sterility of psychoanalysis and psychiatry throughout the world.’ Central to Masson’s story is the case of Emma Eckstein, a patient of Freud and Wilhelm Fliess. Masson concludes that in order to protect himself and, especially, Fliess from any guilt for their mishandling of the Eckstein case, Freud suppressed the seduction theory and replaced it with his new views on the importance of fantasy. A contributing cause to his abandonment and suppression of the seduction theory was Freud’s isolation by the medical community when he propounded the theory. But even without going into any details, the form of Masson’s argument is that Freud abandoned his most ‘brilliant insight’ for personal reasons, because of a failure of courage.
The first, and most obvious, remark that should be made is that Freud never abandoned, much less suppressed, the view that infantile seduction was both real and significant. He returned to the reality of infantile sexual trauma throughout his writings. As late as 1940 in one of his last writings, An Outline of Psychoanalysis, Freud explicitly singles out certain influences on children which, although they do not apply to all children, are ‘common enough’, and he includes in this category ‘the sexual abuse of children by adults’ and ‘their seduction by other children (brothers or sisters)’ (S.E., XXIII, 187). Freud goes on to discuss the Oedipus complex in this context, but the role of the Oedipus complex in his conception of childhood development did not require the abandonment of the reality of infantile sexual seduction. Moreover, in none of the works that Masson quotes does Freud ever deny the reality of seduction in the 18 cases that he originally put forward in 1896. In 1905 Freud discussed the problems with the seduction theory in at least two places, the Three Essays on the Theory of Sexuality and ‘My Views on the Part Played by Sexuality in the Aetiology of the Neuroses’, the latter actually published in 1906. In one of his few textually specific accusations, Masson claims to expose Freud’s insincerity. After discussing what he takes to be some problems with the latter essay, he writes:
Is Freud’s essay, apart from these difficulties, entirely sincere? I quote again: ‘I thus overestimated the frequency of such events [seductions]’ (p.274). Yet in the same year (1905), Freud wrote in Three Essays: ‘I cannot admit that in my paper “The Aetiology of Hysteria” (1896) I exaggerated the frequency or importance of that influence [seduction]’ (p. 190). These statements cannot both be true.
It is useful to look at this apparent insincerity very closely, since the passage exemplifies Masson’s inability to read a text, and may serve as an emblem for his interpretative inadequacies. So here are the passges to which Masson refers. First, from the Three Essays, in the section on ‘The Return of Early Infantile Masturbation’:
I shall have to speak presently of the internal causes; great and lasting importance attaches at this period to the accidental external contingencies. In the foreground we find the effects of seduction, which treats a child as a sexual object prematurely and teaches him, in highly emotional circumstances, how to obtain satisfaction from his genital zones, a satisfaction which he is then usually obliged to repeat again and again by masturbation. An influence of this kind may originate either from adults or from other children. I cannot admit that in my paper on ‘The Aetiology of Hysteria’ (1896) I exaggerated the equency or importance of that influence, though I did not then know that persons who remain normal may have had the same experiences in their childhood, and though I consequently overrated the importance of seduction in comparison with the factors of sexual constitution and development. Obviously seduction is not required in order to arouse a child’s sexual life; that can also come about spontaneously from internal causes.
Here is the relevant passage from ‘My Views on the Part Played by Sexuality in the Aetiology of the Neuroses’:
At that time  my material was still scanty, and it happened by chance to include a disproportionately large number of cases in which sexual seduction by an adult or by older children played the chief part in the history of the patient’s childhood. I thus overestimated the frequency of such events (though in other respects they were not open to doubt). Moreover, I was at that period unable to distinguish with certainty between falsifications made by hysterics in their memories of childhood and traces of real events.
