“You have explained to me, at great length, what psychoanalysis is, and
what knowledge is necessary to practise it with a chance for success. It
certainly could not have hurt me to listen to you.
“However, I do not see how your informations are expected to influence
my personal view. Neuroses, it would appear, are a certain form of
disturbance, and psychoanalysis a certain method to treat such cases—a
special medical treatment, as it were.
“I understand that it is the rule that any physician who intends to
specialize in the one phase or the other of his science is not satisfied
with the training he received before winning his diploma, but rather
goes on studying the intricacies of his special field. This is
especially a necessity, in case he intends to establish himself in a big
city, the only place which opens a satisfactory field for specialists.
Anybody who is going to specialize in surgical work, will practise, for
a few years, in the surgical ward. Corresponding specialized work will
be taken up by the eye or the nose and throat specialist, and the
psychiatrist may forever remain on the staff of a city or county
institution or a private sanitarium.
“The same method of development may be expected of the psychoanalyst.
Whoever decides to take up this new medical specialty, after finishing
his studies proper, will have to attend those institutes, for the
duration of two years, which you have mentioned before, provided it
really takes as long as that to gain the necessary knowledge. He will
then also learn that it would be to his advantage to join a
psychoanalytical society, in order to remain in contact with his
colleagues.
“I really cannot understand why there is any necessity for raising this
question of lay-analyses?”
Any physician, proceeding along the lines you suggested, shall be
welcome to us. As a matter of fact, four-fifths of those whom I consider
my disciples, are physicians. However, permit me to enlighten you as to
relations, as they actually developed between physicians and
psychoanalysis, and what development they appear to be taking in the
future.
Past developments do not give physicians any right to claim a monopoly
of psychoanalysis. As a matter of fact, physicians, in the past, have
done about everything to damage psychoanalysis, beginning with
superficial mockery and going even so far as to indulge in serious
defamation. Of course, you may correctly say that all this belongs to
the past, and should not have any influence on the future. I fully
agree, but I am afraid that the future will not live up to your
expectations.
At this point, permit me to interpret for you the term of “quack,” not
in the way it is legally employed, but rather in the sense in which it
should be logically applied. As far as the law is concerned, a “quack”
is an individual who treats sick people, without being in the possession
of a diploma. I, however, would rather qualify the term “quack” in this
way: A “quack” is anybody who undertakes the treatment of a disease,
without having the indispensable knowledge and ability.
On the basis of this definition, I venture to assert that—not only in
the European countries—physicians, as far as psychoanalysis is
concerned, constitute the majority of “quacks.” Frequently, physicians
will employ psychoanalysis, without having studied it, and without
sufficiently understanding it.
Do not tell me that this would display a lack of conscience, which you
would not suspect in any physician. You might be tempted to say that,
after all, a physician ought to know that a medical diploma does not
constitute a “Letter of Marque,” and that a sick person should not be
considered outlawed. As far as a physician is concerned, it should be
taken for granted that he is proceeding in good faith, even if he makes
a mistake.
However, facts are facts. Let us hope that it will be possible to
explain these facts in a manner, which you apparently wish. I, for my
part, shall try to explain to you how it is possible that a physician,
in matters of psychoanalysis, takes liberties he would carefully avoid
in any other specialized field.
In the first place, it must be taken in consideration that the training
the medical student received is almost the very opposite of that which
would be required of him, as a preparation for psychoanalysis. His
attention has simply been focused upon facts which may be objectively
ascertained, such as present themselves in anatomy, physics, and
chemistry, and which must be understood properly and applied correctly,
to achieve results.
As far as the psychological aspects of life are concerned, no interest
is created in the medical student. The study of higher mental
achievements is not considered to belong within the field of medicine,
but rather into the realm of another science. Psychiatry alone is
supposed to attend to disturbances of psychological functions, and it is
only too well known in which way, and with what objective in view this
is done: psychiatry simply tries to discover the physical reasons for
psychological disturbances, treating them in turn like any other
ailment.
Psychiatry is correct in that respect, and medical training apparently
excellent. Should it be maintained that psychiatry is one-sided, it will
be necessary to fix the point of view from which such a reproach may
arise.
Inherently, all science is one-sided, and must be one-sided, inasmuch as
any science is limited to certain subjects, points of view, and methods.
It is a nonsense which I do not wish to support that one science may be
played against any other. Physics after all, does not minimize the value
of chemistry; it cannot replace the latter nor be substituted for it.
And, surely, psychoanalysis is especially one-sided, as the science of
the psychological Unconscious.
Thus, the right to one-sidedness should not be denied to medicine.
