THE cases in which I have had the opportunity of studying analytically the conditions in which the psychoneuroses of the age of involution arise can be summed up as follows: they were all persons who failed to make the change in the distribution of their libido which accompanies the involutionary processes, or were unable to adapt themselves to the new distribution of libidinal interests.
Since Professor Freud drew my attention to the fact, I know (and can only confirm) that with age the ‘emanations of the libido’2 tend to be withdrawn from the individual’s love-objects and his no doubt quantitatively diminished libidinous interests tend to be devoted to his own ego. The old become narcissistic again—like children; much of their interest in family and social matters fades away, and they lose a great deal of their former capacity for sublimation, particularly in the sphere of shame and disgust. They become cynical, malicious, and mean; that is to say, their libido regresses to the ‘pre-genital stages of development’, and sometimes expresses itself in undisguised anal and urethral eroticism, voyeurism, exhibitionism, and a tendency to masturbation.3
The process is thus apparently the same as that which Freud describes as underlying paraphrenia; in both cases there is the same abandonment of object-cathexis and the same regression to narcissism. But in paraphrenia we must think of the libido as being quantitatively unaltered but entirely directed towards the ego, while at the change of life the ebbing of libido production leads to a diminution of its total quantity, which first makes itself perceptible in the loosest and most external libidinal cathexes, the ‘emanations’ on the object. The symptoms of paraphrenia are like islands that rise suddenly out of the depths in an earthquake; the symptoms of the change of life are like rocks left exposed by the receding waters of an inlet fed by no river and abandoned by the sea.
Noticeably little of all these mental signs of ageing are shown by those whom the climacteric affects neurotically. On the contrary, they show exaggerated family and social helpfulness, unselfishness and modesty, are generally liable to depressions, and are plagued by ideas of guilt and impoverishment which induce melancholy, from which they tend to seek refuge by falling into the arms of religion. But these depressions may be interrupted by their violent falling in love, which the sufferer tries vainly to fight against because of its incompatibility with the decorum required by his or her age. It is this type which has given the climacteric its popular name of the ‘dangerous age’.
Nevertheless I believe that these noisy love affairs are comparable with the roll of drums used at executions to drown the shrieks of the victim, which in this case is object-libido. The patient’s libido has in reality been withdrawn from its object, and it is only the ego which forces the individual to cling to his love ideals, and to conceal by his loud proclamation of love the regression which has in fact taken place. Thus the disastrous failure of ego and libido development to march hand-in-hand follows mankind into old age and forces him to repress that which runs counter to his ideals.
The exaggerated dissipation of sexual interests of many people at the climacteric is a symptom of over-compensation, of the healing tendency, while the real state of the distribution of the libido is represented by the ideas of impoverishment and guilt which accompany the patient’s depression. These are the functional expression of the impoverishment of the libidinal object-cathexes and betray the regression to a-social (hence ‘guilty’) narcissism and auto-eroticism. The depression itself is the expression of the unpleasure and repugnance of a highly civilized consciousness at such incompatible appetites.
As a characteristic instance of this let me describe a case I recently observed. The patient, who had enjoyed a lifelong reputation as a woman-hunter and had had innumerable gallant adventures in which he had cheerfully risked his by no means inconsiderable social position and family interests, succumbed at the age of fifty-five to attacks of depression, with a notable tendency to ideas of impoverishment and guilt for which there was in reality no justification. These fits of depression were interrupted from time to time by periods of (extra-marital) coitus compulsion, during which, however, he turned out to be more or less impotent. Analysis showed that the precipitating cause of the neurosis was the threat, actually by no means a dangerous one, uttered by a husband who had noticed the patient’s gallant intentions towards his wife. The threat was in fact far less dangerous than a hundred others to which he had cheerfully exposed himself in the past, but the slight shock that he had on this occasion was sufficient to release the illness. Further analysis showed that in the course of the years his personal security, his reputation as husband and father, and his money, had grown far more valuable to him than he realized; while amorous adventures had simultaneously lost a great deal of their attraction for him, though he had effectively concealed this from himself by exaggerating the interest he took in women and actually pushing this to the extreme of coitus compulsion. His impotence turned out to be the result of his narcissistic castration-anxiety. Although this had originally been very strong, he had been able to ward it off easily for many years, but, with the regression of libido due to his age, it had gained ground to such an extent that whenever there was the slightest threat of his personal security, his money, or his honour being ‘cut off’ it came immediately into play. In the course of analysis he rapidly adapted his attitude and his way of life to the real distribution of his libidinal interests and dropped his woman-hunting and his superfluous extravagances, whereupon his attacks of depression ceased and his potency returned; but only in relation to his previously neglected wife, and then only when before coitus she touched his genitals, thereby symbolically demonstrating her good will and the danger-free nature of the undertaking. The patient was satisfied with this result, and on financial grounds abandoned further analysis, which would certainly have profited him still further. Thus he succeeded by way of analysis in exchanging the ways of a dashing young man about town for the more modest ways of an elderly Philistine; a process that so many others succeed in accomplishing without medical aid. However, cases such as this show that in the process of growing old man has nearly as many awkward reefs to navigate if he is to avoid falling ill as he had in the transition from childhood to sexual maturity.