There is no problem whatsoever with both of these statements being true. In the Three Essays, Freud is saying that in ‘The Aetiology of Hysteria’ he did not exaggerate the frequency or importance of seduction: that is, in the 18 cases he reported there, seduction played an important role. But, Freud says, sexual constitution and development, so-called internal causes, can also arouse a child’s sex life. In ‘My Views’ Freud is claiming that precisely because in 1896 he had seen so many cases of seduction, he overestimated the frequency of such events. He gives us an additional problem (‘moreover’) with his theory at that time – his inability to distinguish fantasy from real memory, a topic to which I shall return. (But it should be noted here that Freud did not believe that there was a clean bifurcation between fantasy and memory, since the patient’s fantasies ‘were built up out of and over the childhood memories’: S.E., VII, 274.) In this latter paper, Freud restricts his qualifications to overestimating the frequency of seduction, not its reality. And part of the reason for this overestimation was the evidence presented in the 1896 paper. Thus the only contradiction between these two statements is the one produced by misreading. Freud did abandon the seduction theory, the theory that infantile sexual trauma was always a cause of hysteria: but he did not suppress the reality of this trauma or redescribe his case material from 1896.
This interpretative episode is entirely representative of Masson’s subtlety with a text. I could produce similar instances almost indefinitely, but let me just say that anyone interested in the Emma Eckstein case would do better to read Max Shur’s article that first unearthed the case, which discusses some important historical and theoretical questions virtually ignored by Masson, such as the relation of the Emma Eckstein case to the Irma dream of The Interpretation of Dreams and Freud’s transference relationship to Fliess. Shur expertly uses the Eckstein case to show that many of the phenomena that Freud was later to conceptualise under the name of ‘transference’ were already present in his relationship to Fliess. Both Freud and Fliess handled the Emma Eckstein case exceptionally badly, and Freud certainly felt the need to exculpate himself and Fliess. But to conclude, as Masson does, that the reason Freud ‘suppressed’ the seduction theory was because of the mishandling of this case is to fail to be able to distinguish between falsification and traces of real events. Anyone attempting to work out the complicated relation between fantasy and memory in Freud’s work should start with the difficult but important article by Jean Laplanche and J.B. Pontalis, ‘Fantasy and the Origins of Sexuality’.
I have not yet said anything about Masson’s larger historical claims, and turning to them one is confronted by historical reconstructions no better than his textual interpretations. Furthermore, Masson suffers from a simple-minded historiographical view, which one might call the golden event conception of history, the paradigm of which is the picture of Newton discovering gravitation by way of an apple falling on his head. No small set of golden events (the Emma Eckstein case, Freud’s supposed personal isolation, his relationship to Fliess, and so on) will be adequate to a history of psychoanalysis. What we need is a history of the concepts used in psychoanalysis, an account of their historical origins and transformations, their rules of combination, and their employment in a distinctive style of reasoning. But since I obviously cannot produce that here, let me turn to some of Masson’s historical claims in order to advance a radically different interpretation of Freud’s early psychoanalytic writings.
Two competing myths about Freud have gradually developed, alternating in their relative prominence. The first myth paints Freud as a lonely genius, isolated and ostracised by his colleagues, fashioning psychoanalysis single-handedly and in perpetual struggle with the world at large. The second, opposing myth pictures Freud as getting all of his major ideas from someone else, usually Fliess, and taking credit for what were in fact no more than minor modifications in previously developed theories. Each of these myths exaggerates a shred of historical truth, but they are useful in depicting the spectrum of pitfalls one faces in trying to place Freud accurately in the history of 19th-century psychiatry.
In the second chapter of his book, Masson tries to show the influence on Freud of a large body of 19th-century French medico-legal literature. This literature dealt with rape and other violent acts against children as part of the general category of assaults against decency or morals (attentats aux moeurs). Masson argues that Freud was familiar with a significant portion of this vast literature, and that he probably even witnessed autopsies performed on some of the victims of such assaults. I think that nobody can doubt that Freud knew of this literature and that perhaps he did witness some of the autopsies Masson describes. But to claim that this material led to Freud’s ‘later theoretical concepts about the origins of neurosis’ or even that it played ‘a major role in his theoretical thinking’ is to misunderstand completely some crucial problems of 19th-century psychiatry.
