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EXPLANATIONS, APPLICATIONS AND ORIENTATIONS

Persian

 

 

LECTURE XXXIV

LADIES AND GENTLEMEN, – Perhaps you will allow me for once, as a relief from the dry tone of these lectures, to talk to you about some things which have very little theoretical significance but which concern you closely in so far as you are friendlily disposed to psycho-analysis. Let us imagine, for instance, that in your leisure hours you take up a German, English or American novel, in which you expect to find an account of contemporary people and society. After a few pages you come upon a first comment on psychoanalysis and soon afterwards upon others, even though the context does not seem to call for them. You must not imagine that it is a question of applying depth-psychology to a better understanding of the characters in the book or of their actions – though, incidentally, there are other and more serious works in which an attempt of that kind is in fact made. No, these are for the most part facetious remarks intended by the author to display his wide reading and intellectual superiority. Nor will you always form an impression that he really knows what he is talking about. Again, you may go as a recreation to a social gathering – and this need not necessarily happen in Vienna. After a short time the conversation turns upon psycho-analysis and you will hear the greatest variety of people passing their judgement on it, mostly in voices of unwavering certainty. It is quite usual for the judgement to be contemptuous or often slanderous or at least, once again, facetious. If you are so imprudent as to betray the fact that you know something about the subject, they fall upon you with one accord, ask for information and explanations and soon convince you that all these severe judgements had been arrived at without any basis of knowledge, that scarcely any of these critics had ever opened an analytic book or, if they had, had gone beyond the first resistance aroused by their contact with this new material. New Introductory Lectures On Psycho-Analysis 4739 You may perhaps expect an introduction to psycho-analysis to give you instructions, too, on what arguments you should use to correct these obvious errors about analysis, what books you should recommend to give more accurate information, or even what examples you should bring up in the discussion from your reading or experience in order to alter the company’s attitude. I must beg you to do none of this. It would be useless. The best plan would be for you to conceal your superior knowledge altogether. If that is no longer possible, limit yourself to saying that, so far as you can make out, psychoanalysis is a special branch of knowledge, very hard to understand and to form an opinion on, which is concerned with very serious things, so that a few jokes will not bring one to close quarters with it – and that it would be better to find some other plaything for social entertainment. Nor, of course, will you join in attempts at interpretation, if unwary people repeat their dreams; and you will resist the temptation to curry favour for analysis by retailing reports of its cures. But you may raise the question of why these people – both the ones who write books and the conversationalists – behave so badly; and you may incline to the view that the responsibility for this lies not only on them but also on psycho-analysis. I think so too. What you come upon as prejudice in literature and society is an after-effect of an earlier judgement – the judgement, namely, that was formed upon the young psycho-analysis by the representatives of official science. I once complained of this in a historical account I wrote, and I shall not do so again – perhaps that once was too often – but it is a fact that there was no violation of logic, and no violation of propriety and good taste, to which the scientific opponents of psychoanalysis did not give way at that time. The situation recalled what was actually put in practice in the Middle Ages when an evil-doer, or even a mere political opponent, was put in the pillory and given over to maltreatment by the mob. You may not realize clearly, perhaps, how far upwards in our society mobcharacteristics extend, and what misconduct people will be guilty of when they feel themselves part of a crowd and relieved of personal responsibility. At the beginning of that time I was more or less alone and I soon saw that there was no future in polemics but that it was equally senseless to lament and to invoke the help of kindlier spirits, for there were not courts to which such appeals could be made. So I took another road. I made a first application of psycho-analysis by explaining to myself that this behaviour of the crowd was a manifestation of the same resistance which I had to struggle against in individual patients. I refrained from polemics myself and influenced my adherents, when little by little they appeared, in the same direction. This procedure was the right one. The interdict which lay upon psycho-analysis in those days has been lifted since then. But, just as an abandoned faith survives as a superstition, just as a theory which has been given up by science continues to exist as a popular belief, so the original outlawing of psycho-analysis by scientific circles persists to-day in the facetious contempt of the laymen who write books or make conversation. So this will no longer surprise you. New Introductory Lectures On Psycho-Analysis 4740 But you must not expect to hear the glad tidings that the struggle about analysis is over and has ended in its recognition as a science and its admission as a subject for instruction at universities. There is no question of that. The struggle continues, though in more polite forms. What is also new is that a sort of buffer-layer has formed in scientific society between analysis and its opponents. This consists of people who allow the validity of some portions of analysis and admit as much, subject to the most entertaining