We must observe two things: First, how can the conceptions of narcism and egoism be distinguished? I believe narcism is the libidinous complement of egoism. When we speak of egoism we mean only the benefits to the individual; if we speak of narcism we also take into account his libidinous satisfaction. As practical motives the two can be followed up separately to a considerable degree. One can be absolutely egoistic, and still have strong libidinous occupation of objects, in so far as the libidinous gratification by way of the object serves the needs of the ego. Egoism will then take care that the striving for the object results in no harm to the ego. One can be egoistic and at the same time excessively narcistic, i.e., have very slight need of an object. This need may be for direct s.e.xual satisfaction or even for those higher desires, derived from need, which we are in the habit of calling love as opposed to sensuality. In all of these aspects, egoism is the self-evident, the constant, and narcism the variable element. The ant.i.thesis of egoism, _altruism_, is not the same as the conception of libidinous occupation of objects. Altruism differs from it by the absence of desire for s.e.xual satisfaction. But in the state of being completely in love, altruism and libidinous occupation with an object clash. The s.e.x object as a rule draws upon itself a part of the narcism of the ego. This is generally called "s.e.xual over-estimation" of the object. If the altruistic transformation from egoism to the s.e.x object is added, the s.e.x object becomes all powerful; it has virtually sucked up the ego.
I think you will find it a pleasant change if after the dry phantasy of science I present to you a poetic representation of the economic contrast between narcism and being in love. I take it from the _Westostliche Divans_ of Goethe:
SULEIKA: Conqueror and serf and nation; They proclaim it joyously; Mankind"s loftiest elation, Shines in personality.
Life"s enchantment lures and lingers, Of yourself is not afar, All may slip through pa.s.sive fingers, If you tarry as you are.
HATEM: Never could I be thus ravished, Other thoughts are in my mind, All the gladness earth has lavished In Suleika"s charms I find.
When I cherish her, then only Dearer to myself I grow, If she turned to leave me lonely I should lose the self I know.
Hatem"s happiness were over,-- But his changeling soul would glide Into any favored lover Whom she fondles at her side.
The second observation is supplementary to the dream theory. We cannot explain the origin of the dream unless we a.s.sume that the suppressed unconscious has achieved a certain independence of the ego. It does not conform to the wish for sleep and retains its hold on the energies that have seized it, even when all the occupations with objects dependent upon the ego have been released for the benefit of sleep. Not until then can we understand how this unconscious can take advantage of the nocturnal discontinuance or deposition of the censor, and can seize control of fragments left over from the day to fashion a forbidden dream wish from them. On the other hand, it is to the already existing connections with these supposed elements that these fragments owe a part of the resistance directed against the withdrawal of the libido, and controlled by the wish for sleep. We also wish to supplement our conception of dream formation with this trait of dynamic importance.
Organic diseases, painful irritations, inflammation of the organs create a condition which clearly results in freeing the libido of its objects.
The withdrawn libido again finds itself in the ego and occupies the diseased part of the part. We may even venture to a.s.sert that under these conditions the withdrawal of the libido from its objects is more conspicuous than the withdrawal of egoistic interest from the outside world. This seems to open the way to an understanding of hypochondria, where an organ occupies the ego in a similar way without being diseased, according to our conception. I shall resist the temptation of continuing along this line, or of discussing other situations which we can understand or represent through the a.s.sumption that the object libido travels to the ego. For I am eager to meet two objections, which I know are absorbing your attention. In the first place, you want to call me to account for my insistence upon distinguishing in sleep, in sickness and in similar situations between libido and interest, s.e.xual instincts and ego instincts, since throughout the observations can be explained by a.s.suming a single and uniform energy, which, freely mobile, occupies now the object, now the ego, and enters into the services of one or the other of these impulses. And, secondly, how can I venture to treat the freeing of libido from its object as the source of a pathological condition, since such transformation of object-libido into ego-libido--or more generally, ego-energy--belongs to the normal, daily and nightly repeated occurrences of psychic dynamics?
The answer is: Your first objection sounds good. The discussion of the conditions of sleep, of sickness and of being in love would in themselves probably never have led to a distinction between ego-libido and object-libido, or between libido and interest. But you do not take into account the investigations from which we have set out, in the light of which we now regard the psychic situations under discussion.