The story of the emergence of psychiatry as an autonomous medical discipline in the 19th century is in large part a history of how psychiatric categories, explanations and reasoning became independent of the concepts of pathological anatomy, especially as manifested in neurology and cerebral pathology. Pathological anatomy was based on the theoretical proposition that every pathological change was the result of some macroscopic or microscopic anatomical change, and in its quest to demonstrate the connection between disease and anatomical or structural abnormality, it took as its battle cry Bichat’s famous exhortation: ‘Open up a few corpses: you will dissipate at once the darkness that observation alone could not dissipate.’ The French professors of legal medicine whom Masson discusses used the explanations and concepts of pathological anatomy in a way that was deeply at odds with Freud’s early writings. In 1896 Freud believed that sexual trauma played a crucial role in the genesis of psychoneuroses, especially hysteria and obsessional neurosis. But if we look at the writings of Ambroise Tardieu, the most influential of these professors of legal medicine and the one discussed at greatest length by Masson, we find that his reasoning is conceptually incompatible with the very notion of psychoneurosis. Had Masson looked at Tardieu’s thesis, presented to the Faculty of Medicine at the University of Paris in 1844, his repeated surprise at the lack of psychological theorising of these French doctors might have been dissipated. This thesis attempts to show the indispensable role of anatomical diagnosis in clarifying the treatment of the neuroses, and is resolutely in opposition to an independent psychological concept of neurosis. Tardieu admits that there appear to be various diseases without underlying lesions – that is, without underlying anatomical or structural abnormalities – but he quickly adds that it would be ‘just and wise’ to say that these diseases are without any ‘discernible lesion’: ‘a lesion not yet discernible can become discernible and in this regard great progress has been made.’ Tardieu’s discussion of hysteria is perfectly typical of his attempt to apply pathological anatomy to the neuroses. He argues that anatomical diagnosis has made great progress in showing that in a large number of cases the point of departure of hysteria is a discernibly abnormal state of the uterus or related organs. It is absolutely clear that Tardieu did not conceptualise hysteria as an independent psychological disorder, that his concept of hysteria had no real point of contact with the concept as Freud understood it.
His failure to distinguish between anatamopathological reasoning and psychiatric reasoning leads Masson to other fundamental confusions. For instance, he claims that ‘nearly half of Tardieu’s book on attentat aux moeurs is devoted to homosexuality.’ In fact, Tardieu’s book has nothing whatever to do with ‘homosexuality’, a concept that did not exist in 1857 when Tardieu’s book was first published. Tardieu’s medico-legal study is about sodomy, not homosexuality, and our understanding of the history of medicine will be arrested if we do not carefully distinguish the two. Sodomy was a legal category, defined in terms of certain specified behaviour; the sodomite was a judicial subject of the law. Homosexuality was to be a psychic disease of the sexual instinct, and the homosexual a medical patient of psychiatry. Legal medicine was concerned with sodomy because bodily evidence of sodomitic behaviour could be uncovered by a trained medical specialist, and this evidence could be submitted as legal evidence. Homosexuality did not become a concern of medicine until about 1870, and this new object of clinical knowledge presupposed a new style of psychiatric reasoning.
Finally, I should at least mention that Masson’s reliance on the statistics compiled in the 19th-century books he discusses is unsophisticated to the point of undiluted naivety. The use of statistics in 19th-century legal medicine is an outgrowth of what Ian Hacking has called the ‘avalanche of printed numbers’. This employment of statistical evidence and categorisation raises intricate epistemological and political issues that do not even enter Masson’s field of vision. The second chapter of his book, the only one that could claim to make a real historical contribution, is a catalogue of confusions and superficiality.
