The symptom has its origin in the repressed, it is as it were the representative of the repressed in relation to the ego; the repressed is a foreign territory to the ego, an internal foreign territory, just as reality is-you must excuse the unusual expression-an external foreign territory.
SYMPTOM AND CHANCE ACTION
Cases [of lapses of our motor function] in which the entire action appears rather inexpedient, I call "symptomatic and chance actions."
Symptom and the Ego
The process which through repression has become a symptom maintains its existence outside of the ego-organization and independent of it.
Freud created psychoanalysis by giving meaning to symptoms. In his writings following Studies on Hysteria (1895d), he continued to investigate the symptom. At that time, psychiatry reduced the symptom to an opaque and incongruous phenomenon of psychic life. Freud focused on the salient and unusual features of the symptom to understand the dynamics of the unconscious and the development of conflicts.
The symptom cannot be considered equivalent to a defense, since the mechanism of defense is more general and its role less obvious. Moreover, defenses function effectively when repression is successful, when projection is obvious, and when the effects of projection are natural. Similarly, insofar as neurotic behavior and parapraxes prove useful to the subject, their unconscious causes are not apparent and are ignored. The symptom is also distinct from anxiety. Anxiety is far noisier than the symptom, though it is also closely related. Anxiety sounds the alarm that leads from a sense of urgency to the symptom. In fact, the symptom appears to be extinguishing the fires of anxiety, but it does not possess the means to accomplish this. More precisely, the symptom puts an end to anxiety by organizing a new situation different from the one that triggered the anxiety. Thus the symptom corrects the inadequate internal discharge of anxiety by offering the psyche other possibilities for linking and representation. The new situation defines the nature of the symptom and indicates its scope. In the end, it is the drive that constitutes the symptom, and this is why Freud distinguished between symptom and inhibition (1926d ). When repression fails, the drive can break through, but repression has sufficient power to divert it. Thus, the symptom is formed as a compromise. At one level, the compromise concerns the censorship between the unconscious or preconscious and consciousness. At another level, there is a conflict between the different agencies, with the superego taking the organizing role. Later Freud argued that the conflict between the ego and the id defines neurosis, while that between the ego and reality characterizes psychosis (1924b ).
Thus the course that the symptom takes always depends on the unconscious. Eventually, the play of affect and representation get the better of repression. This happens with the conversion hysteric, who suffers from quasi innervation because she marks her own body with an affect that has regressed to its original state as action. Thereafter, every fantasy is converted into a symptom that is incapacitating, but comfortable. Soon this same process is projected by a phobia and frozen in a representation, which leaves a gap in affect that is filled by anxiety (Freud, 1915d, 1915e). Because of the ambivalence of desire and defense, the symptom that the ego has established in a state of "extraterritoriality" (1926d , p. 97) gains ground bit by bit, just like a foreign army, by extending its surveillance beyond the phobic object to any fantasmatic object that can resonate with it. The defensive rituals of the obsessional become similarly eroticized by invading thought. Finally, beyond the borders of the ego, the symptom may bring a relative gain, and the individual and other people may derive from it what Freud called a "secondary gain" (1926d , pp. 99-100). For instance, the symptom may establish an internal equilibrium in the structural field from which it arises or that it organizes. Such is the diversity of pathology that it may also perform a preventive or reparative function outside of itself, as when an obsession precedes or follows a depressive episode or a hallucination makes real what mental life can no longer accept.
Behaviors or bodily abnormalities that are caused by the return of the repressed. According to psychoanalysis, insistent desires that the individual feels s/he must repress will often find alternative paths toward satisfaction and therefore manifest themselves as symptoms. Freud defines a symptom thus: "A symptom is a sign of, and a substitute for, an instinctual satisfaction which has remained in abeyance; it is a consequence of the process of repression" ("Inhibitions, Symptoms, and Anxiety" 20.91). Symptoms tend to be activities that are detrimental or perhaps only useless to one's life. In extreme cases, such symptoms "can result in an extraordinary impoverishment of the subject in regard to the mental energy available to him and so in paralysing him for all the important tasks of life" (Introductory Lectures 16.358).
The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health:
- Strictly, a symptom is a sensation or change in health function experienced by a patient. Thus, symptoms may be loosely classified as strong, mild or weak. In this, medically correct, sense of the word, it is a subjective report, as opposed to a sign, which is objective evidence of the presence of a disease or disorder. Examples of symptoms are fatigue/tiredness, pain, or nausea. The symptom that leads to a diagnosis is called a cardinal symptom. In contrast, elevated blood pressure, or abnormal appearance of the retina, would be a medical sign indicating the nature of the disease.
- A symptom may loosely be said to be a physical condition which shows that one has a particular illness or disorder (see e.g. Longman, 1995). An example of a symptom in this sense of the word would be a rash. However, correctly speaking, this is known as a sign, as would any indication detectable by a person other than the sufferer in the absence of verbal information from the patient.
Some symptoms (e.g. nausea) occur in a wide range of disease processes, whereas other symptoms are fairly specific for a narrow range of illnesses: for example, a sudden loss of sight in one eye has only a very limited number of possible causes.
Some symptoms can be misleading to the patient or the medical practitioner caring for them. For example, inflammation of the gallbladder quite often gives rise to pain in the right shoulder, which might (quite reasonably) lead the patient to attribute the pain to a non-abdominal cause such as muscle strain, rather than the real cause.
The term "Presenting symptom" or "Presenting complaint" is used to describe the initial concern which brings a patient to a doctor.
A symptom can more simply be defined as any feature which is noticed by the patient. A sign is noticed by the doctor or others. It is not necessarially the nature of the sign or symptom which defines it, but who observes it. Clearly then, the same feature may be noticed by both doctor and patient, and so is at once both a sign and a symptoms. The distinction is as simple as this, and therefore it may be nonsensical to argue whether a particular feature is a sign or a symptom. It may be one, the other, or both, depending on the observer(s). Some features, such as pain, can only be symptoms. A doctor can not feel a patient's pain (unless he is the patient!). Others can only be signs, such as a blood cell count measured by a doctor and his/her laboratory.
In engineering, symptom may be used to refer to an undesired effect occuring in a system. To eliminate the effect, a Root cause analysis is performed which traces the symptom to its cause and again through the cause's cause and so on until the subsytem is identified that can be changed to eliminate the symptom.
- Anorexia nervosa
- Cathartic method
- "Dostoyevsky and Parricide"
- Enuresis (bedwetting)
- Five Lectures on Psycho-Analysis
- Flight into illness
- Hysterical paralysis
- Indications and contraindications for psychoanalysis for an adult
- Infantile neurosis
- Inhibitions, Symptoms, and Anxiety
- Introductory Lectures on Psycho-Analysis
- Narcissistic neurosis
- Omnipotence of thought
- Psychic reality
- Psychoanalytical nosography
- Psychoanalytic semiology
- Resolution of the transference
- Self-mutilation in children
- Slips of the tongue
- Studies on Hysteria
- Substitutive formation
- Symbolic equation
- Ulcerative colitis
- War neurosis
- Freud, Sigmund. (1915d). Repression. SE, 14: 141-158.
- ——. (1915e). The unconscious. SE, 14: 159-204.
- ——. (1924b ). Neurosis and psychosis. SE, 19: 147-153.
- ——. (1926d ). Inhibitions, symptoms, and anxiety. SE, 20: 75-172.
- Freud, Sigmund, and Breuer, Josef. (1895d). Studies on hysteria. SE,2.