“I think I know now what your intentions are:—You wish to show me just
what knowledge is necessary for the practice of psychoanalysis, so that
I may be able to judge whether physicians alone shall be permitted to
apply this method. Up to now, you have mainly discussed psychology, and
a little biology or sex science, without a decided medical slant.
However, I may not have heard everything yet.”
Certainly not. There are still a number of gaps to be filled. But may I
ask you a favor? Will you be good enough to describe to me how you
imagine psychoanalytical treatment is applied? Just pretend as if it
were up to you to analyse a patient.
“Well, I may make quite a mess of this! It is surely not my intention to
settle the argument between us, on the basis of such an experiment.
However, I shall do as you ask. After all, the responsibility falls upon
your shoulders.
“Now then: I assume that the patient comes to see me and embarks upon a
recital of his complaints. I promise him to cure, or at least improve,
his condition, provided that he will follow my instructions. Then, I
would ask him to tell me, in all frankness, what he knows, what ideas
enter his mind. I should also request him to make a clean breast of
everything, even though there may be things which he would hate to
mention. Am I adhering to your methods?”
You are! But, in addition you should have the patient tell you all his
thoughts, even if they seem unimportant to him or lacking in sense.
“Very well.—The patient, then, starts to relate his story and I listen.
And what next? Oh, yes, his information will make it possible for me to
conclude what impressions, experiences and desires he may have
repressed, because he came face to face with them at a time when his ‘I’
was still weak and too intimidated to face the dilemma squarely.
“After I have told that to the patient, he will reconstruct the old
situations and correct his reactions to them with my assistance. Thus,
the repressions, his ‘I’ had been forced to resort to, will disappear
and he is cured.—Is that correct?”
Very good, indeed.—I already foresee that more people are going to
reproach me for having trained a non-medical man to practise
psychoanalysis. I surely must admit that you digested what I told you.
“I have only repeated what you told me, like reciting something that has
been committed to memory.
“But I do not feel able to clearly visualize how I really would go about
it. I cannot understand why such an analysis should require an hour or
more a day, for a period of months. As a rule, the average human being
has not met with so many experiences. And as far as repressions during
childhood are concerned, I assume that these are probably identical in
all cases.”
There are many new experiences to make in the course of an analysis.
For example: You would find that it is not so simple at all, from the
information a patient may volunteer, to draw conclusions as to those of
his experiences which he has forgotten, the urges which he once
repressed.
A patient may tell you something which, at the moment, has just as
little sense for you as for him. You will have to make up your mind that
the material which the patient lays before you, in accordance with the
instruction you gave him, must be interpreted in a special way.
Analogous, perhaps, to the treatment iron ore receives for the purpose
of extracting from it valuable steel by some special process. In
retaining this picture, for the purpose of comparison, you must know
that tons and tons of iron ore contain only very little of the valuable
steel for which you are looking. This is one reason which would account
for the fact that psychoanalytical treatment is such a long drawn-out
process.
“But how is this ‘iron ore’ to be converted, to apply your comparison
once more?”
By assuming that the information and ideas of a patient are nothing but
distorted pictures of those impressions and experiences you are trying
to unearth. Hints, as it were, from which you would have to conclude
what is really behind them. To press it into a formula: the information
a patient yields, be it memories, ideas or dreams, will have to be
interpreted first. This interpretation, of course, must be guided by the
expectations you formed of the case on the basis of professional
knowledge, while listening to the patient’s recital.
“‘Interpretation’! What a dreadful word! I do not like to hear this term
because, in applying it, you are depriving me of all confidence. If
everything depends on my interpretation, who is going to assure me that
my interpretation is correct? Such a state of affairs, according to my
mind, simply means that everything is left to fancies and whims.”
Just a moment, now! Things are not as bad as all that. Why exclude
processes of your own soul from the same rule which you are ready to
admit to that of others?
Provided you have acquired a certain self-discipline and are in the
possession of sufficient information, your interpretations will not be
influenced by personal peculiarities, and are bound to prove correct.
Do not draw the conclusion from this that it is my opinion that the
personality of the analyst does not make any difference, for this phase
of the analysis. A certain sensitiveness for that which was
unconsciously repressed, is necessary; also an aptness with which
everybody is not equally endowed. Most of all, it is here where the
absolute necessity for a thorough and searching self-analysis of the
analyst is proved, for the purpose of precluding any prejudice that may
drag a distorted element into the interpretation.