The importance to understanding Freud of distinguishing between anatamo-pathological and psychiatric reasoning can perhaps best be seen if we briefly consider Freud’s relation to J.M. Charcot. Charcot’s influence on Freud has been well documented, but I want to consider one of Freud’s criticisms of Charcot as it bears on the issue of styles of reasoning about neuroses. In certain respects, Charcot’s work functioned as a bridge or attempted mediation between pathological anatomy and psychiatry. Charcot often tried to explain hysteria by a form of physiological reasoning that is exceptionally difficult to interpret. In an important paper entitled ‘Some Points in a Comparative Study of Organic and Hysterical Paralyses’, which has been almost completely neglected by historians of psychoanalysis – it was written at Charcot’s suggestion and begun in the late 1880s, and was published in 1893 in French – Freud singles out this physiological reasoning as being highly problematic. The problem revolves around Charcot’s notion of a dynamic or functional lesion, a notion he invoked to explain hysterical paralyses and attacks. The concept of lesion belongs to pathological anatomy and the concept of dynamic change was soon to become entrenched in psychological explanations. But the concept of dynamic lesion, as used by Charcot, was meant to refer to a physiological abnormality in the nervous system, and Freud had no small difficulty in trying to understand the implications of this concept. Freud argued that in its negative aspect we can well understand the concept of dynamic lesion: ‘it is equivalent to saying that no appreciable tissue changes will be found post mortem.’ But in its positive aspect, claimed Freud, the interpretation of this concept is ‘far from being unequivocal’. Freud believed that those who read Charcot will think that ‘a dynamic lesion is indeed a lesion but one of which no trace is found after death, such as an oedemia, an anaemia or an active hyper-aemia. These, however, although they may not necessarily persist after death, are true organic lesions even if they are slight and transitory’ (S. E., I, 168).
So Freud thought, quite naturally, that dynamic lesions would be assimilated to pathological anatomy as a specific kind of lesion, one that was slight and, more important, transitory. And, in fact, Theodor Meynert, one of Freud’s teachers and a staunch pathological anatomist, tried to explain hysterical symptoms on the basis of an occlusion of the choroid artery. Freud wanted to distance himself from any such explanations and from the ambiguity, perhaps even incoherence, of the notion of dynamic lesion. He concludes his discussion of Charcot with a warning and an assertion: ‘If one reads that “there must be a hysterical lesion” in such and such a centre, the same centre in which an organic lesion would produce a corresponding organic symptom, and if one recalls that one is accustomed to localise a hysterical dynamic lesion in the same manner as an organic lesion, one is led to believe that behind the expression ‘‘dynamic lesion” there is hidden the idea of a lesion like oedemia or anaemia, which are in fact transitory organic affections. I, on the contrary, assert that the lesion in hysterical paralyses must be completely independent of the anatomy of the nervous system, since in its paralyses and other manifestations hysteria behaves as though anatomy did not exist or as though it had no knowledge of it’ (S. E., I, 168-169). The first sentence of this quotation is, in effect, an attempt to indicate the conceptual problem with the notion of dynamic lesion, while the second sentence is an assertion derived from Freud’s comparison of organic and hysterical paralyses in the preceding sections of the paper. Taken together, they enable Freud, in the final section of this paper, to ‘ask permission to move on to psychological ground’ and to outline the psychological explanations of hysteria that he and Breuer have developed (although even Freud sometimes reverts, in this last section, to the concept of lesion, a concept that has absolutely no role in his explanation). With this as general intellectual and historical background, let me offer an interpretative outline of Freud’s earliest psychoanalytic writings that will show how undiscerning Masson’s views are.
I shall do no more than sketch what I think is Freud’s central achievement in his early psychoanalytic writings from 1893 to 1896. But that will be enough to show the way in which Masson’s interpretation obscures this achievement. Freud’s main accomplishment in these early writings is his developing theory of the psychical mechanism of hysterical symptom formation and of the formation of other neurotic symptoms. Freud was concerned with providing a theory of unconscious psychological mechanisms in order to explain the form which neurotic symptoms took. In his ‘On the Psychical Mechanism of Hysterical Phenomena: Preliminary Communication’, written with Josef Breuer and published in 1893, Freud argued that in both traumatic hysteria and traumatic neuroses more generally, it was not the physical injury but the psychical trauma that played the central role. Moreover, he and Breuer argued that in so-called common hysteria, rather than a single major psychical trauma, one often finds a number of partial traumas that as a group provoke the hysterical symptoms. The crucial idea of this paper is the way in which psychical traumas, or more exactly the unconscious memory of these psychical traumas, express themselves in hysterical symptoms. As Freud and Breuer put it, ‘we must presume ... that the psychical trauma – or more precisely the memory of the trauma – acts like a foreign body which long after its entry must continue to be regarded as an agent that is still at work’: thus the famous claim that ‘Hysterics suffer mainly from reminiscences’. In his 1896 paper ‘The Aetiology of Hysteria’ this same conception of the central role of unconscious memories of psychical traumas is present, although it is interwoven with other considerations about the causal significance of infantile sexual seduction. However, Freud is unambivalent in his claim that ‘no hysterical symptom can arise from a real experience alone... ‘(S.E., III, 197). And after arriving at his thesis about childhood sexual trauma, the thesis that is the centrepiece of Masson’s book, Freud writes: ‘And since infantile experiences with a sexual content could after all only exert a psychical effect through their memory-traces, would not this view be a welcome amplification of the finding of psychoanalysis which tells us that hysterical symptoms can only arise with the co-operation of memories?’ (S.E., III, 202). Throughout his writings of this period, Freud believed that without the operation of unconscious memories, a psychological force, there would be no hysterical symptom formation. Indeed, in 1896 he went so far as to describe the first conclusion of psychoanalysis as the ‘proposition that hysterical symptoms are derivatives of memories which are operating unconsciously.’ I refer to these passages because anybody relying on Masson for an account of Freud’s early writings would not know of their existence, much less their centrality.
