Doubtless, it seems wiser to simply submit to the complications which
life presents, rather than to fight them. Not each and every one of the
neurotics we treat may be worth the exertions of an analysis, but there
are surely enough worthwhile individuals among them. It must be our goal
to decrease the number of persons who are forced to face the
exasperations of civilized life with a soul insufficiently prepared. To
this end, we must collect experience upon experience, and come to fully
grasp many problems. Every analysis is bound to prove instructive,
yielding new knowledge, aside from the personal benefit it may confer
upon an individual patient.
“Supposing that the ‘I’ of a patient developed such tendencies which
would make him wish to retain the sickness of which he complains, would
not these tendencies be justified, on the basis of certain reasons and
motives? It is impossible for me to understand why somebody should want
to be sick. What satisfaction could he derive from that?”
Just remember the war neurotics who were exempt from duty, because they
were considered sick. In everyday life, sickness may be successfully
employed as a screen, behind which to hide professional insufficiencies,
or—in the circle of family life—as a means to induce relatives to make
sacrifices, demonstrations of affection, or to foist one’s will upon
them, generally. All this is quite obvious and comes under the term
“sickness profit” (analogous to war profit). It is remarkable, however,
that the neurotic, or rather his “I,” proves unable to grasp the
connection of such motives with their logical consequences.
The influence of such tendencies to gain “sickness profit” is combated,
by forcing the “I” to become aware of them. But there are still other,
more obscure motives, for holding on to sickness, which cannot be
disposed so easily. As a matter of fact, these reasons cannot be
understood, without venturing once more into the sphere of psychological
theories.
“Oh, go right ahead! A little theory, more or less—what does it matter?”
When I explained to you the relations between the “I” and the “It,” I
withheld from you an important part of the soul apparatus. You see,
within the “I” itself, there persists a particular faction which we call
the “Super-Ego.”
This “Super-Ego” enjoys a privileged position between the “I” and the
“It.” It belongs to the “I,” sharing with it its intricate psychological
make-up. On the other hand, it entertains very close relations with the
“It.” The “Super-Ego” is in reality the record of first impressions as
conceived by the “It”; it is the heir of the dissolved Œdipus Complex.
This “Super-Ego,” as a matter of fact, is able to oppose the “I,” act
towards it as if it were something inferior and, in general, treat it
almost with contempt. For the “I” it is just as important to remain in
agreement with the “Super-Ego” as with the “It.” Disagreement between
the “Super-Ego” and the “I” is of far-reaching consequences for the soul
life.
Doubtless, you have already surmised that the “Super-Ego” is the agent
of that phenomenon which we call our conscience.
For the maintenance of healthy soul life, it is very important that the
“Super-Ego” develop normally, that is, becomes sufficiently impersonal.
It is just this development which is insufficient in the neurotic,
because his Œdipus Complex was not properly transformed. His
“Super-Ego,” in regard to the “I,” still assumes the rôle of the strict
father to the child, with the morality of the “I” manifesting itself in
a primitive manner by meekly submitting to punishment, meted out by the
“Super-Ego.” Sickness is resorted to, as the means of this
“self-punishment.” The neurotic, behaving as if under a burden of guilt
accepts sickness as a punishment to assuage this feeling of delinquency.
“That sounds very mysterious. But the most remarkable thing seems to be
that the patient remains unconscious of the power of his conscience.”
Well, we are only now beginning to appreciate the importance of all
these vital conditions. That is the reason why my explanations were so
puzzling to you. But now, I believe I can continue.
All those agents which oppose the recuperation of a patient, we term the
“resistance” of the patient. While “sickness profit” is the source of
such resistance, the “unconscious feeling of guilt” represents the
resistance of the “Super-Ego” of which, as the strongest factor, we are
very much in fear.
But there are other manifestations of resistance which become evident in
the process of treatment.
If the “I,” at an early period, was induced through fear, to take
recourse to a repression, this fear still persists, manifesting itself
now as a resistance, as soon as the “I” approaches that which was
repressed. It is easy enough to realize that difficulties may be
encountered, if a certain tendency, which for decades has proceeded
along a specific course, is suddenly expected to swing into a new path
opened to it.
Such a condition may be termed the resistance of the “It.”
The battle against all these resistances is our main work during the
analytical treatment, in comparison with which the task of
interpretation almost fades into insignificance. But by this battle and
the ensuing defeat of resistances, the “I” of the patient is so
transformed and strengthened that his future behavior, after the
termination of the treatment, may be regarded with complete equanimity.
