Whether this modification shall be enacted as a law will depend mostly
on people who may not be expected to know the peculiarities of
analytical treatment. It will be our task, therefore, to instruct these
impartial referees, these typical laymen whom we will assume, for the
time being, are completely uninformed. It is regrettable that we cannot
arrange for them to attend an analytical treatment in the rôle of an
observer. It is one of the peculiarities of the “analytical situation”
that it will not suffer the presence of a third party.
Moreover, individual sessions are liable to be very unequal, as regards
the information they may yield. Mr. Referee happening in at an
analytical session, would probably not profit to any great extent. As a
matter of fact, he might altogether misinterpret that which is discussed
between the analyst and the patient. He may even become downright bored
with the proceedings. Therefore Mr. Referee must needs be satisfied with
the information we shall presently impart to him, endeavoring to set it
forth as lucidly as possible.
Let us assume that the patient is suffering from attacks of moodiness,
which he is unable to control, or else is the victim of a despondency so
depressing as to paralyse his energy, causing him to lose all confidence
in himself, manifesting extreme self-consciousness when among strangers.
Without grasping the underlying elements of his case, the patient may
observe that not only the discharge of his daily duties becomes more and
more arduous for him, but also that he experiences difficulties when
called upon to make a decision or embark upon some enterprise.
One day—utterly ignorant of the exact cause—he succumbs to an attack of
fear. From then on, he is unable to cross a street alone, or board a
train, without fighting off a certain inarticulate fear. This condition,
as a matter of fact, may even become so pronounced as to render it
absolutely impossible for him to cross a street, or board a train,
unaccompanied.
Or—what appears very peculiar to him—his thoughts “wander”; they are no
longer subject to his will. They attach themselves to problems which, in
reality, do not interest him at all but which he is, nevertheless,
unable to dismiss from his mind. He imposes perfectly ludicrous tasks
upon himself, such as counting the windows along the street. When
attending to simple functions, such as mailing a letter or turning off
the gas, doubts harass him a few moments later, as to whether he has
really dropped the letter into the mail box and whether he actually
turned off the gas.
Perhaps such a condition is merely annoying at first, but it becomes
intolerable when, in advanced stages, it proves impossible to shake off
such preposterous ideas as having flung a child under the wheels of a
car, or thrown somebody from a bridge into the river, or being haunted
by the terrifying doubt of whether he is not in reality the murderer the
police are trying to apprehend for the latest spectacular crime.
All these delusions are utter nonsense, as he himself very well knows.
He has never done any harm to anybody, but if he really were a fugitive
from justice, this obsession, this feeling of contrition could not be
stronger.
To take another case:—this time of a female patient, who is suffering in
an entirely different way, presenting entirely different symptoms. We
will assume that she is a pianiste, who suddenly experiences cramps in
her fingers and discovers herself unable to play. As soon as she thinks
of attending a social affair, she immediately feels the necessity of
obeying a recurrent natural need, making it impossible for her to leave
her own house. Thus, she has been forced to give up mingling with her
friends, or attend dances, the theatre, or concerts.
At the most inopportune moments, she becomes the victim of headaches or
other painful sensations. Eventually, after meals, she feels impelled to
yield to nausea, a condition which, if prolonged, may become dangerous.
Finally, she becomes absolutely unable to stand any of those little
excitements which cannot be eliminated from daily life. Upon such
occasions, she readily faints. As these spells are frequently
complicated with muscular spasms, such attacks assume the aspect of
dreadful afflictions.
Still other patients become subject to disturbances in a sphere where
bodily functions coördinate with manifestations of sentiment. If men,
they find themselves unable to give physiological expression to those
tender urges that induce them to gravitate towards the other sex. On the
other hand, all these physiological reactions may be at their command
when not aimed at the person they cherish most. Then, there are still
other cases, when bonds of sensuality will tie them to persons whom they
actually despise and of whom they have the most earnest desire to free
themselves. Or their sensuality imposes urges upon them whose
fulfillment causes them to shudder.
If they be women, such patients, on account of fear or disgust, or from
some other restraint of unknown origin, become unable to perform those
functions which their sex imposes upon them. In cases where they have
yielded to the prompting of passion, they discover that that
gratification is withheld from them which nature normally offers as a
reward for such complacency.