The development in Freud’s thought from infantile sexual traumas to what he called the infantilism of sexuality was, on any reasonable account of psychoanalysis, of great importance. But we must place this importance in the context of Freud’s emerging account of unconscious psychological mechanisms. In Freud’s early writings, unconscious memories provided the psychological basis from which hysterical symptoms were derived; later, he added the factor of unconscious fantasies which provided another psychological basis for neurotic symptom formation. The discontinuity between memory and fantasy is not so radical if one keeps in mind Freud’s constant preoccupation with formulating a thoroughly psychological form of reasoning about neurosis. Freud’s claim, announced in his famous 21 September 1897 letter to Fliess, that ‘there is no “indication of reality” in the unconscious,’ does not deny the distinction between unconscious memories of real events and unconscious fantasies, but rather articulates the realisation that the unconscious mechanisms of symptom formation can work on memory and fantasy in the same way. This claim is perfectly compatible with Freud’s lifelong insistence that infantile sexual trauma is real and significant: it is simply that, in Freud’s view, without the operation of some psychological force, such as unconscious memory, these traumas could not be transcribed into neurotic symptoms. Freud’s discovery of the importance of unconscious fantasy, as connected with the discovery of infantile sexuality, enlarged the kind of psychological material that he thought could be taken up by the unconscious and transformed into symptoms. Masson’s lack of attention to Freud’s basic mode of reasoning about neurosis leads him to see a certain kind of radical break in Freud’s writings that is nothing more than a product of his historical ignorance.
One must keep firmly in mind the distinction, formulated by Freud at the beginning of the third section of ‘The Aetiology of Hysteria’, between the mechanism of the formation of hysterical symptoms and the causation of these symptoms. Freud’s emphasis on infantile sexual seduction in his 1896 papers focuses on causation rather than on mechanism, although both kinds of consideration are present in virtually all of his early psychoanalytic work. In the context both of previous 19th-century psychiatry and of subsequent developments in psychoanalysis, Freud’s lasting achievement in these early writings is his theory of the mechanisms of symptom formation and not his theory of the causation of these symptoms. His speculations about the causation of neuroses led him to think that he could distinguish between hysteria and obsessional neurosis by reference to the details of the infantile sexual traumas. Specifically, in 1896 he thought that a passive attitude toward the infantile seduction predisposed one to hysteria, while an active attitude toward the seduction predisposed one to obsessional neurosis. But he soon realised that his aetiological speculations were far too simple to account for the problem of ‘choice of neurosis’. Moreover, he recognised that the whole aetiological problem, the issue of the relative causal weight of heredity, constitution and accident in the formation of neurosis, was much more complicated than he had at first believed.
Writing in 1906, he concluded his paper on the role of sexuality in the aetiology of the neuroses with the following cautious remarks: ‘It should not, however, be forgotten that the aetiological problem in the case of the neuroses is at least as complicated as the causative factors in any other illness. A single pathogenic influence is scarcely ever sufficient: in the large majority of cases a number of aetiological factors are required, which support one another and must therefore not be regarded as being in mutual opposition ... To look for the aetiology of the neuroses exclusively in heredity or in the constitution would be just as onesided as to attribute that aetiology solely to the accidental influences brought to bear upon sexuality in the course of the subject’s life’ (S.E., VII, 279). These remarks are a great distance from Freud’s simple causal hypotheses of 1896, and they are far more adequate to the complexity of the causal facts.