On the other hand, you will understand now why our treatment is so
protracted. Expanse and multifariousness of the material are not as
decisive factors as the question of whether the way is clear. Remember
that the same course, which in times of peace, may be traveled in a few
hours by railroad, may take an army, during wartime, weeks and weeks,
because the resistance of the enemy must first be overcome. Battles to
overcome resistance require time in soul life also. I am sorry to say
that, up to now, all exertions to shorten the duration of analytical
treatments to any appreciable degree, have proved unavailing. It seems
that the best way to shorten the length of the treatment, is simply to
apply it as correctly as possible.
“If I ever felt the temptation to dabble with your science and to
attempt to analyze a patient, your information in reference to those
resistances, that may be encountered, cured me thoroughly of any such
ambition.
“But, tell me about the element of personal influence which you have
admitted is present in the analysis. Is this not a valuable factor in
the battle against resistance?”
I am glad that you bring this question up. This personal influence is
our strongest dynamic weapon; it is the agent which we introduce as
something new, into the analytical situation, thus lending it impetus.
This could never be accomplished by the intellectual substance of our
interpretation alone because the patient, sharing all the prejudices of
his environment, need not have more faith in us than our scientific
critics. The neurotic coöperates with the analyst simply because he
believes in him, and he believes in him because he gradually develops a
certain sentimental trend toward the analyst. A child, also, believes
only persons to whom it is attached.
I have already told you how we employ this especially great “suggestive”
influence. Not to suppress the symptoms—it is here where the analytical
method is utterly unlike any other psycho-therapeutical method!—but as a
driving power to induce the “I” of the patient to defeat his
resistances.
“And suppose you succeed? Would that insure easy sailing from then on?”
Such ought to be the case. But an unexpected complication arises.
It was perhaps the greatest surprise for the analyst to observe that the
sentimental relations which the patient endeavors to establish, are of a
very particular nature. Already the first physician who attempted
analysis—it was not I—discovered this phenomenon, which served to
bewilder him intensely. These sentimental relations are, to express it
bluntly, of an amorous nature. Remarkable, isn’t it, if you take into
consideration the fact that the analyst does nothing to invite such
emotions, but rather endeavors to maintain distance, sentimentally
speaking, between the patient and himself.
All this is so much more remarkable, as these odd sentimental relations
utterly disregard all such obstacles, as difference in age, sex, and
social strata. This amorousness appears fated. Not that it constitutes a
characteristic otherwise alien to spontaneous love. You are well aware
that the contrary of this may be only too frequently observed. Although
it is the rule in the analytical situation, the latter, as such, cannot
serve as a rational explanation for this development. To all
appearances, nothing else should result from the relation between the
patient and the analyst, than just a certain measure of respect,
confidence, gratitude and humane sympathy. However, what really results
from it is this condition of attachment, which in itself gives the
impression of being some disorder.
“Well, I should say that such a development would tend to favor
analytical purposes. If one is enamoured, one is complacent and ready to
do almost anything for love’s sweet sake.”
Of course, in the beginning, this condition favors the analysis, but
later on, when these sentimental relations gradually become intensified,
displaying their inherent nature, difficulties crop up which do not
promote the aim of the analysis. You see, an enamoured patient is not
satisfied merely to obey the analyst. The patient becomes presumptuous,
demanding tenderness and sensual gratification. Eventually, jealousy
develops and the lovelorn patient gradually arrives at a stage where
more and more clearly, a preparedness for enmity and revenge is shown.
Simultaneously, analogous to any other form of love, all other impulses
of the soul are repressed, submerging the interest in treatment and
recuperation. There is no doubt that love has assumed the place of the
neurosis, and that our labors have simply resulted in substituting one
disturbance for another.
“That sounds hopeless. What can be done? Perhaps analysis in such a case
should be discarded. But since you say that every case yields this
result, then analysis in general would have to be discarded.”
First, let us take stock of the situation in order to learn from it.
Whatever is thus gained may assist us in mastering the situation. After
all, is it not quite remarkable that we should succeed in transforming a
neurotic condition into a state of unwholesome attachment?
Our conviction that neurotic conditions arise partly from abnormally
directed sentimental tendencies, gains unquestionable corroboration by
our findings. Ascertaining these facts, we feel more assured and dare to
make this enamoured condition the object of analysis.
We also make another observation. This condition of amorousness, as part
of the analysis, is not always so apparent in all cases, as I have tried
to picture it to you.