The necessity of distinguishing between libido and interest, that is, between s.e.xual instincts and those of self-preservation, is forced upon us by our insight into the conflict out of which the transference neuroses emerge. We can no longer reckon without it. The a.s.sumption that object-libido can change into the ego-libido, in other words, that we must reckon with an ego-libido, appeared to us the only possible one wherewith to solve the riddle of the so-called narcistic neuroses--for instance, dementia praec.o.x--or to justify the similarities and differences in a comparison of hysteria and compulsion. We now apply to sickness, sleep and love that which we found undeniably affirmed elsewhere. We may proceed with such applications as far as they will go.
The only a.s.sertion that is not a direct refutation of our a.n.a.lytic experience is that libido remains libido whether it is directed towards objects or toward the ego itself, and is never transferred into egoistic interest, and vice-versa. But this a.s.sertion is of equal weight with the distinction of s.e.x and ego instincts which we have already critically appraised, and which we will maintain from methodological motives until it may possibly be disproved.
Your second objection, too, raises a justified question, but it points in a wrong direction. To be sure the retreat of object-libido into the ego is not purely pathogenic; we see that it occurs each time before going to sleep, only to be released again upon awaking. The little protoplasmic animal draws in its protrusions, only to send them out again on a later occasion. But it is quite another matter when a specific, very energetic process compels the withdrawal of libido from the object. The libido has become narcistic and cannot find its way back to the object, and this hindrance to the mobility of the libido certainly becomes pathogenic. It appears that an acc.u.mulation of narcistic libido cannot be borne beyond a certain point. We can imagine that the reason for occupation with the object is that the ego found it necessary to send out its libido in order not to become diseased because it was pent up. If it were our plan to go further into the subject of dementia praec.o.x, I would show you that this process which frees the libido from the objects and bars the way back to them, is closely related to the process of suppression, and must be considered as its counterpart. But above all you would recognize familiar ground, for the conditions of these processes are practically identical, as far as we can now see, with those of suppression. The conflict appears to be the same, and to take place between the same forces. The reason for a result as different as, for instance, the result in hysteria, can be found only in a difference of dispositions. The vulnerable point in the libido development of these patients lies in another phase; the controlling fixation, which, as you will remember, permits the breach resulting in the formation of symptoms, is in another place probably in the stage of primitive narcism, to which dementia praec.o.x returns in its final stage.
It is noteworthy that for all the narcistic neuroses, we must a.s.sume fixation points of the libido which reach back into far earlier phases of development than in cases of hysteria or compulsion neuroses. But you have heard that the conceptions obtained in our study of transference neuroses are sufficient to orient us in the narcistic neuroses, which present far greater practical difficulties. The similarities are considerable; it is fundamentally the same field of observation. But you can easily imagine how hopeless the explanations of these conditions, which belong to psychiatry, appear to him who is not equipped for this task with an a.n.a.lytic knowledge of transference neuroses.
The picture given by the symptoms of dementia praec.o.x, which, moreover, is highly variable, is not exclusively determined by the symptoms. These result from forcing the libido away from the objects and acc.u.mulating it in the ego in the form of narcistic libido. A large s.p.a.ce is occupied by other phenomena, which result from the impulses of the libido to regain the objects, and so show an attempt toward rest.i.tution and healing.
These symptoms are in fact the more conspicuous, the more clamorous; they show an unquestionable similarity to those of hysteria, or less often to those of compulsion neurosis, and yet they are different in every respect. It appears that in dementia praec.o.x the libido in its endeavor to return to the objects, i.e., to the images of the objects, really captures something, but only their shadows--I mean, the verbal images belonging to them. This is not the place to discuss this matter, but I believe that these reversed impulses of the libido have permitted us an insight into what really determines the difference between a conscious and an unconscious representation.
