to gain some knowledge of the composition of the Ego and of its
structure out of various faculties and elements. We have made a
beginning towards this at one point. From analysis of the delusion of
observation we have come to the conclusion that in the Ego there exists
a faculty that incessantly watches, criticizes, and compares, and in
this way is set against the other part of the Ego. In our opinion,
therefore, the patient reveals a truth which has not been appreciated as
such when he complains that at every step he is spied upon and observed,
that his every thought is known and examined. He has erred only in
attributing this disagreeable power to something outside himself and
foreign to him; he perceives within his Ego the rule of a faculty which
measures his actual Ego and all his activities by an _Ego-ideal_, which
he has created for himself in the course of his development. We also
infer that he created this ideal for the purpose of recovering thereby
the self-satisfaction bound up with the primary infantile narcissism,
which since those days has suffered so many shocks and mortifications.
We recognize in this self-criticizing faculty the Ego-censorship, the
‘conscience’; it is the same censorship as that exercised at night upon
dreams, from which the repressions against inadmissible wish-excitations
proceed. When this faculty disintegrates in the delusion of being
observed, we are able to detect its origin and that it arose out of the
influence of parents and those who trained the child, together with his
social surroundings, by a process of identification with certain of
these persons who were taken as a model.
These are some of the results yielded by the application of
psycho-analysis to the narcissistic disorders. They are still not very
numerous, and many of them still lack that sharpness of outline which
cannot be achieved in a new field until some degree of familiarity has
been attained. All of them have been made possible by employing the
conception of Ego-Libido, or narcissistic Libido, by means of which we
can extend the conclusions established for the transference neuroses on
to the narcissistic neuroses. But now you will put the question whether
it is possible for us to bring all the disorders of the narcissistic
neuroses and of the psychoses into the range of the Libido-theory, for
us to find the libidinal factor in mental life always and everywhere
responsible for the development of disease, and for us never to have to
attribute any part in the causation to the same alteration in the
functions of the self-preservative instincts. Well now, it seems to me
that decision on this point is not very urgent, and above all that the
time is not yet ripe for us to make it; we may leave it calmly to be
decided by advance in the work of science. I should not be astonished if
it should prove that the capacity to induce a pathogenic effect were
actually a prerogative of the libidinal impulses, so that the theory of
the Libido would triumph all along the line from the actual neuroses to
the severest psychotic form of individual derangement. For we know it to
be characteristic of the Libido that it refuses to subordinate itself to
reality in life, to Necessity. But I consider it extremely probable that
the Ego-instincts are involved secondarily and that disturbances in
their functions may be necessitated by the pathogenic affections of the
Libido. Nor can I see that the direction taken by our investigations
will be invalidated if we should have to recognize that in severe
psychosis the Ego-instincts themselves are primarily deranged; the
future will decide—for you, at least.
Let me return for a moment to anxiety, in order to throw light upon the
one obscure point we left there. We said that the relation between
anxiety and Libido, otherwise so well defined, is with difficulty
harmonized with the almost indisputable assumption that real anxiety in
the face of danger is the expression of the self-preservative instincts.
But how if the anxiety-affect is provided, not by self-interest on the
part of the Ego-instincts, but by the Ego-Libido? The condition of
anxiety is after all invariably detrimental; its disadvantage becomes
conspicuous when it reaches an intense degree. It then interferes with
the action that alone would be expedient and would serve the purposes of
self-preservation, whether it be flight or self-defence. Therefore if we
ascribe the affective component of real anxiety to the Ego-Libido, and
the action undertaken to the Ego-preservative instincts, every
theoretical difficulty will be overcome. You will hardly maintain
seriously that we run away _because_ we perceive fear? No, we perceive
fear _and_ we take to flight, out of the common impulse that is roused
by the perception of danger. Men who have survived experiences of
imminent danger to life tell us that they did not perceive any fear,
that they simply acted—for instance, pointed their gun at the oncoming
beast—which was undoubtedly the best thing they could do.
TWENTY-SEVENTH LECTURE
TRANSFERENCE
Now that we are coming to the end of our discussions you will feel a
certain expectation which must not be allowed to mislead you. You are
probably thinking that I surely have not led you through all these
complicated mazes of psycho-analysis only to dismiss you at the end
without a word about the therapy, upon which after all the possibility
of undertaking psycho-analytic work depends. As a matter of fact I could
not possibly leave out this aspect of it; for some of the phenomena
belonging to it will teach you a new fact, without knowledge of which
you would be quite unable to assimilate properly your understanding of
the diseases we have been studying.