Psycho-analytic insight into cases in which libido-impoverishment and its defence reactions appear as the result of alterations induced by age throw light also on circumstances in which this impoverishment is due to other causes. I am thinking in the first place of the consequences of excessive masturbation. Masturbation—and the natural popular feeling in the matter is not to be altered by any ‘masturbation-advocate’—is unquestionably a waste of libido which can be indulged in only at the cost of other interests of the organism. The endless complaints of masturbators about ‘neurasthenic’ disturbances have the same kind of basis in reality as—according to Freud—the hypochondriacal sensation in the organs has in real alterations of the distribution of the libido. But in hypochondria the libido is dammed up, while in neurasthenia it is wasted. The states of depression that accompany masturbation, the ideas of guilt and impoverishment, are perhaps similar to those of the involutionary neuroses—the psychical expression of the libido-impoverishment that has taken place and the damage done to the beloved ego by the waste of libido, the ‘sin against oneself’.
Temporary depression following normal sexual intercourse, the well-known omne animal post coitum triste est, might also perhaps be regarded as an ego reaction to the perhaps excessive self-forgetfulness of sexual transports, i.e. as an expression of concern for one’s own well-being and of narcissistic regret at the loss of precious bodily secretions. The path from the sensation of semen-loss to the idea of impoverishment goes by way of anal eroticism, while the tendency to extravagant masturbation or ejaculation in general seems to be a derivative of urethral eroticism. Post-coital and post-masturbatory organic and mental depression would then be the unpleasure-reaction of all the eroticisms constituting narcissism to the excessive claims on the libido made by a single zone—it is true, the dominant, urogenital zone. While I thus am trying to trace back the involutionary neuroses to a conflict between object-libido and narcissism, I believe that in post-coital and inasturbatory depressions in addition to these a conflict of auto-eroticisms within the individual’s narcissism also plays a part.1
The fact that in the saying quoted above woman is said to be an exception to the rule of post-coital depression (which apparently is true) could have two causes. In the first place woman does not ‘forget herself’ so completely in sexual intercourse as man does; her narcissism prevents an excessive ‘emanation’ of the libido upon the object, and she is therefore partially spared post-coital disappointment. In the second place she ‘loses’ nothing in coitus; on the contrary, she is enriched by the hope of a child. When once one has been convinced by experience of the tremendous importance of bodily narcissism, which is always essentially and entirely primitive, one is in a better position to understand man’s ineradicable fear of ‘loss of bodily fluid’.
The fashion in which many neurotics of the climacteric seek to compensate for their dwindling interest in the external world by frantic libido-production is reminiscent of O. Gross’s view of the state of manic exaltation. The manic phase, according to Gross, is the result of a kind of endogenous pleasure-production, the object of which is to conceal feelings of unpleasure. This manic pleasure-production occasionally reminds me of alcoholism;2 but the alcoholic attains forgetfulness by taking in his drink from outside, while the manic is able to produce his stimulant endogenously. The manic’s real and fundamental mood—melancholic depression—makes its appearance only when the manic intoxication is over and the endogenous pleasure-production has faded away. After the above experiences of neurotic states in the elderly—which are often reminiscent of melancholia—the question arises whether it is not possible that melancholic depression in the non-elderly (together with the characteristic delusions of guilt and impoverishment) may not be only a reaction of narcissism to damage by libido-impoverishment.