To defend the view that it is the conception of psychical mechanisms and not the theory of causation that is the lasting achievement of these writings, something further must be said about how this conception was made more determinate by Freud. The passages I have already quoted give, so to speak, only the abstract form of the psychical mechanism: a significant affect attached to an unconscious memory is not sufficiently discharged and is therefore transcribed into a neurotic symptom. Freud was, however, concerned to give more structure to this mechanism and soon after the publication with Breuer of the ‘Preliminary Communication’, he directly addressed the problem. In 1894, in his paper on ‘The Neuro-Psychoses of Defence’, Freud took a major conceptual step forward by clearly elaborating, for the first time, the concept of defence, and by arguing that different kinds of symptom formation can be understood by means of different forms of defence. But in order to see how the concept of defence allowed him to give more structure to the notion of psychical mechanisms, one must first see how some basic ideas of the 1893 ‘Preliminary Communication’ served as, in effect, conceptual obstacles to further advance. Although in 1893 a vague anticipation of the concept of defence can be exhumed from a half-sentence of the ‘Preliminary Communication’, Freud and Breuer focused on two sets of conditions that can prevent a hysterical patient from reacting to or abreacting a psychical trauma. The first set of conditions prevent abreaction ‘because the nature of the trauma excluded a reaction, as in the case of the apparently irreparable loss of a loved person or because social circumstances made a reaction impossible’ (S.E., II, 10). In the second set of conditions, abreaction is prevented because of ‘the psychical states in which the patient received the experiences in question’: that is, when ideas not in themselves significant ‘originated during the prevalence of severely paralysing affects, such as fright, or during positively abnormal psychical states, such as the semi-hypnotic twilight state of day-dreaming, auto-hypnoses, and so on’ (S.E., II, 11).
In his 1894 paper on ‘The Neuro-Psychoses of Defence’ Freud refers to the kind of hysteria that results when the nature of the psychical trauma prevents abreaction, particularly as a result of circumstances outside the patient’s control, as retention hysteria. He refers to the kind of hysteria that results when the psychical state of the patient prevents abreaction as hypnoid hysteria, the psychical state being similar to one produced by hypnosis. Moreover, in 1893, no doubt under Breuer’s influence, the ‘Preliminary Communication’ emphasises the idea of hypnoid states and hypnoid hysteria, going so far as to claim that the ‘basis and sine qua non of hysteria is the existence of hypnoid states’. As long as the idea of hypnoid states was central to the conceptualisation of hysteria, it was not possible to develop the concepts necessary for a dynamic understanding of psychical mechanisms. As against employing the concepts of psychical conflict and defence to fill out the notion of an unconscious psychical mechanism, the presence of a hypnoid state was used to account for the formation of separate, unconscious psychical groups and the resulting dissociation and splitting of consciousness found in hysteria.
The idea of hypnoid states, and the conception of hysteria based on them, did not have enough structure to account for neurotic symptom formation in the way that Freud could explain it as soon as he isolated the ideas of defence and defence hysteria. In 1894 defence hysteria was conceptualised as one species of neuro-psychosis of defence, the other two being obsessional neurosis and paranoia (called hallucinatory psychosis). Common to the neuro-psychoses of defence is an incompatibility between an idea with a distressing affect and the ego. The ego attempts to deal with this conflict by means of a defence, the patient’s effort to forget the idea and its affect following a path that leads to the formation of a neurotic symptom:
The task which the ego, in its defensive attitude, sets itself of treating the incompatible idea as ‘non arrivé’ simply cannot be fulfilled by it. Both the memory-trace and the affect which is attached to the idea are there once and for all and cannot be eradicated. But it amounts to an approximate fulfilment of the task if the ego succeeds in turning this powerful idea into a weak one, in robbing it of the affect – the sum of excitation – with which it is loaded. The weak idea will then have virtually no demands to make on the work of association. But the sum of excitation which has been detached from it must be put to another use.