However, a more practical point of view is gained if observations are
not made as to scientific medicine, but rather as to practical healing.
Sick people, presenting complicated problems, should impress upon us the
fact that psychological manifestations—be they ever so hard to
comprehend—cannot be simply eliminated from the picture. The neurotic,
more than any other patient, presents an undesirable complication. He
offers a dilemma, not less embarrassing to medicine than to law.
However, as long as such cases exist, they are a responsibility
especially of medicine. Nevertheless, medical training, sorry to say, is
not paying sufficient attention to such conditions,—doing nothing for
them. Absolutely nothing at all!
As there are very close inter-relations between those things we consider
physical and those which we look upon as psychological, it may be
expected that the day will come when organic biology and chemistry will
finally approach the understanding of neurotic manifestations. This day,
to be sure, seems to be in the distant future. At present, such ailments
are still unapproachable, from a medical angle.
If medical training would only deny information to the student in the
field of neurosis, this would be tolerable. But medical training is
doing more. It implants into the young student an incorrect and harmful
point of view. Physicians, whose interest for psychological facts has
not been awakened, have naturally a tendency of making little of such
facts, going even so far as to decry them as unscientific. Conditions of
neurotic character are hardly ever taken seriously by them, while their
lack of knowledge serves to breed disrespect for psychological research.
Thus, neurosis is not accorded sufficient attention.
Of course, these neurotics must be treated when they consult physicians,
and new discoveries must be tried out right along. But why go in for a
protracted period of preparation? It can be done without that! After
all, who knows whether there is really any value to that which is taught
in psychoanalytical institutes?
Thus, as usual, lack of information results in a most daring spirit of
enterprise. Only true initiates are modest, because they realize how
insufficient their knowledge is!
From all this, it follows that it is impossible to draw upon a
comparison of psychoanalysis with other branches of medicine, as you
attempted to do.
As far as surgery, and ophthalmology, are concerned, medical schools and
post graduate courses offer sufficient opportunities for training. The
psychoanalytical institutes are limited in number, young in years, and
lack the aureola of authority. Medical science has not recognized them,
nor does it give a hoot about them. On the other hand, the young
physician who has been forced to believe his teachers, to such a degree,
that he hardly ever had a chance to form his own judgment, will only be
too glad to try his hand at playing the critic, in a field where there
is no established authority as yet.
There are still other circumstances which favor the mushroom-like
increase of young physicians as psychoanalytical “quacks.”
If a physician would undertake cataract operations, without sufficient
training as an eye specialist, he would soon enough lose his patients.
Compared to this, the application of psychoanalysis hardly involves any
danger. The public, generally observing effective cataract operations,
expects results from a physician pretending to be an eye specialist.
However, if a nerve specialist does not achieve results, apparently
nobody is surprised. We surely have not been spoiled by the efficacy of
therapeutical treatment of nerve cases, and it seems to suffice that the
physician “tried everything.” Nature must simply assert herself and time
exert its healing propensities.
If the patient happens to be a young girl, it is first the menstruation
which is expected to work wonders, then marriage, and in later years,
change of life. In the end, death itself may finally prove the great
healer.
Moreover, whatever the medical analyst employed in the treatment of such
a case, is so inconspicuous, as to offer no cause for reproach. After
all, he did not resort to instruments, nor did he write prescriptions.
He just talked and talked, trying either to talk something into the
patient, or out of the patient.
How could such treatment do any damage, especially as extreme care had
been taken not to touch upon painful or exciting matters? The medical
analyst, once he has thrown the strict instructions overboard that were
given to him, will surely have tried to improve upon psychoanalysis by
extracting from it certain features—poisonous fangs, as it were—to make
analysis more acceptable to the patient. How splendid, if he really went
only as far as that and not so far as to awaken resistances which he
would be unable to cope with. He would be apt to make himself disliked
in such a case!
Justice demands that it be admitted that an untrained analyst cannot do
as much harm to a patient, as an untrained surgeon. The possible injury
may amount to unnecessary expenditure of money and time, and chances for
a cure may have either been destroyed, or else spoilt to a certain
degree. In addition to this, the reputation of psychoanalytical therapy
as a whole would suffer. All this is quite undesirable, but surely not
as serious as the damage that may arise from the knife of a surgical
“quack.” According to my observations, permanent aggravation of an
ailment is not to be expected from the incorrect application of
psychoanalysis. Reactions of an undesirable nature disappear quickly. In
comparison to the traumata inflicted by life itself, which resulted in
the disturbances, a little incorrect treatment does not amount to
anything. The unsuitable therapeutical attempt has simply not benefited
the patient.