qualifications, but who on the other hand reject other portions of it, a fact which they cannot proclaim too loudly. It is not easy to divine what determines their choice in this. It seems to depend on personal sympathies. One person will take objection to sexuality, another to the unconscious; what seems particularly unpopular is the fact of symbolism. Though the structure of psycho-analysis is unfinished, it nevertheless presents, even to-day, a unity from which elements cannot be broken off at the caprice of whoever comes along: but these eclectics seem to disregard this. I have never had the impression that these half- or quarter-adherents based their rejection on an examination of the facts. Some distinguished men, too, are included in this category. They, to be sure, are excused by the fact that their time and their interest belong to other things – to those things, namely, in mastering which they have achieved so much. But in that case would they not do better to suspend their judgement instead of taking sides so decisively? With one of these great men I once succeeded in effecting a rapid conversion. He was a world-famous critic, who had followed the spiritual currents of the time with benevolent understanding and prophetic penetration. I only came to know him when he was past his eightieth year; but he was still enchanting in his talk. You will easily guess whom I mean. Nor was it I who introduced the subject of psycho-analysis. It was he who did so, by comparing himself with me in the most modest fashion. ‘I am only a literary man,’ he said, ‘but you are a natural scientist and discoverer. However, there is one thing I must say to you: I have never had sexual feelings towards my mother.’ ‘But there is no need at all for you to have known them,’ was my reply; ‘to grown-up people those are unconscious feelings.’ ‘Oh! so that’s what you think!’ he said with relief, and pressed my hand. We went on talking together on the best of terms for another few hours. I heard later that in the few remaining years of his life he often spoke of analysis in a friendly way and was pleased at being able to use a word that was new to him – ‘repression’. New Introductory Lectures On Psycho-Analysis 4741 There is a common saying that we should learn from our enemies. I confess I have never succeeded in doing so; but I thought all the same that it might be instructive for you if I undertook a review of all the reproaches and objections which the opponents of psycho-analysis have raised against it, and if I went on to point out the injustices and offences against logic which could so easily be revealed in them. But ‘on second thoughts’ I told myself that it would not be at all interesting but would become tedious and distressing and would be precisely what I have been so carefully avoiding all these years. So you must forgive me if I pursue this path no further and if I spare you the judgements of our so-called scientific opponents. After all it is nearly always a question of people whose one qualification is the impartiality which they have preserved by keeping at a distance from the experiences of psycho-analysis. But I know there are other cases in which you will not let me off so lightly. ‘Nevertheless’, you will tell me, ‘there are such a number of people to whom your last remark does not apply. They have not evaded analytic experience, they have analysed patients and have perhaps been analysed themselves; for a time they have even been your collaborators. Yet they have arrived at other views and theories on the basis of which they have seceded from you and founded independent schools of psycho-analysis. You ought to throw some light for us on the possibility and significance of these secessionist movements which have been so frequent in the history of analysis.’ New Introductory Lectures On Psycho-Analysis 4742 Well, I will try to do so; but only in brief, since they contribute less to an understanding of analysis than you might expect. I feel sure you will be thinking in the first place of Adler’s ‘Individual Psychology’, which, in America for instance, is regarded as a line of thought collateral with our psycho-analysis and on a par with it and which is regularly mentioned alongside of it. Actually, Individual Psychology has very little to do with psycho-analysis but, as a result of certain historical circumstances, leads a kind of parasitic existence at its expense. The determinants which we have attributed to this group of opponents apply to the founders of Individual Psychology only to a limited extent. Its very name is inappropriate and seems to have been the product of embarrassment. We cannot allow the legitimate use of the term as an antithesis to ‘group psychology’ to be interfered with; moreover, our own activity is concerned for the most part and primarily with the psychology of human individuals. I shall not enter to-day upon an objective criticism of Adler’s Individual Psychology; there is no place for it in the plan of these introductory lectures. Besides, I have already attempted it once, and feel no temptation to change anything in what I said then. I will, however, illustrate the impression his views produce by a small episode dating from the years before analysis. In the neighbourhood of the little Moravian town in which I was born, and which I left when I was a threeyear-old child, there is a modest health-resort, prettily situated in the woods. During my schooldays I went there several times in the holidays. Some twenty years later the illness of a near relative was the occasion for my visiting the place again. In the course of a conversation with the physician attached to the spa, who had attended my relative, I enquired among other things about his relations with the peasants – Slovaks, I believe – who constituted his whole clientèle during the winter. He told me that his medical practice proceeded as follows. In his consulting hours the patients came into his room and stood in a row. One after another stepped forward and described his complaint: he had backache or pains in his stomach or had tired legs, and so on. The doctor then examined him and, after satisfying himself as to what was the matter, called out the diagnosis, which was the same in every case. He translated the word to me; it meant approximately ‘bewitched’. I asked in astonishment whether the peasants made no objection to his verdict being the same with every patient. ‘Oh, no!’ he replied, ‘they are very pleased with it: it is what they expected. Each of them, as he went back to his place in the row, showed the others by looks and gestures that I was a fellow who understood things.’ Little did I guess at the time in what circumstances I should come across an analogous situation once again. New Introductory Lectures On Psycho-Analysis 4743 For, whether a man is a homosexual or a necrophilic, a hysteric suffering from anxiety, an obsessional neurotic cut off from society, or a raving lunatic, the ‘Individual Psychologist’ of the Adlerian school will declare that the impelling motive of his condition is that he wishes to assert himself, to overcompensate for his inferiority, to remain ‘on top’, to pass from the feminine to the masculine line. In my young student days we used to hear something very much the same in the out-patients’ department when a case of hysteria was introduced: hysterical patients, we were told, produce their symptoms to make themselves interesting, to draw attention to themselves. It is a remarkable thing how these ancient pieces of wisdom keep on cropping up. But even at that time this fragment of psychology did not seem to cover the riddle of hysteria. It left unexplained, for instance, why the patients used no other methods for attaining their purpose. There must, of course, be something correct in this theory of the ‘Individual Psychologists’: a small particle is taken for the whole. The self-preservative instinct will try to profit by every situation; the ego will seek to turn even illness to its advantage. In psycho-analysis this is known as the ‘secondary gain from illness’. Though, indeed, when we think of the facts of masochism, of the unconscious need for punishment and of neurotic self-injury, which make plausible the hypothesis of there being instinctual impulses that run contrary to selfpreservation, we even feel shaken in our belief in the general validity of the commonplace truth on which the theoretical structure of Individual Psychology is erected. But a theory such as this is bound to be very welcome to the great mass of the people, a theory which recognizes no complications, which introduces no new concepts that are hard to grasp, which knows nothing of the unconscious, which gets rid at a single blow of the universally oppressive problem of sexuality and which restricts itself to the discovery of the artifices by which people seek to make life easy. For the mass of the people themselves take things easily: they call for no more than a single reason by way of explanation, they do not thank science for its diffuseness, they want to have simple solutions and to know that problems are solved. When we consider how very far Individual Psychology goes in meeting these demands, we cannot suppress the recollection of a sentence in Wallenstein: Wär’ der Gedank’ nicht so verwünscht gescheidt, Man wär’ versucht, ihn herzlich dumm zu nennen. New Introductory Lectures On Psycho-Analysis 4744 Criticism from specialist circles, which is so relentless against psycho-analysis, has in general handled Individual Psychology with kid gloves. It is true that in America one of the most highly respected psychiatrists published a paper against Adler under the title ‘Enough’, in which he gave energetic expression to his boredom at the ‘compulsion to repeat’ of Individual Psychology. If others have treated it far more amiably, no doubt their antagonism to analysis has had much to do with it. I need not say much about other schools which have branched off from our psycho-analysis. The fact that they have done so cannot be used either for or against the validity of psycho-analytic theories. You have only to think of the strong emotional factors that make it hard for many people to fit themselves in with others or to subordinate themselves, and of the still greater difficulty justly insisted on by the dictum ‘Quot capita tot sensus’. When the differences of opinion had gone beyond a certain point, the most sensible thing was to part and thereafter to proceed along our different ways – especially when the theoretical divergence involved a change in practical procedure. Suppose, for instance, that an analyst attaches little value to the influence of the patient’s personal past and looks for the causation of neuroses exclusively in present-day motives and in expectations of the future. In that case he will also neglect the analysis of childhood; he will have to adopt an entirely different technique and will have to make up for the omission of the events from the analysis of childhood by increasing his didactic influence and by directly indicating certain particular aims in life. We for our part will then say: ‘This may be a school of wisdom; but it is no longer analysis.’ Or someone else may arrive at the view that the experience of anxiety at birth sows the seed of all later neurotic disturbances. It may thereupon seem to him legitimate to restrict analysis to the consequences of this single impression and to promise therapeutic success from a treatment lasting from three to four months. As you will observe, I have chosen two examples which start from diametrically opposite premisses. It is an almost universal characteristic of these ‘secessionist movements’ that each of them takes hold of one fragment out of the wealth of themes in psycho-analysis and makes itself independent on the basis of this seizure – selecting the instinct for mastery, for instance, or ethical conflict, or the mother, or genitality, and so on. If it appears to you that secessions of this sort are already more numerous to-day in the history of psycho-analysis than in other intellectual movements, I am not sure that I should agree with you. If it is the case, the responsibility must be laid on the intimate relations which exist in psycho-analysis between theoretical views and therapeutic treatment. Mere differences of opinion would be tolerable for far longer. People like accusing us psycho-analysts of intolerance. The only manifestation of this ugly characteristic has been precisely our parting from those who think differently from us. No other harm has been done to them. On the contrary, they have fallen on their feet, and are better off than they were before. For by their separation they have usually freed themselves of one of the burdens which weigh us down – the odium of infantile sexuality, perhaps, or the absurdity of symbolism – and are regarded by their environment as passably respectable, which is still not true of those of us who are left behind. Moreover, apart from one notable exception, it was they who excluded themselves. New Introductory Lectures On Psycho-Analysis 4745 What further claims do you make in the name of tolerance? That when someone has uttered an opinion which we regard as completely false we should say to him: ‘Thank you very much for having given voice to this contradiction. You are guarding us against the danger of complacency and are giving us an opportunity of showing the Americans that we are really as “broad-minded” as they always wish. To be sure, we do not believe a word of what you are saying, but that makes no difference. Probably you are just as right as we are. After all, who can possibly know who is right? In spite of our antagonism, pray allow us to represent your point of view in our publications. We hope that you will be kind enough in exchange to find a place for our views which you deny.’ In the future, when the misuse of Einstein’s relativity has been entirely achieved, this will obviously become the regular custom in scientific affairs. For the moment, it is true, we have not gone quite so far. We restrict ourselves, in the old fashion, to putting forward only our own convictions, we expose ourselves to the risk of error because it cannot be guarded against, and we reject what is in contradiction to us. We have made plentiful use in psycho-analysis of the right to change our opinions if we think we have found something better. One of the first applications of psycho-analysis was to teach us to understand the opposition offered to us by our contemporaries because we practised psycho-analysis. Other applications, of an objective nature, may claim a more general interest. Our first purpose, of course, was to understand the disorders of the human mind, because a remarkable experience had shown that here understanding and cure almost coincide, that a traversable road leads from the one to the other. And for a long time it was our only purpose. Then, however, we perceived the close relations, the internal identity indeed, between pathological processes and what are known as normal ones. Psycho-analysis became a depth-psychology; and, since nothing that men make or do is understandable without the co-operation of psychology, the applications of psycho-analysis to numerous fields of knowledge, in particular to those of the mental sciences, came about of their own accord, pushed their way to the front and called for ventilation. These tasks unluckily came up against obstacles which, rooted as they were in the circumstances, have not yet been overcome even to-day. An application of this kind presupposes specialized knowledge which an analyst does not possess, while those who possess it, the specialists, know nothing of analysis and perhaps want to know nothing. The result has been that analysts, as amateurs with an equipment of greater or less adequacy, often hastily scraped together, have made excursions into such fields of knowledge as mythology, the history of civilization, ethnology, the science of religion and so on. They were no better treated by the experts resident in those fields than are trespassers in general: their methods and their findings, in so far as they attracted attention, were in the first instance rejected. But these conditions are constantly improving, and in every region there is a growing number of people who study psycho-analysis in order to make use of it in their special subject, and in order, as colonists, to replace the pioneers. Here we may expect a rich harvest of new discoveries. Applications of analysis are always confirmations of it as well. There, too, where scientific work is further removed from practical activity, the inevitable differences of opinion will no doubt take a less embittered form. New Introductory Lectures On Psycho-Analysis 4746 I feel a strong temptation to conduct you through all the applications of psycho-analysis to the mental sciences. They are things worth knowing by anyone with intellectual interests; and not to hear about abnormality and illness for a time would be a well-deserved relaxation. But I must renounce the idea: it would once more carry us outside the framework of these lectures and, I must honestly admit, I should not be equal to the task. It is true that in a few of these regions I myself took the first step; but to-day I no longer embrace the whole field, and I should have to do a great deal of studying in order to master what has been accomplished since my beginnings. Any of you who are disappointed by my refusal may make up for it in the pages of our periodical Imago, which is designed to cover the non-medical applications of analysis. But there is one topic which I cannot pass over so easily – not, however, because I understand particularly much about it or have contributed very much to it. Quite the contrary: I have scarcely concerned myself with it at all. I must mention it because it is so exceedingly important, so rich in hopes for the future, perhaps the most important of all the activities of analysis. What I am thinking of is the application of psycho-analysis to education, to the upbringing of