I have now brought you into the field where we may expect the further progress of a.n.a.lytic work. Since we can now employ the conception of ego-libido, the narcistic neuroses have become accessible to us. We are confronted with the problem of finding a dynamic explanation of these conditions and at the same time of enlarging our knowledge of psychic life by an understanding of the ego. The ego psychology, which we strive to understand, must not be founded upon introspective data, but rather, as in the libido, upon a.n.a.lysis of the disturbances and decompositions of the ego. When this greater task is accomplished we shall probably disparage our previous knowledge of the fate of the libido which we gained from our study of the transference neuroses. But there is still much to be said in this matter. Narcistic neuroses can scarcely be approached by the same technique which served us in the transference neuroses. Soon you will hear why. After forging ahead a little in the study of narcistic neuroses we always seem to come to a wall which impedes progress. You know that in the transference neuroses we also encountered such barriers of resistance, but we were able to break them down piece by piece. In narcistic neuroses the resistance is insuperable; at best we are permitted to cast a curious glance over the wall to spy out what is taking place on the other side. Our technical methods must be replaced by others; we do not yet know whether or not we shall be able to find such a subst.i.tute. To be sure, even these patients furnish us with ample material. They do say many things, though not in answer to our questions, and for the time being we are forced to interpret these utterances through the understanding we have gained from the symptoms of transference neuroses. The coincidence is sufficiently great to a.s.sure us a good beginning. How far this technique will go, remains to be seen.
There are additional difficulties that impede our progress. The narcistic conditions and the psychoses related to them can only be solved by observers who have schooled themselves in a.n.a.lytic study of transference neuroses. But our psychiatrists do not study psychoa.n.a.lysis and we psychoa.n.a.lysts see too few psychiatric cases. A race of psychiatrists that has gone through the school of psychoa.n.a.lysis as a preparatory science most first grow up. The beginnings of this are now being made in America, where many leading psychiatrists explain the teachings of psychoa.n.a.lysis to their students, and where many owners of sanatoriums and directors of inst.i.tutes for the insane take pains to observe their patients in the light of these teachings. But even here we have occasionally been successful in casting a glance over the narcistic wall and I shall tell you a few things that we think we have discovered.
The disease of paranoia, chronic systematic insanity, is given a very uncertain position by the attempts at cla.s.sification of present-day psychiatry. There is no doubt of its close relationship to dementia praec.o.x. I once was so bold as to propose that paranoia and dementia praec.o.x could be cla.s.sed together under the common name of paraphrenia.
The types of paranoia are described according to their content as: megalomania, the mania of persecution, eroto mania, mania of jealousy, etc. From psychiatry we do not expect attempts at explanation. As an example of such an attempt, to be sure an antiquated and not entirely valid example, I might mention the attempt to develop one symptom directly out of another by means of an intellectual rationalization, as: the patient who primarily believes he is being persecuted draws the conclusion from this persecution that he must be an extraordinarily important personality and thus develops megalomania. In our a.n.a.lytical conception megalomania is the immediate outcome of exaggeration of the ego, which results from the drawing-in of libidinous occupation with objects, a secondary narcism as a recurrence of the originally early infantile form. In cases of the mania of persecution we have noticed a few things that lead us to follow a definite track. In the first place, we observed that in the great majority of cases the persecutor was of the same s.e.x as the persecuted. This could still be explained in a harmless way, but in a few carefully studied cases it was clearly shown that the person of the same s.e.x, who was most loved in normal times, became the persecutor after the malady set in. A further development is made possible by the fact that one loved person is replaced by another, according to familiar affinities, e.g., the father by the teacher or the superior. We concluded from such ever-increasing experiences, that paranoia persecutoria is the form in which the individual guards himself against a h.o.m.os.e.xual tendency that has become too powerful. The change from affection to hate, which notoriously may take the form of serious threats against the life of the loved and hated person, expresses the transformation of libidinous impulse into fear, which is a regularly recurring result of the process of suppression. As an ill.u.s.tration I shall cite the last case in which I made observations on this subject. A young physician had to be sent away from his home town because he had threatened the life of the son of a university professor, who up to that time had been his best friend. He ascribed truly devilish intentions to his erstwhile friend and credited him with power of a demon. He was to blame for all the misfortunes that had in recent years befallen the family of the patient, for all his personal and social ill-luck. But this was not enough. The wicked friend, and his father the professor, had been the cause of the war and had called the Russians into the land.
He had forfeited his life a thousand times and our patient was convinced that with the death of the culprit all misfortune would come to an end.