“I have listened to your description of the ‘quack’ without interrupting
you, and have gained the impression that your position in regard to
physicians is barbed with hostility. The reason for this enmity is
obvious, from the many hints you have dropped. At any rate, I am of the
opinion that as long as psychoanalysis is to be employed, it should be
only by such persons as are thoroughly trained for it. But it seems that
you believe that even those physicians who may take up psychoanalysis,
in the course of time, will not go in for the necessary thorough
training?”
Exactly! As long as the relation between the medical schools and the
psychological institutes prevail as they do today, I do not think that
young physicians will resist the temptation of making things easy for
themselves.
“It appears to me that you constantly avoid making any direct statement
in regard to the problem of lay-analyses. Apparently, what you wish me
to surmise now is that it would be your suggestion to withhold, as a
means of revenge, as an act of punishment, so to speak, the monopoly of
practising psychoanalysis from physicians, because such physicians as
employ analysis, are beyond control. You would, however, permit the
application of such medical activity to laymen.”
I am not so sure that you surmised my motives correctly. Perhaps, I may
later on be in a position to prove to you that my point of view is not
as partial as all that. But be that as it may, _I strongly emphasize my
demand that nobody should be permitted to practise psychoanalysis,
unless he has obtained this privilege on the basis of thorough
training_. Whether such a person is a qualified physician or not does
not seem important to me.
“What, then, are your practical suggestions?”
I am not as far as that yet. I don’t even know whether I shall ever get
that far. There is some other question which I wish to take up with you,
and by way of introduction, touch upon a certain point.
It is reported that the authorities, on the strength of suggestions made
by medical bodies, may put a sweeping prohibition for the practise of
psychoanalysis by laymen on the statute books. Such prohibition would
naturally also hit the non-medical members of psychoanalytical
societies—men and women who have undergone a very thorough training and
improved themselves greatly by practice. Should such a sweeping
prohibition become an actual fact, the incongruous condition would then
present itself whereby people really capable of applying psychoanalysis
properly, would be excluded from this practice, while on the other hand,
this privilege would be extended to individuals insufficiently informed,
and not specially trained for such work.
Of course, no legislature aims at so absurd an effect.
But the dilemma that presents itself with this piece of legislature, is
neither important nor difficult. It would concern only a handful of
people who would not even suffer appreciably. Analogous to measures
enacted by monarchical Austria, republican Austria could also resort to
exception laws. Under the Hapsburg régime, it happened that certain
“quacks” whose ability in the treatment of certain diseases was
convincing, were privileged _ad personam_ to treat sick people. These
were mostly cases of rustic healers, who enjoyed the recommendation of
one of those exalted, once so plentiful, archduchesses. However, it
should be possible to assume that the benefit of such exception laws
should also pertain to city inhabitants, who are recommended by mere
experts.
Of course, if the law is put on the statutes in accordance with the
wording of the bill now pending, the Vienna Psychoanalytical Institute,
for example, would no longer be permitted to accept students, unless
they belonged to the medical profession. All these endeavors to restrict
the application of psychoanalysis hark back, more or less, to obsolete
legislature, dealing with quackery as such. This seems anachronistic,
inasmuch as at the time of the enactment of these anti-quackery laws,
the particular nature of neurotic disturbances had not yet been
discovered and psychoanalysis did not yet exist.
I am now approaching the question which appears most essential to me: Is
the practice of psychoanalysis of such a nature as to lend itself to the
interference of legislative authorities, or would it not be much better
to leave psychoanalysis to its natural development?
Of course, I shall not decide this question, but I am taking the liberty
of submitting it to you. It appears that in Austria, not unlike other
countries, by the way, there prevails a real _furor prohibendi_, a
veritable mania for prohibition and general interference, a trend which
usually, as is only too well known, makes for unsatisfactory results.
According to my own personal view, a superabundance of ordinances and
prohibitions will only serve to injure the dignity of the law. It may
usually be observed that wherever there are just a few laws, these laws
are strictly adhered to, whereas where laws exist in great numbers, the
temptation arises to break them.
Furthermore, a man cannot be considered an anarchist, simply because he
believes that legislative statutes—in the view of their very
origin—cannot very well be regarded as something holy that must never be
touched. Legislative measures sometimes are insufficient, or gradually
become that, at the same time outraging our innate sense for justice and
common sense. Then the time is on hand, where there is no other means of
correcting such unbearable conditions than to simply trespass against
such laws. It seems advisable, for the purpose of maintaining respect
for laws and ordinances, not to enact any which may be difficult to
enforce.