I know you do not expect directions in the technique of practising
analysis for therapeutic purposes; you only want to know in a general
way by what means the psycho-analytic therapy works and to gain a
general idea of what it accomplishes. And you have an undeniable right
to learn this; nevertheless I am not going to tell you—I am going to
insist upon your finding it out for yourselves.
Think for a moment! You have already learnt everything essential, from
the conditions by which illness is provoked to all the factors which
take effect within the diseased mind. Where is the opening in all this
for therapeutic influence? First of all there is the hereditary
disposition,—we do not often mention it because it is so strongly
emphasized in other quarters and we have nothing new to say about it.
But do not suppose that we underestimate it; as practitioners we are
well aware of its power. In any event we can do nothing to change it;
for us also it is a fixed datum in the problem, which sets a limit to
our efforts. Next, there is the influence of the experiences of early
childhood, which we are accustomed in analysis to rank as very
important; they belong to the past, we cannot undo them. Then there is
all that unhappiness in life which we have included under ‘privation in
reality,’ from which all the absence of love in life proceeds—namely,
poverty, family strife, mistaken choice in marriage, unfavourable social
conditions, and the severity of the demands by which moral convention
oppresses the individual. There is indeed a wide opening for a very
effective treatment in all this; but it would have to follow the course
of the dispensations of Kaiser Joseph in the Viennese legend—the
benevolent despotism of a potentate before whose will men bow and
difficulties disappear! But who are we that we can exert such
beneficence as a therapeutic measure? Poor as we are and without
influence socially, with our living to earn by our medical practice, we
are not even in a position to extend our efforts to penniless folk, as
other physicians with other methods can do; our treatment takes too much
time and labour for that. But perhaps you are still clinging on to one
of the factors put forward, and believe you see an opening for our
influence there. If the conventional restrictions imposed by society
have had a part in the privations forced upon the patient, the treatment
could give him the courage and even directly advise him to defy these
obstacles, and to seize satisfactions and health for himself at the cost
of failing to achieve an ideal which, though highly esteemed, is after
all often set at naught by the world. Health is to be won by “free
living,” then. There would be this blot upon analysis, to be sure, that
it would not be serving general morality; what it gave to the individual
it would take from the rest of the world.
But now, who has given you such a false impression of analysis? It is
out of the question that part of the analytic treatment should consist
of advice to “live freely”—if for no other reason because we ourselves
tell you that a stubborn conflict is going on in the patient between
libidinal desires and sexual repression, between sensual and ascetic
tendencies. This conflict is not resolved by helping one side to win a
victory over the other. It is true we see that in neurotics asceticism
has gained the day; the result of which is that the suppressed sexual
impulses have found a vent for themselves in the symptoms. If we were to
make victory possible to the sensual side instead, the disregarded
forces repressing sexuality would have to indemnify themselves by
symptoms. Neither of these measures will succeed in ending the inner
conflict; one side in either event will remain unsatisfied. There are
but few cases in which the conflict is so unstable that a factor like
medical advice can have any effect upon it, and these cases do not
really require analytic treatment. People who can be so easily
influenced by physicians would have found their own way to that solution
without this influence. After all, you know that a young man living in
abstinence who makes up his mind to illicit sexual intercourse, or an
unsatisfied wife who seeks compensation with a lover, does not as a rule
wait for the permission of a physician, still less of an analyst, to do
so.
In considering this question people usually overlook the essential point
of the whole difficulty—namely, that the pathogenic conflict in a
neurotic must not be confounded with a normal struggle between
conflicting impulses all of which are in the same mental field. It is a
battle between two forces of which one has succeeded in coming to the
level of the preconscious and conscious part of the mind, while the
other has been confined on the unconscious level. That is why the
conflict can never have a final outcome one way or the other; the
antagonists meet each other as little as the whale and the polar bear in
the well-known story. An effective decision can be reached only when
they confront each other on the same ground. And, in my opinion, to
accomplish this is the sole task of the treatment.
Besides this, I can assure you that you are quite misinformed if you
imagine that advice and guidance concerning conduct in life forms an
integral part of the analytic method. On the contrary, so far as
possible we refrain from playing the part of mentor; we want nothing
better than that the patient should find his own solutions for himself.
To this end we expect him to postpone all vital decisions affecting his
life, such as choice of career, business enterprises, marriage or
divorce, during treatment and to execute them only after it has been
completed. Now confess that you had imagined something very different.
Only with certain very young or quite helpless and defenceless persons
is it impossible to keep within such strict limitations as we should
wish. With them we have to combine the positions of physician and
educator; we are then well aware of our responsibility and act with the
necessary caution.