the next generation. I am glad that I am at least able to say that my daughter, Anna Freud, has made this study her life-work and has in that way compensated for my neglect. New Introductory Lectures On Psycho-Analysis 4747 The road that led to this application is easily traced. When in the treatment of an adult neurotic we followed up the determinants of his symptoms, we were regularly led back to his early childhood. A knowledge of the later aetiological factors was not sufficient either for understanding the case or for producing a therapeutic effect. We were therefore compelled to make ourselves acquainted with the psychical peculiarities of childhood; we learnt a quantity of things which could not have been learnt except through analysis, and we were able to put right many opinions that were generally held about childhood. We recognized that particular importance attached to the first years of childhood – up to the age of five, perhaps – for several reasons. Firstly, because those years include the early efflorescence of sexuality which leaves behind it decisive instigating factors for the sexual life of maturity. Secondly, because the impressions of this period impinge upon an immature and feeble ego, and act upon it like traumas. The ego cannot fend off the emotional storms which they provoke in any way except by repression and in this manner acquires in childhood all its dispositions to later illnesses and functional disturbances. We realized that the difficulty of childhood lies in the fact that in a short span of time a child has to appropriate the results of a cultural evolution which stretches over thousands of years, including the acquisition of control over his instincts and adaptation to society – or at least the first beginnings of these two. He can only achieve a part of this modification through his own development; much must be imposed on him by education. We are not surprised that children often carry out this task very imperfectly. During these early times many of them pass through states that may be put on a par with neuroses – and this is certainly so in the case of all those who produce manifest illnesses later on. In some children the neurotic illness does not wait till maturity but breaks out already in childhood and gives parents and doctors plenty of trouble. New Introductory Lectures On Psycho-Analysis 4748 We had no misgivings over applying analytic treatment to children who either exhibited unambiguous neurotic symptoms or who were on the road to an unfavourable development of character. The apprehension expressed by opponents of analysis that the child would be injured by it proved unfounded. What we gained from these undertakings was that we were able to confirm on the living subject what we had inferred (from historical documents, as it were) in the case of adults. But the gain for the children was also very satisfactory. It turned out that a child is a very favourable subject for analytic therapy; the results are thorough and lasting. The technique of treatment worked out for adults must, of course, be largely altered for children. A child is psychologically a different object from an adult. As yet he possesses no super-ego, the method of free association does not carry far with him, transference (since the real parents are still on the spot) plays a different part. The internal resistances against which we struggle in adults are replaced for the most part in children by external difficulties. If the parents make themselves vehicles of the resistance, the aim of the analysis – and even the analysis itself – is often imperilled. Hence it is often necessary to combine with a child’s analysis a certain amount of analytic influencing of his parents. On the other hand, the inevitable deviations of analyses of children from those of adults are diminished by the circumstance that some of our patients have retained so many infantile character traits that the analyst (once again adapting himself to his subject) cannot avoid making use with them of certain of the techniques of child-analysis. It has automatically happened that child-analysis has become the domain of women analysts, and no doubt this will remain true. New Introductory Lectures On Psycho-Analysis 4749 The recognition that most of our children pass through a neurotic phase in the course of their development carries with it the germ of a hygienic challenge. The question may be raised whether it would not be expedient to come to a child’s help with an analysis even if he shows no signs of a disturbance, as a measure for safeguarding his health, just as to-day we inoculate healthy children against diphtheria without waiting to see if they fall ill of it. The discussion of this question has only an academic interest at present, but I may venture to consider it here. The mere suggestion would seem to the great bulk of our contemporaries to be a monstrous outrage, and in view of the attitude towards analysis of most people in a parental position any hope of putting through such an idea must be abandoned for the time being. Prophylaxis such as this against neurotic illness, which would probably be very effective, also presupposes a quite other constitution of society. The watchword for the application of psycho-analysis to education is to be found to-day elsewhere. Let us make ourselves clear as to what the first task of education is. The child must learn to control his instincts. It is impossible to give him liberty to carry out all his impulses without restriction. To do so would be a very instructive experiment for child-psychologists; but life would be impossible for the parents and the children themselves would suffer grave damage, which would show itself partly at once and partly in later years. Accordingly, education must inhibit, forbid and suppress, and this it has abundantly seen to in all periods of history. But we have learnt from analysis that precisely this suppression of instincts involves the risk of neurotic illness. As you will remember, we have examined in