a fortunate observation made possible by the co-operation of the
patient. Now you must not rack your brains to try and understand this by
seeking to compare it with something similar that is already familiar to
you; but you must recognize in it a fundamentally new fact, by means of
which much else becomes explicable. Allow me therefore to express it
again to you in other words.
The symptom is formed as a substitute for something else which remains
submerged. Certain mental processes would, under normal conditions,
develop until the person became aware of them consciously. This has not
happened; and, instead, the symptom has arisen out of these processes
which have been interrupted and interfered with in some way and have had
to remain unconscious. Thus something in the nature of an exchange has
occurred; if we can succeed in reversing this process by our therapy we
shall have performed our task of dispersing the symptom.
Breuer’s discovery still remains the foundation of psycho-analytic
therapy. The proposition that symptoms vanish when their unconscious
antecedents have been made conscious has been borne out by all
subsequent research; although the most extraordinary and unexpected
complications are met with in attempting to carry this proposition out
in practice. Our therapy does its work by transforming something
unconscious into something conscious, and only succeeds in its work in
so far as it is able to effect this transformation.
Now for a rapid digression, lest you should run the risk of imagining
that this therapeutic effect is achieved too easily. According to the
conclusions we have reached so far, neurosis would be the result of a
kind of ignorance, a not-knowing of mental processes which should be
known. This would approach very closely to the well-known Socratic
doctrine according to which even vice is the result of ignorance. Now it
happens in analysis that an experienced practitioner can usually surmise
very easily what those feelings are which have remained unconscious in
each individual patient. It should not therefore be a matter of great
difficulty to cure the patient by imparting this knowledge to him and so
relieving his ignorance. At least, one side of the unconscious meaning
of the symptom would be easily dealt with in this way, although it is
true that the other side of it, the connection between the symptom and
the previous experiences in the patient’s life, can hardly be divined
thus; for the analyst does not know what the experiences have been, he
has to wait till the patient remembers them and tells him. But one might
find a substitute even for this in many cases. One might ask for
information about his past life from the friends and relations; they are
often in a position to know what events have been of a traumatic nature,
perhaps they can even relate some of which the patient is ignorant
because they took place at some very early period of childhood. By a
combination of these two means it would seem that the pathogenic
ignorance of the patients might be overcome in a short time without much
trouble.
If only it were so! But we have made discoveries that we were quite
unprepared for at first. There is knowing and knowing; they are not
always the same thing. There are various kinds of knowing, which
psychologically are not by any means of equal value. _Il y a fagots et
fagots_, as Molière says. Knowing on the part of the physician is not
the same thing as knowing on the part of the patient and does not have
the same effect. When the physician conveys his knowledge to the patient
by telling him what he knows, it has no effect. No, it would be
incorrect to say that. It does not have the effect of dispersing the
symptoms; but it has a different one, it sets the analysis in motion,
and the first result of this is often an energetic denial. The patient
has learned something that he did not know before—the meaning of his
symptom—and yet he knows it as little as ever. Thus we discover that
there is more than one kind of ignorance. It requires a considerable
degree of insight and understanding of psychological matters in order to
see in what the difference consists. But the proposition that symptoms
vanish with the acquisition of knowledge of their meaning remains true,
nevertheless. The necessary condition is that the knowledge must be
founded upon an inner change in the patient which can only come about by
a mental operation directed to that end. We are here confronted by
problems which to us will soon develop into the _dynamics_ of
symptom-formation.
Now I must really stop and ask you whether all that I have been saying
is not too obscure and complicated? Am I confusing you by so often
qualifying and restricting, spinning out trains of thought and then
letting them drop? I should be sorry if it were so. But I have a strong
dislike of simplification at the expense of truth, I am not averse from
giving you a full impression of the many-sidedness and intricacy of the
subject, and also I believe that it does no harm to tell you more about
each point than you can assimilate at the moment. I know that every
listener and every reader arranges what is offered him as suits him in
his own mind, shortens it, simplifies it, and extracts from it what he
will retain. Within certain limits it is true that the more we begin
with the more we shall have at the end. So let me hope that, in spite of
the elaboration, you will have grasped the essential substance of my
remarks concerning the meaning of symptoms, the Unconscious, and the
connection between the two. You have probably understood also that our
further efforts will proceed in two directions; first, towards
discovering how people become ill, how they come to take up the
characteristic neurotic attitude towards life, which is a clinical
problem; and secondly, how they develop the morbid symptoms out of the
conditions of a neurosis, which remains a problem of mental dynamics.
The two problems must somewhere have a point of contact.