Sooner or later, all such persons come to consider themselves as sick
and appeal to physicians, expecting to be cured of their nervous
ailments. Physicians have classified these manifestations, diagnosing
them differently, according to their own personal point of view. These
ailments are listed under such terms as neurasthenia, psychasthenia,
phobias and neuroses of different kinds, and with that sweeping term
hysterics. The parts of the body inducing such disturbances are
examined: the heart, the stomach, the intestines, the sex organs, and
all are found to be in the best of condition. The physician then advises
the patient to change his mode of living, to take a vacation, to
exercise. Thus, with perhaps the aid of mild stimulants, the patient’s
condition may, or may not, be temporarily relieved.
Eventually, the patient is informed that there are certain practitioners
who specialize in the treatment of just such ailments, and thus they
come to be psychoanalysed.
Mr. Referee, whom we will assume is present, has impatiently listened,
while we have given an account of the nervous disturbances with which
one may be afflicted. Mr. Referee suddenly becomes attentive, expressing
his growing interest in these words: “Well, now at last we shall see
what the psychoanalyst will do with the patient, whom physicians could
not help.”
To all appearances, nothing takes place between patient and
psychoanalyst except that they talk with each other. The psychoanalyst
does not take recourse to any instruments, while examining the patient,
nor does he write out prescriptions. If it can be arranged, he will not
even take the patient out of his usual surroundings, or upset his daily
routine in any way, while treating him. Such a procedure is, of course,
not of indispensable necessity, quite frequently proving impossible to
arrange. Usually the analyst simply makes an appointment with his
patient, then lets him talk, listens to him, lets him talk again and
listens once more.
Mr. Referee now clearly manifests relief but, at the same time, his face
also assumes a disdainful expression. Apparently, he thinks: “Is that
all? ‘Words, words, words,’ as Prince Hamlet says. Is psychoanalysis
perhaps some sort of magic rite, employing mere words with which to
chase away a patient’s ailment?”
Quite right! It surely would be magic if it would only work faster. One
of the indispensable essentialities of magic is quickness, sudden
results. But psychoanalytical treatment demands months, sometimes even
years. Proceeding at such a snail’s pace, it loses the character of
anything resembling magic.
As far as “words, words, words” are concerned, they are surely not to be
looked down upon. Words, after all, are a powerful instrument, the means
by which we express our feelings to each other, the agent through which
we influence one another. Words are able to benefit us in the extreme,
or liable to hurt us to the quick. Doubtless, “in the beginning was the
Deed” and the Word came only later. Under certain circumstances, the
reduction of the Deed to the mere Word may even prove a cultural
achievement. At any rate, the Word was originally an implement of
sorcery, a magic manifestation which even today still retains much of
its old potency.
Mr. Referee now remarks: “Assuming that the patient is not any better
prepared for the understanding of psychoanalytical treatment, than I
myself, how are you going to induce him to believe in the Magic of the
Word, that is to deliver him from his sufferings?”
Of course, some preparatory work is necessary, but that is easily
accomplished in a simple manner. The patient is asked to be absolutely
frank with the psychoanalyst, not to withhold intentionally anything
that crowds itself into his mind, and to overcome gradually all such
influences as may exert themselves to prevent certain of his thoughts or
memories from being communicated to the psychoanalyst.
There is not one of us but does not know that there are certain things
which we hate to tell anybody else, or which we are utterly unable to
express at all. These are the so-called “most intimate” things. We also
surmise—and this proves the great progress that has been made in the
psychological understanding of our Selves—that there are some other
things which we hate to admit to ourselves, which we try to hide from
ourselves and which, once they are accidentally touched upon, we
immediately endeavor to crowd out of our thoughts.
Doubtless, the root of a very remarkable psychological problem manifests
itself in the fact that there are certain of our thoughts which we try
to hide from our very own Self! That would seem to indicate that our
very own Self is not an indivisible unit, as we have always considered
it! Rather, that there is a certain something which may rise in
opposition to our very own Self! Vaguely, then, we surmise that our own
Self and our soul life may be two different things! If, now, the patient
submits to the demand of psychoanalysis to express everything in words
that comes to his mind, he comes to believe that an interchange of
thoughts, under such extraordinary conditions, is liable to lead to
extraordinary results.