detail how this occurs. Thus education has to find its way between the Scylla of non-interference and the Charybdis of frustration. Unless this problem is entirely insoluble, an optimum must be discovered which will enable education to achieve the most and damage the least. It will therefore be a matter of deciding how much to forbid, at what times and by what means. And in addition we have to take into account the fact that the objects of our educational influence have very different innate constitutional dispositions, so that it is quite impossible that the same educational procedure can be equally good for all children. A moment’s reflection tells us that hitherto education has fulfilled its task very badly and has done children great damage. If it discovers the optimum and carries out its task ideally, it can hope to wipe out one of the factors in the aetiology of falling ill – the influence of the accidental traumas of childhood. It cannot in any case get rid of the other factor – the power of an insubordinate instinctual constitution. If now we consider the difficult problems that confront the educator – how he has to recognize the child’s constitutional individuality, to infer from small indications what is going on in his immature mind, to give him the right amount of love and yet to maintain an effective degree of authority – we shall tell ourselves that the only appropriate preparation for the profession of educator is a thorough psycho-analytic training. It would be best that he should have been analysed himself, for, when all is said and done, it is impossible to assimilate analysis without experiencing it personally. The analysis of teachers and educators seems to be a more efficacious prophylactic measure than the analysis of children themselves, and there are less difficulties in the way of putting it into practice. New Introductory Lectures On Psycho-Analysis 4750 We may mention, though only as an incidental consideration, an indirect way in which the upbringing of children may be helped by analysis and which may with time acquire a greater influence. Parents who have themselves experienced an analysis and owe much to it, including an insight into the faults of their own upbringing, will treat their children with better understanding and will spare them much of what they themselves were not spared. Parallel with the efforts of analysts to influence education, other investigations are being made into the origin and prevention of delinquency and crime. Here again I am only opening the door for you and showing you the rooms that lie beyond it, without leading you inside. I am certain that if you remain loyal to your interest in psycho-analysis you will be able to learn much that is new and valuable on these subjects. I must not, however, leave the topic of education without referring to one particular aspect of it. It has been said – and no doubt justly – that every education has a partisan aim, that it endeavours to bring the child into line with the established order of society, without considering how valuable or how stable that order may be in itself. If one is convinced of the defects in our present social arrangements, education with a psychoanalytic alignment cannot justifiably be put at their service as well: it must be given another and higher aim, liberated from the prevailing demands of society. In my opinion, however, this argument is out of place here. Such a demand goes beyond the legitimate function of analysis. In the same way, it is not the business of a doctor who is called in to treat a case of pneumonia to concern himself with whether the patient is an honest man or a suicide or a criminal, whether he deserves to remain alive or whether one ought to wish him to. This other aim which it is desired to give to education will also be a partisan one, and it is not the affair of an analyst to decide between the parties. I am leaving entirely on one side the fact that psycho-analysis would be refused any influence on education if it admitted to intentions inconsistent with the established social order. Psycho-analytic education will be taking an uninvited responsibility on itself if it proposes to mould its pupils into rebels. It will have played its part if it sends them away as healthy and efficient as possible. It itself contains enough revolutionary factors to ensure that no one educated by it will in later life take the side of reaction and suppression. It is even my opinion that revolutionary children are not desirable from any point of view. I propose further, Ladies and Gentlemen, to say a few words to you about psycho-analysis as a form of therapy. I discussed the theoretical side of this question fifteen years ago and I cannot formulate it in any other manner to-day; I have now to tell you of our experience during this interval. As you know, psychoanalysis originated as a method of treatment; it has far outgrown this, but it has not abandoned its homeground and it is still linked to its contact with patients for increasing its depth and for its further development. The accumulated impressions from which we derive our theories could be arrived at in no other way. The failures we meet with as therapists are constantly setting us new tasks and the demands of real life are an effective guard against an overgrowth of the speculation which we cannot after all do without in our work. I have already discussed long ago the means used by psycho-analysis in helping patients, when it does help them, and the method by which it does so; to-day I shall enquire how much it achieves. New Introductory Lectures On Psycho-Analysis 4751 You are perhaps aware that I have never been a therapeutic enthusiast; there is no danger of my misusing this lecture by indulging in eulogies. I would rather say too little than too much. During the period at which I was the only analyst, people who were ostensibly friendly to my ideas used to say to me: ‘That’s all very nice and clever; but show me a case that you have cured by analysis.’ This was one of the many formulas which in the course of time have succeeded one another in performing the function of pushing the uncomfortable novelty aside. To-day it is as out of date as many others: the analyst, too, has a heap of letters in his files from grateful patients who have been cured. The analogy does not stop at that. Psychoanalysis is really a method of treatment like others. It has its triumphs and its defeats, its difficulties, its limitations, its indications. At one time a complaint was made against analysis that it was not to be taken seriously as a treatment since it did not dare to issue any statistics of its successes. Since then, the Psycho-Analytic Institute in Berlin, which was founded by Dr. Max Eitingon, has published a statement of its results during its first ten years. Its therapeutic successes give grounds neither for boasting nor for being ashamed. But statistics of that kind are in general uninstructive; the material worked upon is so heterogeneous that only very large numbers would show anything. It is wiser to examine one’s individual experiences. And here I should like to add that I do not think our cures can compete with those of Lourdes. There are so many more people who believe in the miracles of the Blessed Virgin than in the existence of the unconscious. If we turn to mundane competitors, we must compare psycho-analytic treatment with other kinds of psychotherapy. To-day organic physical methods of treating neurotic states need scarcely be mentioned. Analysis as a psycho-therapeutic procedure does not stand in opposition to other methods used in this specialized branch of medicine; it does not diminish their value nor exclude them. There is no theoretical inconsistency in a doctor who likes to call himself a psychotherapist using analysis on his patients alongside of any other method of treatment according to the peculiarities of the case and the favourable or unfavourable external circumstances. It is in fact technique that necessitates the specialization in medical practice. Thus in the same way surgery and orthopaedics were obliged to separate. Psycho-analytic activity is arduous and exacting; it cannot well be handled like a pair of glasses that one puts on for reading and takes off when one goes for a walk. As a rule psycho-analysis possesses a doctor either entirely or not at all. Those psychotherapists who make use of analysis among other methods, occasionally, do not to my knowledge stand on firm analytic ground; they have not accepted the whole of analysis but have watered it down – have drawn its fangs, perhaps; they cannot be counted as analysts. This is, I think, to be regretted. But co-operation in medical practice between an analyst and a psychotherapist who restricts himself to other techniques would serve quite a useful purpose. New Introductory Lectures On Psycho-Analysis 4752 Compared with the other psychotherapeutic procedures psycho-analysis is beyond any doubt the most powerful. It is just and fair, too, that this should be so for it is also the most laborious and time-consuming; it would not be used on slight cases. In suitable cases it is possible by its means to get rid of disturbances and bring about changes for which in pre-analytic times one would not have ventured to hope. But it has its very appreciable limits. The therapeutic ambition of some of my adherents has made the greatest efforts to overcome these obstacles so that every sort of neurotic disorder might be curable by psycho-analysis. They have endeavoured to compress the work of analysis into a shorter duration, to intensify transference so that it may be able to overcome any resistance, to unite other forms of influence with it so as to compel a cure. These efforts are certainly praiseworthy, but, in my opinion, they are vain. They bring with them, too, a danger of being oneself forced away from analysis and drawn into a boundless course of experimentation. The expectation that every neurotic phenomenon can be cured may, I suspect, be derived from the layman’s belief that the neuroses are something quite unnecessary which have no right whatever to exist. Whereas in fact they are severe, constitutionally fixed illnesses, which rarely restrict themselves to only a few attacks but persist as a rule over long periods or throughout life. Our analytic experience that they can be extensively influenced, if the historical precipitating causes and accidental auxiliary factors of the illness can be dealt with, has led us to neglect the constitutional factor in our therapeutic practice, and in any case we can do nothing about it; but in theory we ought always to bear it in mind. The radical inaccessibility of the psychoses to analytic treatment should, in view of their close relationship to the neuroses, restrict our pretensions in regard to these latter. The therapeutic effectiveness of psycho-analysis remains cramped by a number of weighty and scarcely assailable factors. In the case of children, where one might count on the greatest successes, the difficulties are the external ones connected with their relation to their parents, though these difficulties are after all a necessary part of being a child. In the case of adults the difficulties arise in the first instance from two factors: the amount of psychical rigidity present and the form of the illness with all that that covers in the way of deeper determinants. New Introductory Lectures On Psycho-Analysis 4753 The first of these factors is often unjustly overlooked. However great may be the plasticity of mental life and the possibility of reviving old conditions, not everything can be brought to life again. Some changes seem to be definitive and correspond to scars formed when a process has run its course. On other occasions one has an impression of a general stiffening of mental life; the psychical processes, to which one could very well indicate other paths, seem incapable of abandoning the old ones. But perhaps this is the same thing as what I mentioned just now, only looked at differently. All too often