I shall not go further into this to-day; but as our time is not yet up I
propose to draw your attention to another characteristic of our two
analyses; namely, _the memory gaps or amnesias_, again a point which
only later will appear in its full significance. You have heard that the
task of the psycho-analytic treatment can be summed up in this formula:
everything pathogenic in the Unconscious must be transferred into
consciousness. Now you will be perhaps astonished to hear that another
formula may be substituted for that one: all gaps in the patient’s
memory must be filled in, his amnesias removed. It amounts to the same
thing; which means that an important connection is to be recognized
between the development of the symptoms and the amnesias. If you
consider the case of the first patient analysed you will, however, not
find this view of amnesia justified; the patient had not forgotten the
scene from which the obsessive act is derived; on the contrary, it was
vivid in her memory, nor is there any other forgotten factor involved in
the formation of her symptom. The situation is quite analogous, although
less clear, in the second case, the girl with the obsessional
ceremonies. She, too, had not really forgotten her behaviour in former
years, the fact that she had insisted upon the open door between her
parents’ bedroom and her own, and that she had turned her mother out of
her place in the parents’ bed; she remembered it quite clearly, although
with hesitation and unwillingness. What is remarkable about it is that
the first patient, although she had carried out her obsessive act such a
countless number of times, had not _once_ been reminded of its
similarity to the scene after the wedding-night, nor did this
recollection ever occur to her when she was directly asked to search for
the origin of her obsessive act. The same thing is true in the case of
the girl, where not merely the ritual, but the situation which gave rise
to it, was repeated identically every evening. In neither case was there
really an amnesia, a lapse of memory; but a connection, which should
have existed intact and have led to the reproduction, the recollection,
of the memory, had been broken. This kind of disturbance of memory
suffices for the obsessional neurosis; in hysteria it is different. This
latter neurosis is usually characterized by amnesias on a grand scale.
As a rule the analysis of each single hysterical symptom leads to a
whole chain of former impressions, which upon their return may be
literally described as having been hitherto forgotten. This chain
reaches, on the one hand, back to the earliest years of childhood, so
that the hysterical amnesia is seen to be a direct continuation of the
infantile amnesia which hides the earliest impressions of our mental
life from all of us. On the other hand, we are astonished to find that
the most recent experiences of the patient are liable to be forgotten
also, and that in particular the provocations which induced the outbreak
of the disease or aggravated it are at least partially obliterated, if
not entirely wiped out, by amnesia. From the complete picture of any
such recent recollection important details have invariably disappeared
or been replaced by falsifications. It happens again and again, almost
invariably, that not until shortly before the completion of an analysis
do certain recollections of recent experiences come to the surface,
which had managed to be withheld throughout it and had left noticeable
gaps in the context.
These derangements in the capacity to recall memories are, as I have
said, characteristic of hysteria, in which disease it also happens even
that states occur as symptoms (the hysterical attacks) without
necessarily leaving a trace of recollection behind them. Since it is
otherwise in the obsessional neurosis, you may infer that these amnesias
are part of the psychological character of the hysterical change and are
not a universal trait of neurosis in general. The importance of this
difference will be diminished by the following consideration. Two things
are combined to constitute the meaning of a symptom; its _whence_ and
its _whither_ or _why_; that is, the impressions and experiences from
which it sprang, and the purpose which it serves. The _whence_ of a
symptom is resolved into impressions which have been received from
without, which were necessarily at one time conscious, and which may
have become unconscious by being forgotten since that time. The _why_ of
the symptom, its tendency, is however always an endo-psychic process,
which may possibly have been conscious at first, but just as possibly
may never have been conscious and may have remained in the Unconscious
from its inception. Therefore it is not very important whether the
amnesia has also infringed upon the _whence_, the impressions upon which
the symptom is supported, as happens in hysteria; the _whither_, the
tendency of the symptom, which may have been unconscious from the
beginning, is what maintains the symptom’s dependence upon the
Unconscious, in the obsessional neurosis no less strictly than in
hysteria.
By thus emphasizing the unconscious in mental life we have called forth
all the malevolence in humanity in opposition to psycho-analysis. Do not
be astonished at this and do not suppose that this opposition relates to
the obvious difficulty of conceiving the Unconscious or to the relative
inaccessibility of the evidence which supports its existence. I believe
it has a deeper source. Humanity has in the course of time had to endure
from the hands of science two great outrages upon its naïve self-love.
The first was when it realized that our earth was not the centre of the
universe, but only a tiny speck in a world-system of a magnitude hardly
conceivable; this is associated in our minds with the name of
Copernicus, although Alexandrian doctrines taught something very
similar. The second was when biological research robbed man of his
peculiar privilege of having been specially created, and relegated him
to a descent from the animal world, implying an ineradicable animal
nature in him: this transvaluation has been accomplished in our own time
upon the instigation of Charles Darwin, Wallace, and their predecessors,
and not without the most violent opposition from their contemporaries.