And why isn’t that the case? We shall soon see.
In the same measure as the sensual and hostile aspects of a patient’s
attachment endeavor to manifest themselves, the inherent opposition of
the patient against such tendencies asserts itself. He combats them and
attempts to repress them, before our very eyes. Thus we come to
comprehend the whole development:—The patient merely repeats, in the
form of being enamoured with the analyst, experiences of his soul life
of days gone by. Certain tendencies of his soul, ready to burst forth,
and closely connected with the inception of his neurosis, have simply
been transferred by him to the analyst. He also repeats before our eyes
all those gestures of opposition, gone through before, and would like
nothing so much as to repeat in his relations with the analyst, all the
phases of that forgotten period of his life.
What the patient is showing us now is accordingly the very nucleus of
the most intimate story of his life. He is reproducing this nucleus in a
tangible form, as if actual, instead of just remembering this incipient
stage of his condition. Thus, the riddle of transferred love has been
solved and the analysis, with the assistance of this new discovery
which, for a time, almost seemed to wreck it, may be continued.
“That is surely complicated. Does the patient believe so easily that he
is not in love, and merely feels forced to revive an old episode, as it
were?”
Everything now depends upon the greatest dexterity in handling this
“transference,” to achieve our objective. You will easily see that the
demands of the analytical technique at this point are very exacting. It
is here where the most serious mistakes may be committed, or the most
splendid results achieved. Any attempt to evade these difficulties, by
suppressing or neglecting the transference, would be senseless. Such
evasion would not be deserving of the term of analysis. To send a
patient home, as soon as the discomfort of a transference neurosis
manifests itself, would also be senseless and would amount to cowardice.
It would be approximately analogous to calling forth spirits and then
running away, as soon as they put in their appearance.
Of course, there is no other way out sometimes. There are cases in which
it is impossible to master an unshackled transference, and the analysis
must then be terminated. But at least one should wrestle with these evil
spirits to the best of one’s ability.
To give in to the demands of a transference—the desires of a patient for
tenderness or sensual gratification—is impossible, not only for moral
reasons but also as it would prove impractical, if resorted to as a
means to achieve a successful analysis. A neurotic cannot be healed, by
being permitted to indulge in uncorrected repetitions of situations
which he unconsciously prepared. When making a compromise with a
neurotic, by meeting him halfway, it is necessary to take care not to be
manœuvred into the ludicrous position of the clergyman, who tried to
convert the insurance agent with the result that the insurance agent did
not join the church, but the clergyman took out a policy.
The only way out of the dilemma of transference is to delve into the
past of the patient and reconstruct events as they were actually lived
through by the patient, or else only pictured, with the assistance of
his urge-stimulated imagination. For all this, the analyst requires much
dexterity, patience, calmness and self-effacement.
“And where, do you think, did the neurotic meet the original of this
transference love?”
In his childhood, and, as a rule, in one of his parents. You will
readily remember how much importance we had to attach to these earliest
of all sentimental relations. Here, the circle is completed.
“You have finished, then? To be frank with you, I am quite bewildered by
all you have told me. But, now pray tell me, where to study all that is
necessary to practise analysis?”
Two institutes serve this purpose by giving instruction in
psychoanalysis. The first is in Berlin, in charge of Dr. Max Eitigon of
the local organization. The second is maintained by the Vienna
Psychoanalytical Society, with great sacrifice. The authorities, up to
now, have thrown many obstacles in the path of the young institute. A
third institute will be opened in London, by the local organization
there and will be under the direction of Dr. E. Jones.
In all these institutes, the disciples themselves are analysed, and are
then given theoretical instruction in all subjects important for them.
When permitted to analyse their first, simple cases, they have the
advantage of being under the supervision of more experienced analysts.
The course usually requires about two years, but even after this period,
a disciple is still a beginner, and not by far to be considered a
master. What else the young analyst needs, he acquires thorough
practice, and by intercourse with older colleagues.
The preparatory work for the analytical training is not at all simple:
the work is hard, the responsibility tremendous.
Whoever attended such a course, has been analysed himself, has grasped
the Psychology of the Unconscious, as far as it can be taught today, is
sufficiently versed in the science of sex, and has acquired the
difficult technique of psychoanalysis, including the art of
interpretation, the method of combating resistances and the manner in
which to handle transferences, can no longer be considered a layman, in
the field of psychoanalysis. He is able to treat neurotic disturbances
and will, in time, be in a position to achieve all that may be expected
of this therapy.