You must not be led away by my eagerness to defend myself against the
accusation that in analytic treatment neurotics are encouraged to “live
a free life” and conclude from it that we influence them in favour of
conventional morality. That is at least as far removed from our purpose
as the other. We are not reformers, it is true; we are merely observers;
but we cannot avoid observing with critical eyes, and we have found it
impossible to give our support to conventional sexual morality or to
approve highly of the means by which society attempts to arrange the
practical problems of sexuality in life. We can demonstrate with ease
that what the world calls its code of morals demands more sacrifices
than it is worth, and that its behaviour is neither dictated by honesty
nor instituted with wisdom. We do not absolve our patients from
listening to these criticisms; we accustom them to an unprejudiced
consideration of sexual matters like all other matters; and if after
they have become independent by the effect of the treatment they choose
some intermediate course between unrestrained sexual licence and
unconditional asceticism, our conscience is not burdened whatever the
outcome. We say to ourselves that anyone who has successfully undergone
the training of learning and recognizing the truth about himself is
henceforth strengthened against the dangers of immorality, even if his
standard of morality should in some respect deviate from the common one.
Incidentally, we must beware of overestimating the importance of
abstinence in affecting neurosis; only a minority of pathogenic
situations due to privation and the subsequent accumulation of Libido
thereby induced can be relieved by the kind of sexual intercourse that
is procurable without any difficulty.
So you cannot explain the therapeutic effect of psycho-analysis by
supposing that it permits patients free sexual indulgence; you must look
round for something else. I think that one of the remarks I made while I
was disposing of this conjecture on your part will have put you on the
right track. Probably it is the substitution of something conscious for
something unconscious, the transformation of the unconscious thoughts
into conscious thoughts, that makes our work effective. You are right;
that is exactly what it is. By extending the unconscious into
consciousness the repressions are raised, the conditions of
symptom-formation are abolished, and the pathogenic conflict exchanged
for a normal one which must be decided one way or the other. We do
nothing for our patients but enable this one mental change to take place
in them; the extent to which it is achieved is the extent of the benefit
we do them. Where there is no repression or mental process analogous to
it to be undone there is nothing for our therapy to do.
The aim of our efforts may be expressed in various formulas—making
conscious the unconscious, removing the repressions, filling in the gaps
in memory; they all amount to the same thing. But perhaps you are
dissatisfied with this declaration; you imagined the recovery of a
nervous person rather differently, that after he had been subjected to
the laborious process of psycho-analysis he would emerge a different
person altogether, and then you hear that the whole thing only amounts
to his having a little less that is unconscious and a little more that
is conscious in him than before. Well, you probably do not appreciate
the importance of an inner change of this kind. A neurotic who has been
cured has really become a different person, although at bottom of course
he remains the same—that is, he has become his best self, what he would
have been under the most favourable conditions. That, however, is a
great deal. Then when you hear of all that has to be done, of the
tremendous exertion required to carry out this apparently trifling
change in his mental life, the significance attached to these
differences between the various mental levels will appear more
comprehensible to you.
I will digress a moment to enquire whether you know what ‘a causal
therapy’ means? This name is given to a procedure which puts aside the
manifestations of a disease and looks for a point of attack in order to
eradicate the cause of the illness. Now is psycho-analysis a causal
therapy or not? The answer is not a simple one, but it may give us an
opportunity to convince ourselves of the futility of such questions. In
so far as psycho-analytic therapy does not aim immediately at removing
the symptoms it is conducted like a causal therapy. In other respects
you may say it is not, for we have followed the causal chain back far
beyond the repressions to the instinctive predispositions, their
relative intensity in the constitution, and the aberrations in the
course of their development. Now suppose that it were possible by some
chemical means to affect this mental machinery, to increase or decrease
the amount of Libido available at any given moment, or to reinforce the
strength of one impulse at the expense of another—that would be a causal
therapy in the literal sense, and our analysis would be the
indispensable preliminary work of reconnoitring the ground. As you know,
there is at present no question of any such influence upon the processes
of the Libido; our mental therapy makes its attack at another point in
the concatenation, not quite at the place where we perceive the
manifestations to be rooted, but yet comparatively far behind the
symptoms themselves, at a place which becomes accessible to us in very
remarkable circumstances.
What then have we to do in order to bring what is unconscious in the
patient into consciousness? At one time we thought that would be very
simple; all we need do would be to identify this unconscious matter and
then tell the patient what it was. However, we know already that that
was a short-sighted mistake. Our knowledge of what is unconscious in him
is not equivalent to his knowledge of it; when we tell him what we know
he does not assimilate it _in place of_ his own unconscious thoughts,
but _alongside_ of them, and very little has been changed. We have
rather to regard this unconscious material topographically; we have to
look for it in his memory at the actual spot where the repression of it
originally ensued. This repression must be removed, and then the
substitution of conscious thought for unconscious thought can be
effected straightaway. How is a repression such as this to be removed?