But man’s craving for grandiosity is now suffering the third and most
bitter blow from present-day psychological research which is
endeavouring to prove to the “ego” of each one of us that he is not even
master in his own house, but that he must remain content with the
veriest scraps of information about what is going on unconsciously in
his own mind. We psycho-analysts were neither the first nor the only
ones to propose to mankind that they should look inward; but it appears
to be our lot to advocate it most insistently and to support it by
empirical evidence which touches every man closely. This is the kernel
of the universal revolt against our science, of the total disregard of
academic courtesy in dispute, and the liberation of opposition from all
the constraints of impartial logic. And besides this, we have been
compelled to disturb the peace of the world in yet another way, as you
will soon hear.
NINETEENTH LECTURE
RESISTANCE AND REPRESSION
We now need more data before we can advance further in our understanding
of the neuroses; two observations lie to hand for us. Both are very
remarkable and at first were very surprising. You are of course prepared
for both of them by the work we did last year.
First: when we undertake to cure a patient of his symptoms he opposes
against us a vigorous and tenacious _resistance_ throughout the entire
course of the treatment. This is such an extraordinary thing that we
cannot expect much belief in it. It is best to say nothing about it to
the patient’s relations, for they invariably regard it as a pretext set
up by us to excuse the length or the failure of the treatment. The
patient, too, exhibits all the manifestations of this resistance without
recognizing it as such, and it is a great step forward when we have
brought him to realize this fact and to reckon with it. To think that
the patient, whose symptoms cause him and those about him such
suffering, who is willing to make such sacrifices in time, money,
effort, and self-conquest in order to be freed from them,—that he
should, in the interests of his illness, resist the help offered him.
How improbable this statement must sound! And yet it is so, and if the
improbability is made a reproach against us we need only reply that it
is not without its analogies; for a man who has rushed off to a dentist
with a frightful toothache may very well fend him off when he takes his
forceps to the decayed tooth.
The resistance shown by patients is highly varied and exceedingly
subtle, often hard to recognize and protean in the manifold forms it
takes; the analyst needs to be continually suspicious and on his guard
against it. In psycho-analytic therapy we employ the technique which is
already familiar to you through dream-interpretation: we require the
patient to put himself into a condition of calm self-observation,
without trying to think of anything, and then to communicate everything
which he becomes inwardly aware of, feelings, thoughts, remembrances, in
the order in which they arise in his mind. We expressly warn him against
giving way to any kind of motive which would cause him to select from or
to exclude any of the ideas (associations), whether because they are too
“disagreeable,” or too “indiscreet” to be mentioned, or too
“unimportant” or “irrelevant” or “nonsensical” to be worth saying. We
impress upon him that he has only to attend to what is on the surface
consciously in his mind, and to abandon all objections to whatever he
finds, no matter what form they take; and we inform him that the success
of the treatment, and, above all, its duration, will depend upon his
conscientious adherence to this fundamental technical rule. We know from
the technique of dream-interpretation that it is precisely those
associations against which innumerable doubts and objections are raised
that invariably contain the material leading to the discovery of the
unconscious.
The first thing that happens as a result of instituting this technical
rule is that it becomes the first point of attack for the resistance.
The patient attempts to escape from it by every possible means. First he
says nothing comes into his head, then that so much comes into his head
that he can’t grasp any of it. Then we observe with displeasure and
astonishment that he is giving in to his critical objections, first to
this, then to that; he betrays it by the long pauses which occur in his
talk. At last he admits that he really cannot say something, he is
ashamed to, and he lets this feeling get the better of his promise. Or
else, he has thought of something but it concerns someone else and not
himself, and is therefore to be made an exception to the rule. Or else,
what he has just thought of is really too unimportant, too stupid and
too absurd, I could never have meant that he should take account of such
thoughts. So it goes on, with untold variations, to which one
continually replies that telling everything really means telling
everything.
One hardly ever meets with a patient who does not attempt to make a
reservation in some department of his thoughts, in order to guard them
against intrusion by the analysis. One patient, who in the ordinary way
was remarkably intelligent, concealed a most intimate love-affair from
me for weeks in this way; when accused of this violation of the sacred
rule he defended himself with the argument that he considered this
particular story his private affair. Naturally analytic treatment cannot
countenance a right of sanctuary like this; one might as well try to
allow an exception to be made in certain parts of a town like Vienna,
and forbid that any arrests should be made in the market-place or in the
square by St. Stephen’s church, and then attempt to take up a “wanted”
man. Of course he would never be found anywhere but in those safe
places. Once I decided to permit a man to make an exception of such a
point; for a great deal depended on his recovering his capacity for work
and he was bound by his oath as a civil servant not to communicate
certain matters to any other person. He was content with the result, it
is true, but I was not: I made up my mind never again to repeat the
attempt under such conditions.