“I understand you very well,” Mr. Referee says. “You simply assume that
everybody suffering from a nervous disturbance is harboring something
that depresses him, some dark secret, perhaps, and by inducing him to
impart this secret to you, you relieve him of that depression, thus
alleviating his suffering. That, after all, is the very principle of the
Confessional which the Catholic church has employed for centuries to
wield her influence over her communicants.”
Yes and no, is our answer to this. The Confessional, to a certain
extent, may be considered as belonging into the realm of psychoanalysis;
leading up to it, as it were. However, the Confessional as such is far
removed from coinciding with the very being of psychoanalysis, and it is
unable to explain the results of psychoanalytical treatment. In the
Confessional, the sinner tells what he knows, but in the Analysis, the
neurotic is expected to reveal much more. Besides, there are no known
cases where the Confessional proved effective enough to remedy direct
symptoms of ailments.
“Then I don’t understand you after all,” Mr. Referee interjects. “What
do you mean by stating that the neurotic is ‘expected to reveal more’ in
the course of psychoanalytical treatment? Of course, I can very well
imagine that you, as a psychoanalyst, may wield a greater influence over
your patient than the Father Confessor over a penitent, for the simple
reason that you become better acquainted with him, employing your
growing influence to talk unhealthy thoughts out of your patient, as it
were, disseminating his apprehensions, and so forth. Frankly, it appears
most remarkable to me that by such a procedure, it should be possible to
alleviate purely physical manifestations, such as nausea, diarrhœa, and
cramps. I know that such results are possible by taking recourse to
hypnosis. Most probably, through prolonged association with your
patient, you gradually succeed in establishing hypnotic relations
between you and him. By this I mean that you inadvertently come to exert
upon him a suggestive influence. Thus, the miracle wrought by your
therapy is nothing other than the result of hypnotic suggestion.
However, as far as I know, results by hypnotic therapy are procured much
quicker than by psychoanalysis which you yourself admit takes months,
and sometimes even years.”
After all, Mr. Referee does not seem to be so utterly uninformed and
helplessly at sea as we had considered him in the beginning. Doubtless,
he is eagerly bent upon grasping the essence of psychoanalysis, on the
basis of certain knowledge which he has acquired. He endeavors to
connect psychoanalysis with something he already knows.
Thus, he forces upon us the difficult task of explaining to him that he
will never succeed in comprehending psychoanalysis in this way, because
psychoanalysis is a process _sui generis_, something new and peculiar,
understandable only with the assistance of new conceptions, or
presumptions.
However, we still owe our inquisitive friend a reply to a point raised
by him.
What you, Mr. Referee, mentioned before about the personal influence
exerted by the psychoanalyst on his patient, should not go without
comment. Such an influence actually prevails in the analysis, playing an
important rôle. However, this influence is utterly unlike the influence
induced by hypnosis.
I shall have to prove to you that the situations in these two cases
decidedly differ from each other. However, for the time being, the
statement may suffice that this personal influence—this “suggestive
element” if you wish—is not drawn upon for the purpose of suppressing
symptoms of nervous afflictions analogous to treatment by hypnotic
suggestions. Besides, it is absolutely wrong to assume that this
“suggestive element” is the agent and promoter of analytical treatment.
It may be that such is the case right at the beginning of the treatment.
Later, however, this very same “suggestive element” proves itself an
opposing factor, forcing us to resort to extensive counter-measures.
Just let me explain to you how thoroughly opposed the technique of
analysis is to anything and everything resembling the hypnotic technique
of diverting or dissipating a patient’s apprehensions.
Assumed that our patient is obsessed with an intense feeling of being
guilty of, say, some horrible crime, we do not advise him to stifle the
qualms of his conscience simply on the strength of the fact that there
is no doubt as to his innocence. He himself has already proceeded along
this trend of reasoning, but to no avail. On the contrary, we try to
impress him with the possibility that there may be something tangible at
the bottom of so profound a feeling of guilt, and that it may be
possible to detect this disturbing something.
“I should be greatly astonished,” Mr. Referee interrupts, “if you could
really assuage your patient’s feeling of guilt by agreeing that there
may be some tangible reason for his apprehension. But what is the mode
of procedure which is applied in your analysis, and to what treatment do
you subject your patient?”