And yet his old affection for his friend was so great that it had paralyzed his hand when he had had the opportunity of shooting down the enemy at close quarters. In my short consultations with the patient, I discovered that the friendship between the two dated back to early school-life. Once at least the bonds of friendship had been over-stepped; a night spent together had been the occasion for complete s.e.xual intercourse. Our patient never felt attracted to women, as would have been natural to his age or his charming personality. At one time he was engaged to a beautiful and distinguished young girl, but she broke off the engagement because she found so little affection in her fiance.
Years later his malady broke out just at that moment when for the first time he had succeeded in giving complete gratification to a woman. When this woman embraced him, full of grat.i.tude and devotion, he suddenly felt a strange pain which cut around his skull like a sharp incision.
His later interpretation of this sensation was that an incision such as is used to expose a part of the brain had been performed upon him, and since his friend had become a pathological anatomist, he gradually came to the conclusion that he alone could have sent him this last woman as a temptation. From that time on his eyes were also opened to the other persecutions in which he was to be the victim of the intrigues of his former friend.
But how about those cases where the persecutor is not of the same s.e.x as the persecuted, where our explanation of a guard against h.o.m.os.e.xual libido is apparently contradicted? A short time ago I had occasion to investigate such a case and was able to glean corroboration from this apparent contradiction. A young girl thought she was followed by a man, with whom she had twice had intimate relations. She had, as a matter of fact, first laid these maniacal imputations at the door of a woman, whom we may consider as having played the part of a mother-subst.i.tute in her psychic life. Only after the second meeting did she progress to the point of diverting this maniacal idea from the woman and of transferring it to the man. The condition that the persecutor must be of the same s.e.x was also originally maintained in this instance. In her claim before the lawyer and the physician, this patient did not mention this first stage of her mania, and this caused the appearance of a contradiction to our theory of paranoia.
h.o.m.os.e.xual choice of object is originally more natural to narcism than the heteros.e.xual. If it is a matter of thwarting a strong and undesirable h.o.m.os.e.xual impulse, the way back to narcism is made especially easy. Until now I have had very little opportunity of speaking to you about the fundamental conditions of love-life, so far as we know them, and now I cannot make up for lost time. I only want to point out that the choice of an object, that progress in the development of the libido which comes after the narcistic stage, can proceed according to two different types--either according to the _narcistic_ type, which puts a very similar personality in the place of the personal ego, or according to the _dependent_ type, which chooses those persons who have become valuable by satisfying needs of life other than as objects of the libido. We also accredit a strong fixation of the libido to the narcistic type of object-choice when there is a disposition toward manifest h.o.m.os.e.xuality.
You will recall that in our first meeting of this semester I told you about the case of a woman who suffered from the mania of jealousy. Since we are so near the end you certainly will be glad to hear the psychoa.n.a.lytic explanation of a maniacal idea. But I have less to say about it than you expect. The maniacal idea as well as the compulsion idea cannot be a.s.sailed by logical arguments or actual experience. This is explained by their relation to the unconscious, which is represented by the maniacal idea or the compulsion idea, and held down by whichever is effective. The difference between the two is based upon respective localization and dynamic relations of the two conditions.
As in paranoia, so also in melancholia, of which, moreover, very different clinical forms are described. We have discovered a point of vantage which will yield us an insight into the inner structure of the condition. We realize that the self-accusations with which these melancholic patients torture themselves in the most pitiless way, really apply to another person, namely, the s.e.x object which they have lost, or which through some fault has lost value for them. From this we may conclude that the melancholic has withdrawn his libido from the object.
Through a process which we designate as "narcistic identification" the object is built up within the ego itself, is, so to say, projected upon the ego. Here I can give you only a descriptive representation, as yet without reference to the topical and dynamic relations. The personal ego is now treated in the same manner as the abandoned object, and suffers all the aggression and expressions of revenge which were planned for the object. Even the suicidal tendencies of melancholia are more comprehensible when we consider that this bitterness of the patient falls alike on the ego itself and on the object of its love and hate. In melancholia as well as in other narcistic conditions a feature of emotional life is strikingly shown which, since the time of Bleuler, we have been accustomed to designate as _ambivalence_. By this we mean that hostile and affectionate feelings are directed against one and the same person. I have, in the course of these discussions, unfortunately not been in a position to tell you more about this emotional ambivalence.
