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.
See also: Amnesia; Anorexia nervosa; Autosuggestion; Bulimia; Cathartic method; Change; Claustrophobia; Cure; Dipsomania; "Dostoyevsky and Parricide"; Doubt; Encopresis; Enuresis (bedwetting); Five Lectures on Psycho-Analysis ; Flight into illness; Forgetting; Hypochondria; Hysteria; Hysterical paralysis; Indications and contraindications for psychoanalysis for an adult; Infantile neurosis; Inhibition; Inhibitions, Symptoms, and Anxiety ; Interpretation; Introductory Lectures on Psycho-Analysis ; Mythomania; Narcissistic neurosis; Obsession; Omnipotence of thought; Pain; Persecution; Psychic reality; Psychoanalytical nosography; Psychoanalytic semiology; Psychotherapy; Reaction-formation; Resolution of the transference; Schizophrenia; Self-mutilation in children; Slips of the tongue; Stammering; Studies on Hysteria ; Substitutive formation; Symbol; Symbolic equation; Symptom-formation; Tics; 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.
Luborsky, Lester. (1996). The symptom-context method: Symptoms as opportunities in psychotherapy. Washington DC: American Psychological Association.
symp·tom / ˈsim(p)təm/ • n. Med. a physical or mental feature that is regarded as indicating a condition of disease, particularly such a feature that is apparent to the patient: dental problems may be a symptom of other illness. Compare with sign (sense 1). ∎ a sign of the existence of something, esp. of an undesirable situation: the government was plagued by leaks—a symptom of divisions and poor morale.DERIVATIVES: symp·tom·less adj.
So symptomatic XVII. — F. or late L.