Our work enters upon a second phase here; first, the discovery of the
repression, and then the removal of the resistance which maintains this
repression.
How can this resistance be got rid of? In the same way: by finding it
out and telling the patient about it. The resistance too arises in a
repression, either from the very one which we are endeavouring to
dispel, or in one that occurred earlier. It is set up by the
counter-charge which rose up to repress the repellent impulse. So that
we now do just the same as we were trying to do before; we interpret,
identify, and inform the patient; but this time we are doing it at the
right spot. The counter-charge or the resistance is not part of the
Unconscious, but of the Ego which co-operates with us, and this is so,
even if it is not actually conscious. We know that a difficulty arises
here in the ambiguity of the word ‘unconscious,’ on the one hand, as a
phenomenon, on the other hand, as a system. That sounds very obscure and
difficult; but after all it is only a repetition of what we have said
before, is it not? We have come to this point already long ago.—Well
then, we expect that this resistance will be abandoned, and the
counter-charge withdrawn, when we have made the recognition of them
possible by our work of interpretation. What are the instinctive
propelling forces at our disposal to make this possible? First, the
patient’s desire for recovery, which impelled him to submit himself to
the work in co-operation with us, and secondly, the aid of his
intelligence which we reinforce by our interpretation. There is no doubt
that it is easier for the patient to recognize the resistance with his
intelligence, and to identify the idea in his Unconscious which
corresponds to it, if we have first given him an idea which rouses his
expectations in regard to it. If I say to you: “Look up at the sky and
you will see a balloon,” you will find it much more quickly than if I
merely tell you to look up and see whether you can see anything; a
student who looks through a microscope for the first time is told by the
instructor what he is to see; otherwise he sees nothing, although it is
there and quite visible.
And now for the fact! In quite a number of the various forms of nervous
illness, in the hysterias, anxiety conditions, obsessional neuroses, our
hypothesis proves sound. By seeking out the repression in this way,
discovering the resistances, indicating the repressed, it is actually
possible to accomplish the task, to overcome the resistances, to break
down the repression, and to change something unconscious into something
conscious. As we do this we get a vivid impression of how, as each
individual resistance is being mastered, a violent battle goes on in the
soul of the patient—a normal mental struggle between two tendencies on
the same ground, between the motives striving to maintain the
counter-charge and those which are ready to abolish it. The first of
these are the old motives which originally erected the repression; among
the second are found new ones more recently acquired, which it is hoped
will decide the conflict in our favour. We have succeeded in revivifying
the old battle of the repression again, in bringing the issue, so long
ago decided, up for revision again. The new contribution we make to it
lies, first of all, in demonstrating that the original solution led to
illness and in promising that a different one would pave the way to
health, and secondly, in pointing out that the circumstances have all
changed immensely since the time of that original repudiation of these
impulses. Then, the Ego was weak, infantile, and perhaps had reason to
shrink with horror from the claims of the Libido as being dangerous to
it. To-day it is strong and experienced and moreover has a helper at
hand in the physician. So we may expect to lead the revived conflict
through to a better outcome than repression; and, as has been said, in
hysteria, anxiety-neurosis, and the obsessional neurosis success in the
main justifies our claims.
There are other forms of illness, however, with which our therapeutic
treatment never is successful, in spite of the similarity of the
conditions. In them also there was originally a conflict between Ego and
Libido, leading to repression—although this conflict may be
characterized by topographical differences from the conflict of the
transference neuroses; in them too it is possible to trace out the point
in the patient’s life at which the repressions occurred; we apply the
same method, are ready to make the same assurances, offer the same
assistance by telling the patient what to look out for; and here also
the interval in time between the present and the point at which the
repressions were established is all in favour of a better outcome of the
conflict. And yet we cannot succeed in overcoming one resistance or in
removing one of the repressions. These patients, paranoiacs,
melancholics, and those suffering from dementia præcox, remain on the
whole unaffected, proof against psycho-analytic treatment. What can be
the cause of this? It is not due to lack of intelligence; a certain
degree of intellectual capacity must naturally be stipulated for
analysis, but there is no deficiency in this respect in, for instance,
the very quick-witted deductive paranoiac. Nor are any of the other
propelling forces regularly absent: melancholics, for instance, in
contrast to paranoiacs, experience a very high degree of realization
that they are ill and that their sufferings are due to this; but they
are not on that account any more accessible to influence. In this we are
confronted with a fact that we do not understand, and are therefore
called upon to doubt whether we have really understood all the
conditions of the success possible with the other neuroses.