One thing, of course, still remains: Personal Equation, which, as an
element of individuality, is destined to play a much more important part
in psychoanalysis than anywhere else. Although an abnormal man may
develop into an expert physicist, an analyst will always be handicapped
by his own anomalies, when it comes to conceive pictures of soul life,
free from distortions.
Inasmuch as it is impossible to prove to anybody his anomalies, general
unanimity in the matter of Psychology of the Depths will prove
especially difficult to achieve. There are even a handful of
psychologists who claim it to be practically impossible ever to achieve
such unanimity, and who also insist that every fool is entitled to
proclaim his special brand of foolishness as wisdom.
I admit I am more optimistically inclined. After all, our experiences
prove that, even in psychology, harmony of opinion may be achieved to a
tolerably satisfactory degree. No doubt, each individual realm of
science presents its own individual difficulties which have to be
eliminated. Moreover, there are some aspects of the art of
interpretation, as applied in analysis which, like some other knowledge,
may be acquired by study. For example, those aspects pertaining to the
peculiarly indirect representation by symbols.
“To be frank with you: I have lost all ambition, even to dabble
theoretically with the application of psychoanalysis. Heaven knows what
further surprises are still in store for me!”
You are perfectly correct to abandon such an intention.
You have already convinced yourself how much training and practice is
necessary. And once you have found the correct interpretations, a new
problem presents itself. It is then up to you to lay in wait and
virtually pounce upon the correct, the psychological moment, if you wish
to acquaint your patient of your interpretations with the idea of
benefiting him.
“How to tell what is the psychological moment?”
That is a matter of extreme tact which, by the way, may be greatly
improved through experience. You would commit a very grave error if you
would fling your interpretation, as soon as it had been ascertained, at
the patient. This would only lead to resistance, refusal, indignation,
but never result in his “I” getting a firm hold of whatever it was that
caused his repressions. It is an iron clad rule to permit your patient
to approach this elusive cause of repression close enough, to make it
possible for him to obtain an immediate and strong grip on it, under the
correctly timed guidance of the interpretation you may suggest.
“I am very much afraid that I would never master this art. But suppose
that I observe this rule strictly, then what?”
Then it will be your lot to make a discovery which you did not expect to
make.
“What kind of a discovery?”
That you had an entirely wrong opinion about your patient. That there is
no reason in the world for you to depend on his coöperation or
complacency. That, as a matter of fact, your patient is resolved to
raise as many obstacles as possible against your combined exertions.
With one word: that he does not altogether want to get well!
“Well, that is about the most ludicrous statement you have made so far!
I simply don’t believe it! The patient, suffering so intensely,
complaining so heartrendingly, sacrificing so much to be cured, actually
does not want to get well! Is it possible you really mean what you say?”
I mean every word of it! What I have just stated is the truth. Not the
whole truth, but a good deal of it. The patient wants, yet does not
want, to get well. Because his “I” has lost its unity of purpose, it is
preventing him from summing up undivided will power. Were the state of
affairs a different one, our patient would not be a neurotic!
The results of his repression have simply invaded his “I,” firmly
holding their ground there, so to speak. The “I” is wielding just as
little influence over these effects as over the repression itself.
Usually, the “I” is not at all aware of the prevailing state of affairs.
These patients are of a peculiar type, putting difficulties in our way
which we do not expect to encounter. All our social institutions are
organized to fit individuals with a unified, normal “I,” which may be
classified as either good or bad. This “I” either functions properly, or
is impeded by some overwhelming influence. Thus, the forensic
alternative: mentally responsible or not responsible.
But all these standard terms do not fit the neurotic!
Doubtless, it is difficult to adapt the demands of social life to their
psychological condition. During the War, this was proved to a great
extent.
Were those neurotics who shirked from military duty, pretending illness,
simulants or not?
They were both!
As soon as such patients were treated as simulants, by making it
uncomfortable for them to indulge in sickness, they recuperated; and as
soon as allegedly cured patients had been returned to the rank and file,
they once more became ill. There was simply no way to deal effectively
with them.
Analogous to this is the case of the neurotic in everyday life.
They complain about their sickness, at the same time exploiting it to
the limit. As a matter of fact, if an attempt is made to cure them of
their ailment, they will protect this most cherished possession of
theirs with the selfsame fervor with which a lioness defends her
offspring. But there would be no sense in blaming neurotics for the
contradictory behavior they display.
“Would it not be best, then, not to treat such difficult people at all?
Simply leave them to themselves? It seems to me that it cannot possibly
be worthwhile to spend as much effort on them as appears necessary,
according to what you say.”