S.E., III, 48-49
So far, according to Freud, the psychical processes in hysteria, obsessions and paranoia are the same, but he then distinguished between them in terms of the use to which the affect was put, the specific mechanisms of defence by which the affect was redirected. In hysteria, the affect is detached from the incompatible idea and converted into something somatic; in obsessional neurosis, the affect is detached from the incompatible idea and transposed to an idea which is not unbearable; in hallucinatory psychosis, both the incompatible idea and the affect are projected into reality as hallucination. In 1894 Freud distinguished between various illnesses in terms of the specific unconscious psychological mechanisms that are operating: conversion in hysteria, transposition or substitution in obsession, and projection in paranoia. Freud’s objection against Janet that emphasising the splitting of consciousness ‘has failed to produce any characteristic that sufficiently distinguishes the splitting of consciousness in hysteria from that in psychoses and similar states’ (S.E., III, 51) could well have been used against Breuer and Freud’s 1893 emphasis on hypnoid states. But once Freud introduced and made central the concepts of psychical conflict, defence, and mechanism of defence, the way was open to provide the specific characteristics that distinguished the different illnesses. This line of thought would lead not only to the work of Anna Freud but also to that of Melanie Klein. Moreover, the conceptual apparatus in Freud’s 1894 paper was the first significant step forward in giving some determinate structure to the unconscious, in describing its laws and modes of operation, and so in allowing one to discover definitively that the unconscious was not merely the result of the disintegration of conscious mental processes – a view pervasive in 19th-century French and German psychiatry. Finally, this conceptual apparatus was essential to Freud’s formulation of the distinction between the actual neuroses, such as neurasthenia and anxiety neurosis, and the psychoneuroses – a crucial issue in the development of his thought.
If one reads Freud’s 1896 paper, ‘Further Remarks on the Neuro-Psychoses of Defence’, one finds that he has two different ways of distinguishing, for instance, between hysteria and obsessional neurosis. On the one hand, there is his 1896 preoccupation with differentiating between the two in terms of the details of the precipitating sexual trauma: whether the child was passive or active in the infantile sexual seduction. On the other hand, there is the attempt, sketched in 1894 and reiterated in 1895 and 1896, to show ‘how different neurotic disturbances arise from the different methods adopted by the “ego” in order to escape from this incompatibility [between the ego and some idea presented to it]’. In the context of both Freud’s earlier and later writings, of the conceptual state of 19th-century psychiatry, and of later developments in psychoanalytic theory, it is the latter attempt that should be viewed as Freud’s historical achievement: the theory of the ego’s mechanisms of defence. Masson ignores this achievement, not to mention the important recent work done on childhood sexual abuse. Freud’s early writings on unconscious psychical mechanisms were the prolegomena to the future development of his thought, and were to lay the foundation for his further articulation of these mechanisms in The Interpretation of Dreams, The Psychopathology of Everyday Life and Jokes and their Relation to the Unconscious.
I have not discussed the last chapter of Masson’s book, which concerns the case of Sandor Ferenczi, since it raises questions distinct from those I consider most important. In 1932 Ferenczi presented a paper to the International Psychoanalytic Congress in Wiesbaden that put forward a version of Freud’s old 1896 seduction theory. Masson evidently wishes to be a second Ferenczi, rediscovering a view of Freud’s which neither he nor Ferenczi adequately understood. To this wish one can only apply Marx’s remark that although Hegel said that historical events and persons occur, as it were, twice, he forgot to add: the first time as tragedy, the second as farce.
 ‘Some Additional “Day Residues” of “The Specimen Dream of Psychoanalysis” ’ in Psychoanalysis – A General Psychology, edited by R. Loewen stein.
 International Journal of Psychoanalysis, 1968.
 I discuss homosexuality, and perversion more generally, as a disease category in 19th-century medicine in ‘Closing up the Corpses’. I&C. No 10/11.
 ‘Biopower and the Avalanche of Printed Numbers’: Humanities in Society, Vol. 5, No 3/4. Also see Hacking’s ‘How should we do the history of statistics?’ I&C, No 8.