We have, in addition to narcistic identification, an hysterical identification as well, which moreover has been known to us for a much longer time. I wish it were possible to determine clearly the difference between the two. Of the periodic and cyclic forms of melancholia I can tell you something that you will certainly be glad to hear, for it is possible, under favorable circ.u.mstances--I have twice had the experience--to prevent these emotional conditions (or their ant.i.theses) by means of a.n.a.lytic treatment in the free intervals between the attacks. We learn that in melancholia as well as in mania, it is a matter of finding a special way for solving the conflict, the prerequisites for which entirely coincide with those of other neuroses.
You can imagine how much there still is for psychoa.n.a.lysis to learn in this field.
I told you, too, that we hoped to gain a knowledge of the structure of the ego, and of the separate factors out of which it is built by means of the a.n.a.lysis of narcistic conditions. In one place we have already made a beginning. From the a.n.a.lysis of the maniacal delusion of being watched we concluded that in the ego there is really an agent which continually watches, criticizes and compares the other part of the ego and thus opposes it. We believe that the patient imparts to us a truth that is not yet sufficiently appreciated, when he complains that all his actions are spied upon and watched, all his thoughts recorded and criticized. He errs only in transferring this distressing force to something alien, outside of himself. He feels the dominance of a factor in his ego, which compares his actual ego and all of its activities to an _ideal ego_ that he has created in the course of his development. We also believe that the creation of this ideal ego took place with the purpose of again establishing that self-satisfaction which is bound up with the original infantile narcism, but which since then has experienced so many disturbances and disparagements. In this self-observing agent we recognize the ego-censor, the conscience; it is the same factor which at night exercises dream-censorship, and which creates the suppressions against inadmissible wish-impulses. Under a.n.a.lysis in the maniacal delusion of being watched it reveals its origin in the influence of parents, tutors and social environment and in the identification of the ego with certain of these model individuals.
These are some of the conclusions which the application of psychoa.n.a.lysis to narcistic conditions has yielded us. They are certainly all too few, and they often lack that accuracy which can only be acquired in a new field with the attainment of absolute familiarity.
We owe them all to the exploitation of the conception of ego-libido or narcistic libido, by the aid of which we have extended to narcistic neuroses those observations which were confirmed in the transference neuroses. But now you will ask, is it possible for us to succeed in subordinating all the disturbances of narcistic conditions and the psychoses to the libido theory in such a way that in every case we recognize the libidinous factor of psychic life as the cause of the malady, and never make an abnormality in the functioning of the instincts of self-preservation answerable? Ladies and gentlemen, this conclusion does not seem urgent to me, and above all not ripe for decision. We can best leave it calmly to the progress of the science. I should not be surprised to find that the power to exert a pathogenic influence is really an exclusive prerogative of the libidinous impulses, and that the libido theory will celebrate its triumphs along the whole line from the simplest true neurosis to the most difficult psychotic derangement of the individual. For we know it to be a characteristic of the libido that it is continually struggling against subordinating itself to the realities of the world. But I consider it most probable that the ego instincts are indirectly swept along by the pathogenic excitations of the libido and forced into a functional disturbance.
Moreover, I cannot see any defeat for our trend of investigation when we are confronted with the admission that in difficult psychoses the ego impulses themselves are fundamentally led astray; the future will teach us--or at least it will teach you. Let me return for one moment more to fear, in order to eliminate one last ambiguity that we have left. We have said that the relation between fear and the libido, which in other respects seems clearly defined, does not fit in with the a.s.sumption that in the face of danger real fear should become the expression of the instinct of self-preservation. This, however, can hardly be doubted. But suppose the emotion of fear is not contested by the egoistic ego impulse, but rather by the ego-libido? The condition of fear is in all cases purposeless and its lack of purpose is obvious when it reaches a higher level. It then disturbs the action, be it flight or defense, which alone is purposeful, and which serves the ends of self-preservation. If we accredit the emotional component of actual fear to the ego-libido, and the accompanying activity to the egoistic instinct to self-preservation, we have overcome every theoretical difficulty. Furthermore, you do not really believe that we flee _because_ we experience fear? On the contrary, we first are afraid _and then_ take to flight from the same motive that is awakened by the realization of danger. Men who have survived the endangering of their lives tell us that they were not at all afraid, they only acted. They turned the weapon against the wild animal, and that was in fact the most purposeful thing to do.
