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These two observations, then, argue in favour of what we have called
hypochondriacal speech or ‘organ-speech’. But, what seems to us more important, they
also point to something else, of which we have innumerable instances (for
example, in the cases collected in Bleuler’s monograph) and which may be reduced to a
definite formula. In schizophrenia words are subjected to the same process as that which makes the dream images out of
latent dream-thoughts - to what we have called the primary psychical process.
They undergo condensation, and by means of displacement transfer their cathexes
to one another in their entirety. The process may go so far that a single
word, if it is specially suitable on account of its numerous connections, takes
over the representation of a whole train of thought. The works of Bleuler, Jung
and their pupils offer a quantity of material which particularly supports this
assertion.¹
Before we draw any conclusion from impressions such as these, let us
consider further the distinctions between the formation of substitutes in
schizophrenia on the one hand, and in hysteria and obsessional neurosis on the other -
subtle distinctions which nevertheless make a strange impression. A patient whom I
have at present under observation has allowed himself to be withdrawn from all
the interests of life on account of a bad condition of the skin of his face. He
declares that he has black heads and deep holes in his face which everyone
notices. Analysis shows that he is playing out his castration complex upon his
skin. At first he worked at these blackheads remorselessly; and it gave him great
satisfaction to squeeze them out, because, as he said, something spurted out
when be did so. Then he began to think that a deep cavity appeared wherever he
had got rid of a blackhead, and he reproached himself most vehemently with having
ruined his skin for ever by ‘constantly fiddling about with his hand’.
Pressing out the content of the blackheads is clearly to him a substitute for
masturbation. The cavity which then appears owing to his fault is the female genital,
i.e. the fulfilment of the threat of castration (or the phantasy representing
that threat) provoked by his masturbating. This substitutive formation has, in
spite of its hypochondriacal character, considerable resemblance to a hysterical
conversion; and yet we have a feeling that something different must be going on
here, that a substitutive formation such as this cannot be attributed to
hysteria, even before we can say in what the difference consists. A tiny little
cavity such as a pore of the skin would hardly be used by a hysteric as a symbol
for the vagina, which he is otherwise ready to compare with every imaginable
object that encloses a hollow space. Besides, we should expect the multiplicity of
these little cavities to prevent him from using them as a substitute for the
female genital. The same applies to the case of a young patient reported by Tausk
some years ago to the Vienna Psycho-Analytical Society. This patient behaved
in other respects exactly as though he were suffering from an obsessional
neurosis; he took hours to wash and dress, and so on. It was noticeable, however,
that he was able to give the meaning of his inhibitions without any resistance. In
putting on his stockings, for instance, he was disturbed by the idea that he
must pull apart the stitches in the knitting, i.e. the holes, and to him every
hole was a symbol of the female genital aperture. This again is a thing which we
cannot attribute to an obsessional neurotic. Reitler observed a patient of the
latter sort, who also suffered from having to take a long time over putting on
his stockings; this man, after overcoming his resistances, found as the
explanation that his foot symbolized a penis, that putting on the stocking stood for
a masturbatory act, and that he had to keep on pulling the stocking on and off,
partly in order to complete the picture of masturbation, and partly in order
to undo that act.
¹ The dream-work, too, occasionally treats words like things, and so creates
very similar ‘schizophrenic’ utterances or neologisms.