one seems to see that it is only the treatment’s lack of the necessary motive force that prevents one from bringing the change about. One particular dependent relation, one special instinctual component, is too powerful in comparison with the opposing forces that we are able to mobilize. This is quite generally true with the psychoses. We understand them well enough to know the point at which the levers should be applied, but they would not be able to move the weight. It is here, indeed, that hope for the future lies: the possibility that our knowledge of the operation of the hormones (you know what they are) may give us the means of successfully combating the quantitative factors of the illnesses: but we are far from that to-day. I realize that the uncertainty in all these matters is a constant instigation towards perfecting analysis and in particular the transference. Beginners in analysis especially are left in doubt in case of a failure whether they should blame the peculiarities of the case or their own clumsy handling of the therapeutic procedure. But, as I have said already, I do not think much can be achieved by efforts in this direction. New Introductory Lectures On Psycho-Analysis 4754 The second limitation upon analytic successes is given by the form of the illness. You know already that the field of application of analytic therapy lies in the transference neuroses – phobias, hysteria, obsessional neurosis – and further, abnormalities of character which have been developed in place of these illnesses. Everything differing from these, narcissistic and psychotic conditions, is unsuitable to a greater or less extent. It would be entirely legitimate to guard against failures by carefully excluding such cases. This precaution would lead to a great improvement in the statistics of analysis. There is, however, a pitfall here. Our diagnoses are very often made only after the event. They resemble the Scottish King’s test for identifying witches that I read about in Victor Hugo. This king declared that he was in possession of an infallible method of recognizing a witch. He had the women stewed in a cauldron of boiling water and then tasted the broth. Afterwards he was able to say: ‘That was a witch’, or ‘No, that was not one.’ It is the same with us, except that we are the sufferers. We cannot judge the patient who comes for treatment (or, in the same way, the candidate who comes for training) till we have studied him analytically for a few weeks or months. We are in fact buying a pig in a poke. The patient brings along indefinite general ailments which do not admit of a conclusive diagnosis. After this period of testing it may turn out that the case is an unsuitable one. If so we send him away if he is a candidate, or continue the trial a little longer if he is a patient on the chance that we may yet see things in a more favourable light. The patient has his revenge by adding to our list of failures, and the rejected candidate does so perhaps, if he is paranoid, by writing books on psychoanalysis himself. As you see, our precautions have been of no avail. New Introductory Lectures On Psycho-Analysis 4755 I am afraid these detailed discussions are exhausting your interest. But I should be still more sorry if you were to think it is my intention to lower your opinion of psycho-analysis as a therapy. Perhaps I really made a clumsy start. For I wanted to do the opposite: to excuse the therapeutic limitations of analysis by pointing out their inevitability. With the same aim in view I turn to another point: the reproach against analytic treatment that it takes a disproportionately long time. On this it must be said that psychical changes do in fact only take place slowly; if they occur rapidly, suddenly, that is a bad sign. It is true that the treatment of a fairly severe neurosis may easily extend over several years; but consider, in case of success, how long the illness would have lasted. A decade, probably, for every year of treatment: the illness, that is to say (as we see so often in untreated cases), would not have ended at all. In some cases we have reasons for resuming an analysis many years afterwards. Life had developed fresh pathological reactions to fresh precipitating causes; but in the meantime our patient had been well. The first analysis had not in fact brought to light all his pathological dispositions, and it was natural for the analysis to have been stopped when success was achieved. There are also severely handicapped people who are kept under analytic supervision all through their lives and are taken back into analysis from time to time. But these people would otherwise have been altogether incapable of existence and we must feel glad that they can be kept on their feet by this piecemeal and recurrent treatment. The analysis of character disorders also calls for long periods of treatment; but it is often successful; and do you know of any other therapy with which such a task could even be approached? Therapeutic ambition may feel unsatisfied by such results; but we have learnt from the example of tuberculosis and lupus that success can only be obtained when the treatment has been adapted to the characteristics of the illness. New Introductory Lectures On Psycho-Analysis 4756 I have told you that psycho-analysis began as a method of treatment; but I did not want to commend it to your interest as a method of treatment but on account of the truths it contains, on account of the information it gives us about what concerns human beings most of all – their own nature – and on account of the connections it discloses between the most different of their activities. As a method of treatment it is one among many, though, to be sure, primus inter pares. If it was without therapeutic value it would not have been discovered, as it was, in connection with sick people and would not have gone on developing for more than thirty years.

 

 

Source: archive.org


shortlink:
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  Date of Publish: 6 April 2017