TWENTY-SEVENTH LECTURE
GENERAL THEORY OF THE NEUROSES
_Transference_
We are nearing the close of our discussions, and you probably cherish certain expectations, which shall not be disappointed. You think, I suppose, that I have not guided you through thick and thin of psychoa.n.a.lytic subject matter to dismiss you without a word about therapy, which furnishes the only possibility of carrying on psychoa.n.a.lysis. I cannot possibly omit this subject, for the observation of some of its aspects will teach you a new fact, without which the understanding of the diseases we have examined would be most incomplete.
I know that you do not expect any guidance in the technique of practising a.n.a.lysis for therapeutic purposes. You wish to know only along what general lines psychoa.n.a.lytic therapy works and approximately what it accomplishes. And you have an undeniable right to know this. I shall not actually tell you, however, but shall insist that you guess it yourselves.
Only think! You know everything essential, from the conditions which precipitate the illness to all the factors at work within. Where is there room for therapeutic influence? In the first place, there is hereditary disposition; we do not speak of it often because it is strongly emphasized from another quarter, and we have nothing new to say about it. But do not think that we underestimate it. Just because we are therapeutists, we feel its power distinctly. At any rate, we cannot change it; it is a given fact which erects a barrier to our efforts. In the second place, there is the influence of the early experiences of childhood, which are in the habit of becoming sharply emphasized under a.n.a.lysis; they belong to the past and we cannot undo them. And then everything that we include in the term "actual forbearance"--misfortunes of life out of which privations of love arise, poverty, family discord, unfortunate choice in marriage, unfavorable social conditions and the severity of moral claims. These would certainly offer a foothold for very effectual therapy. But it would have to be the kind of therapy which, according to the Viennese folk-tale, Emperor Joseph practiced: the beneficial interference of a potentate, before whose will men bow and difficulties vanish. But who are we, to include such charity in the methods of our therapy? Poor as we are, powerless in society, forced to earn our living by practicing medicine, we are not even in a position to treat free of charge those patients who are unable to pay, as physicians who employ other methods of treatment can do. Our therapy is too long drawn-out, too extended for that. But perhaps you are still holding to one of the factors already mentioned, and think that you have found a factor through which our influence may be effective. If the restrictions of morality which are imposed by society have a share in the privation forced upon the patient, treatment might give him the courage, or possibly even the prescription itself, to cross these barriers, might tell him how gratification and health can be secured in the renunciation of that ideal which society has held up to us but often disregards. One grows healthy then, by giving one"s s.e.xuality full reign. Such a.n.a.lytic treatment, however, would be darkened by a shadow; it does not serve our recognized morality. The gain to the individual is a loss to society.
But, ladies and gentlemen, who has misinformed you to this degree? It is inconceivable that the advice to give one"s s.e.xuality full reign can play a part in a.n.a.lytic therapy, if only from the circ.u.mstance we have ourselves described, that there is going on within the patient a bitter conflict between libidinous impulse and s.e.xual suppression, between sensual and ascetic tendencies. This conflict is not abolished by giving one of these tendencies the victory over its opponent. We see that in the case of the nervous, asceticism has retained the upper hand. The consequence of this is that the suppressed s.e.xual desire gains breathing s.p.a.ce by the development of symptoms. If, on the other hand, we were to give the victory to s.e.xuality, symptoms would have to replace the s.e.xual suppression, which has been pushed aside. Neither of the two decisions can end the inner conflict, one part always remains unsatisfied. There are only a few cases wherein the conflict is so labile, that a factor such as the intervention of the physician could be decisive, and these cases really require no a.n.a.lytic treatment. Persons who can be so much influenced by a physician would have found some solution without him.
You know that when an abstinent young man decides upon illegitimate s.e.x-intercourse, or when an unsatisfied woman seeks compensation from another man, they have generally not waited for the permission of a physician, far less of an a.n.a.lyst, to do this.
