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THE PROBLEM OF LIBIDO IN DEMENTIA PRAECOX

In my book Wandlungen und Symbole der Libido I tried to furnish proof of these transgressions and at the same time to show the need for a new conception of libido which took account only of the energic view. Freud himself was forced to admit that his original conception of libido might possibly be too narrow when he tried to apply the energic view consistently to a famous case of dementia praecox – the so-called Schreber case. This case is concerned among other things with that well-known problem in the psychology of dementia praecox, the loss of adaptation to reality, a peculiar phenomenon consisting in the special tendency of these patients to construct an inner fantasy world of their own, surrendering for this purpose their adaptation to reality.

One aspect of this phenomenon, the absence of emotional rapport, will be well known to you, as this is a striking disturbance of the reality function. By dint of much psychoanalytic work with these patients we established that this lack of adaptation to reality is compensated by a progressive increase in the creation of fantasies, which goes so far that the dream world becomes more real for the patient than external reality. Schreber found an excellent figurative description for this phenomenon in his delusion about the “end of the world.” He thus depicts the loss of reality in a very concrete way. The dynamic explanation is simple: we say that libido has withdrawn more and more from the external world into the inner world of fantasy, and there had to create, as a substitute for the lost world, a so-called reality equivalent. This substitute is built up piece by piece, so to speak, and it is most interesting to see out of what psychological material this inner world is constructed.

This way of looking at the displacement of libido is based on the everyday use of the term, its original, purely sexual connotation being very rarely remembered. In actual practice we speak simply of libido, and this is understood in so innocuous a sense that Claparède once remarked to me that one could just as well use the word “interest.” The customary use of the term has developed, quite naturally and spontaneously, into a usage which makes it possible to explain Schreber’s end of the world simply as a withdrawal of libido. On this occasion Freud remembered his original sexual definition of libido and tried to come to terms with the change of meaning that had quietly taken place in the meantime. In his paper on Schreber he asks himself whether what the psychoanalytic school calls libido and conceives as “interest from erotic sources” coincides with interest in general. You see that, putting the problem in this way, Freud asks himself the question which Claparède had already answered in practice.

Freud thus broaches the question of whether the loss of reality in schizophrenia, to which I drew attention in my “Psychology of Dementia Praecox,” is due entirely to the withdrawal of erotic interest, or whether this coincides with objective interest in general. We can hardly suppose that the normal “fonction du réel” (Janet) is maintained solely by erotic interest. The fact is that in very many cases reality disappears altogether, so that not a trace of psychological adaptation can be found in these patients. (In these states reality is replaced by complex contents.) We are therefore compelled to admit that not only the erotic interest, but all interest whatsoever, has got lost, and with it the whole adaptation to reality.

Earlier, in my “Psychology of Dementia Praecox,” I tried to get round this difficulty by using the expression “psychic energy,” because I could not base the theory of dementia praecox on the theory of displacements of libido sexually defined. My experience – at that time chiefly psychiatric – did not permit me to understand this latter theory: only later did I come to realize its partial correctness as regards the neuroses, thanks to increased experiences in the field of hysteria and obsessional neurosis. Abnormal displacements of libido, quite definitely sexual, do in fact play a great role in these illnesses. But although very characteristic repressions of sexual libido do take place in the neuroses, the loss of reality so typical of dementia praecox never occurs. In dementia praecox the loss of the reality function is so extreme that it must involve the loss of other instinctual forces whose sexual character must be denied absolutely, for no one is likely to maintain that reality is a function of sex. Moreover, if it were, the withdrawal of erotic interest in the neuroses would necessarily entail a loss of reality comparable to that which occurs in dementia praecox. But, as I said before, this is not the case.

(Another thing to be considered – as Freud also pointed out in his work on the Schreber case – is that the introversion of sexual libido leads to an investment of the ego which might conceivably produce that effect of loss of reality. It is indeed tempting to explain the psychology of the loss in this way. But when we examine more closely the various things that can arise from the withdrawal and introversion of sexual libido, we come to see that though it can produce the psychology of an ascetic anchorite, it cannot produce dementia praecox. The anchorite’s whole endeavour is to exterminate every trace of sexual interest, and this is something that cannot be asserted of dementia praecox.^*)

These facts have made it impossible for me to apply Freud’s libido theory to dementia praecox. I am also of the opinion that Abraham’s essay on this subject is theoretically untenable from the standpoint of Freud’s conception of libido. Abraham’s belief that the paranoid system, or the schizophrenic symptomatology, is produced by the withdrawal of sexual libido from the outside world cannot be justified in terms of our present knowledge. For, as Freud has clearly shown, a mere introversion or regression of libido invariably leads to a neurosis and not to dementia praecox. It seems to me impossible simply to transfer the libido theory to dementia praecox, because this disease shows a loss of reality which cannot be explained solely by the loss of erotic interest.