In the few cases of melancholic depression which I have had the opportunity of studying analytically, the ideas of impoverishment have always concealed fear of the consequences of masturbation, and the delusion of guilt has always been the expression of a capacity for object-love that was constitutionally defective, or had become defective.1 Also I invariably found in the pre-history of my patients a clinical picture that could be described only as neurasthenia. Moreover, the physical disturbances accompanying the melancholia were also reminiscent of the physical symptoms accompanying neurasthenia, in particular insomnia, weariness, temperatures below normal, headaches, and obstinate constipation.
Thus the actual neurosis underlying the melancholic depression is possibly nothing but neurasthenia, caused originally by a squandering of the libido in masturbation, which might be the organic root of manic-depressive psychosis, just as anxiety neurosis lies at the root of the paraphrenic states.
Consideration of the libido distribution in extreme old age may perhaps contribute something to the understanding of the picture, confusing as it is, of senile dementia. Hitherto the consequences of senile cerebral atrophy have alone been taken into consideration; but, apart from these, it should be possible to explain some of the symptoms as signs of senile libido alterations, others as compensatory attempts to cope with them, and others again as ‘residuary phenomena’ (cf. Freud’s grouping of paraphrenic symptoms in his paper ‘On Narcissism’). It strikes me as being very likely that the noticeable loss of receptivity for new sensory impressions in the aged, side by side with their retention of old memories, may be the result, not of histopathological alterations in the brain, but of impoverishment of the available object-libido; old memories spring to the mind so readily because of the lively feeling-tone—a residue of still undiminished object-libido—which still remains associated with them, though the present interest in the outside world is no longer sufficient for the acquisition of new lasting memories.
In any case, in senile dementia, as a consequence of sheer anatomical and psychical alterations, there disappears a large part of that difference between the level of ego-interests and of the libido which in the case of involuntary neurosis leads to repression and the symptom-formation associated with it. In dementia the level of intelligence also regresses to that lower level to which only the libido regresses in the case of senile neurotics. There takes place in them that undisguised breakthrough of the normally repressed which Gulliver observed among the Struldbrugs. The Struldbrugs, Swift says, cannot die and are condemned to eternal life: ‘By degrees they grew melancholy and dejected, increasing in both till they came to fourscore.’ After reaching this age the depression disappears, but instead they become ‘not only opinionative, peevish, covetous, morose, vain, talkative, but uncapable of friendship, and dead to all natural affection…. Envy and impotent desires arc their prevailing passions…. They have no remembrance of anything, but what they learned and observed in their youth and middle age…. The least miserable among them appear to be those who turn to dotage and entirely lose their memories; these … want many bad qualities which abound in others.’
This is an admirable description of the effects of mental conflict in old age, as well as of their final outcome.
1 Posthumous paper. First published in German: Bausteine III (1939). First English translation.
2 See Freud, ‘On Narcissism’, 1914. Reprinted in Collected Papers, Vol. IV.
3 Voyeurism in old age is illustrated in the story of Susanna and the Elders, in which Susanna is lewdly observed by the Elders while bathing; exhibitionism is a common symptom of so-called senile dementia. Freud’s paper, ‘The Predisposition to Obsessional Neurosis’, 1913 (reprinted in Collected Papers, Vol. III, p. 122) draws attention to regression in ageing women to pre-genital forms of eroticism (sadism and anal eroticism).
1 I propose shortly to give pathological examples based on analytic investigation in support of these probably only provisional suggestions for an understanding of the ‘hierarchy of the eroticisms’. (Cf. Thalassa (1933) Ed.)
2 Cf. Alkohol und Neurosen, 1911. Reprinted in Bausteine, Vol. I, 145.
1 Cf. Abraham, who in his paper ‘Notes on the Psycho-Analytical Investigations and Treatment of Manic-Depressive Conditions and Allied Conditions’ (1911) (reprinted in Selected Papers, p. 137. Hogarth Press, 1927) emphasized the defective capacity for object-love of manic-depressives.