Much of what has been said here about the application of psychoanalysis
by physicians would have to be repeated with regard to lay-analyses
proper, which the legislatures of some countries are now prepared to
prohibit. In view of the fact that the application of the analysis is a
very simple procedure, consisting merely of conversation without
resorting to instruments or prescriptions, it would be rather difficult
to prove that a layman actually employed psychoanalysis, if he stoutly
maintained that he had merely benefited a person by administering a good
“talking to.” Such assistance, to a person in need of it, could not very
well be prohibited simply because a physician may once in a while resort
to the identical thing!
In English speaking countries, Christian Science has gained tremendous
popularity. To my mind, it constitutes a dialectic abnegation of such
evils as life presents, by resorting to the teaching of Christian
religion. I do not hesitate to state that such measures strike me as a
regrettable fallacy of the human mind. But who in the United States or
England would ever think of prohibiting Christian Science or seek to
punish its followers?
Generally speaking, is governmental authority always so certain to be on
the right side? Assumed even that many, left to their own devices, would
encounter danger and experience harm, would it not just the same be much
better if governmental authority would merely indicate dangerous ground,
but on the whole leave it to the individual to be taught by experience
and mutual influence?
Psychoanalysis is so new, the broad masses so insufficiently informed
about it, the official view of science still so vacillating, that it
appears to me as premature to impede its progress by legislative
measures.
Why not leave it to the patients themselves to learn that it is
dangerous for them to apply for psychological assistance to persons who
are not sufficiently informed?
If people are sufficiently enlightened and warned, prohibition will
surely prove superfluous.
On Italian highways, poles, carrying high tension electric power,
display this warning: “_Chi tocca, muore!_” Which has proven perfectly
sufficient. In contrast to this, in other countries, for example Austria
and Germany, this warning is of an insulting verbosity:— “Inasmuch as
touching these high tension wires is dangerous to life, it is herewith
strictly prohibited to meddle with them!” Why this prohibition? Whoever
cherishes his life will not touch them, and whoever wants to commit
suicide will surely not be detained by the warning.
“But there are cases which may be quoted as precedent for the
prohibition of lay-analyses. For example, the law against the practice
of hypnosis by laymen, and another enacted against occult séances and
the organization of spiritualistic societies.”[1]
I must admit that it is beyond me to admire these measures. As far as
the last mentioned prohibition is concerned, it surely constitutes a
case of grave over-officiousness, encroaching upon intellectual freedom.
As far as I am personally concerned, I do not think that anybody would
suspect me of having faith in occult phenomena, or of being interested
in its general acceptance. However, such prohibitive measures will never
serve to stifle the interest that some people manifest for the alleged
secrets of an occult world. Such officious interference may do a lot of
damage by preventing impartial seekers for truth to arrive at a finding
which would do away with occult misconceptions. Here also, we observe
the fact that other countries do not interfere with so-called
“parapsychic” research, but only Austria.
As far as hypnosis is concerned, it is somewhat different from analysis.
Hypnosis is nothing else but induction of an abnormal condition of the
soul, serving the layman merely as a means of entertainment. Had
hypnotic therapy fulfilled its early promise, conditions would have
evolved similar to those now prevailing in psychoanalysis.
Aside from this, the history of hypnosis contributes another precedent
for the fate of psychoanalysis. When I was still a young instructor of
neuropathology, physicians fervently fought against hypnosis, claiming
it to be nothing but a fake, an infernal delusion, a most dangerous
practice. Today, this same hypnosis has been monopolized by them. They
are resorting to it as a method of examination. For some nerve
specialists, hypnosis is their most important stock in trade.
However, I have already told you that I do not intend to discuss whether
restriction by law or a hands-off policy would be the most correct
procedure, concerning psychoanalysis. I know very well that this is a
question of principle which will be decided by the inclination of
influential people rather than by strict argumentation. What seems to me
to suggest a policy of _laissez faire_ I have already mentioned. But if
the decision should be one for active interference, then, to be sure, it
would appear to me as a one-sided and unjust measure to enact a sweeping
prohibition against the practice of psychoanalysis by laymen. Then, it
would be up to the legislature to fix the conditions under which the
application of psychoanalysis would be permissible for those who would
be privileged to employ it. It would also be necessary to appoint an
authority who could be appealed to for information, who would decide
what constitutes psychoanalysis, what the training would be, and how to
administer it.
Thus, things must either be left alone or else order must be created and
the situation, in general, clarified. But there is no use in simply
interfering with a complicated situation, by means of a prohibition,
which is based without much discretion, upon obsolete acts of an
antiquated legislature.