Obsessional patients are exceedingly clever at making the technical rule
almost useless by bringing their over-conscientiousness and doubt to
bear upon it. Patients with anxiety-hysteria sometimes succeed in
reducing it to absurdity by only producing associations which are so far
removed from what is wanted that they yield nothing for analysis.
However, I do not intend to introduce you to these technical
difficulties of the treatment. It is enough to know that finally, with
resolution and perseverance, we do succeed in extracting from the
patient a certain amount of obedience for the rule of the technique; and
then the resistance takes another line altogether. It appears as
intellectual opposition, employs arguments as weapons, and turns to its
own use all the difficulties and improbabilities which normal but
uninstructed reasoning finds in analytical doctrines. We then have to
hear from the mouth of the individual patient all the criticisms and
objections which thunder about us in chorus in scientific literature.
What the critics outside shout at us is nothing new, therefore. It is
indeed a storm in a teacup. Still, the patient can be argued with; he is
very glad to get us to instruct him, teach him, defeat him, point out
the literature to him so that he can learn more; he is perfectly ready
to become a supporter of psycho-analysis on the condition that analysis
shall spare him personally. We recognize resistance in this desire for
knowledge, however; it is a digression from the particular task in hand
and we refuse to allow it. In the obsessional neurosis the resistance
makes use of special tactics which we are prepared for. It permits the
analysis to proceed uninterruptedly along its course, so that more and
more light is thrown upon the problems of the case, until we begin to
wonder at last why these explanations have no practical effect and
entail no corresponding improvement in the symptoms. Then we discover
that the resistance has fallen back upon the doubt characteristic of the
obsessional neurosis and is holding us successfully at bay from this
vantage-point. The patient has said to himself something of this kind:
“This is all very pretty and very interesting. I should like to go on
with it. I am sure it would do me a lot of good if it were true. But I
don’t believe it in the least, and as long as I don’t believe it, it
doesn’t affect my illness.” So it goes on for a long time, until at last
this reservation itself is reached and then the decisive battle begins.
The intellectual resistances are not the worst; one can always get the
better of them. But the patient knows how to set up resistances within
the boundaries of analysis proper, and the defeat of these is one of the
most difficult tasks of the technique. Instead of remembering certain of
the feelings and states of mind of his previous life, he reproduces
them, lives through again such of them as, by means of what is called
the ‘transference,’ may be made effective in opposition against the
physician and the treatment. If the patient is a man, he usually takes
this material from his relationship with his father, in whose place he
has now put the physician; and in so doing he erects resistances out of
his struggles to attain to personal independence and independence of
judgement, out of his ambition, the earliest aim of which was to equal
or to excel the father, out of his disinclination to take the burden of
gratitude upon himself for the second time in his life. There are
periods in which one feels that the patient’s desire to put the analyst
in the wrong, to make him feel his impotence, to triumph over him, has
completely ousted the worthier desire to bring the illness to an end.
Women have a genius for exploiting in the interests of resistance a
tender erotically-tinged transference to the analyst; when this
attraction reaches a certain intensity all interest in the actual
situation of treatment fades away, together with every obligation
incurred upon undertaking it. The inevitable jealousy and the
embitterment consequent upon the unavoidable rejection, however
considerately it is handled, is bound to injure the personal
relationship with the physician, and so to put out of action one of the
most powerful propelling forces in the analysis.
Resistances of this kind must not be narrowly condemned. They contain so
much of the most important material from the patient’s past life and
bring it back in so convincing a fashion that they come to be of the
greatest assistance to the analysis, if a skilful technique is employed
correctly to turn them to the best use. What is noteworthy is that this
material always serves at first as a resistance and comes forward in a
guise which is inimical to the treatment. Again it may be said that they
are character-traits, individual attitudes of the Ego, which are thus
mobilized to oppose the attempted alterations. One learns then how these
character-traits have been developed in connection with the conditions
of the neurosis and in reaction against its demands, and observes
features in this character which would not otherwise have appeared, at
least, not so clearly: that is, which may be designated latent. Also you
must not carry away the impression that we look upon the appearance of
these resistances as an unforeseen danger threatening our analytic
influence. No, we know that these resistances are bound to appear; we
are dissatisfied only if we cannot rouse them definitely enough and make
the patient perceive them as such. Indeed, we understand at last that
the overcoming of these resistances is the essential work of the
analysis, that part of the work which alone assures us that we have
achieved something for the patient.