In studying the situation, one essential point is generally overlooked, that the pathogenic conflict of the neurotic must not be confused with normal struggles between psychic impulses of which all have their root in the same psychological soil. The neurotic struggle is a strife of forces, one of which has attained the level of the fore-conscious and the conscious, while the other has been held back in the unconscious stage. That is why the conflict can have no outcome; the struggling parties approach each other as little as in the well-known instance of the polar-bear and the whale. A real decision can be reached only if both meet on the same ground. To accomplish this is, I believe, the sole task of therapy.
Moreover, I a.s.sure you that you are misinformed if you a.s.sume that advice and guidance in the affairs of life is an integral part of the a.n.a.lytic influence. On the contrary, we reject this role of the mentor as far as possible. Above all, we wish to attain independent decisions on the part of the patient. With this intention in mind, we require him to postpone all vital resolutions such as choice of a career, marriage or divorce, until the close of the treatment. You must confess that this is not what you had imagined. It is only in the case of certain very young or entirely helpless persons that we cannot insist upon the desired limitation. Here we must combine the function of physician and educator; we are well aware of the responsibility and behave with the necessary precaution.
Judging from the zeal with which I defend myself against the accusation that a.n.a.lytic treatment urges the nervous person to give his s.e.xuality full reign, you must not gather that we influence him for the benefit of conventional morality. We are just as far removed from that. We are no reformers, it is true, only observers, but we cannot help observing with critical eyes, and we have found it impossible to take the part of conventional s.e.x morality, or to estimate highly the way in which society has tried to regulate the problems of s.e.xual life in practice.
We can prove to society mathematically that its code of ethics has exacted more sacrifices than is its worth, and that its procedure rests neither on veracity nor wisdom. We cannot spare our patients the task of listening to this criticism. We accustom them to weigh s.e.xual matters, as well as others, without prejudice; and when, after the completion of the cure, they have become independent and choose some intermediate course between unrestrained s.e.xuality and asceticism, our conscience is not burdened by the consequences. We tell ourselves: whoever has been successfully educated in being true to himself is permanently protected against the danger of immorality, even if his moral standard diverges from that of society. Let us, moreover, be careful not to overestimate the significance of the problem of abstinence with respect to its influence on neuroses. Only the minority of pathogenic situations of forbearance, with a subsequent condition of pent-up libido, can be resolved without more ado by such s.e.xual intercourse as can be procured with little trouble.
And so you cannot explain the therapeutic influence of psychoa.n.a.lysis by saying that it simply recommends giving full sway to s.e.xuality. You must seek another solution. I think that while I was refuting this supposition of yours, one of my remarks put you on the right track. Our usefulness consists in replacing the unconscious by the conscious, in translating the unconscious into the conscious. You are right; that is exactly it. By projecting the unconscious into the conscious, we do away with suppressions, we remove conditions of symptom formation and transform a pathogenic into a normal conflict which can be decided in some way or other. This is the only psychic change we produce in our patients; its extent is the extent of our helpfulness. Wherever no suppression and no a.n.a.logous psychic process can be undone, there is no place for our therapy.
We can express the aim of our efforts by various formulae of rendering the unconscious conscious, removing suppressions, filling out amnestic gaps--it all amounts to the same thing. But perhaps this admission does not satisfy you. You imagined that when a nervous person became cured something very different happened, that after having been subjected to the laborious process of psychoa.n.a.lysis, he was transformed into a different human being. And now I tell you that the entire result is only that he has a little less of the unconscious, a little more of the conscious within him. Well, you probably underestimate the significance of such an inner change. The person cured of neurosis has really become another human being. Fundamentally, of course, he has remained the same.
That is to say, he has only become what he might have been under the most favorable conditions. But that is saying a great deal. When you learn all that has to be done, the effort required to effect apparently so slight a change in psychic life, the significance of such a difference in the psychic realm will be credible to you.
I shall digress for a moment to ask whether you know what is meant by a causal therapy? This name is given to the procedure which does not take the manifestations of disease for its point of departure, but seeks to remove the causes of disease. Is our psychoa.n.a.lytical therapy causal or not? The answer is not simple, but perhaps it will give us the opportunity of convincing ourselves that this point of departure is comparatively fruitless. In so far as a.n.a.lytical therapy does not concern itself immediately with the removal of symptoms, it may be termed causal. Yet in another respect, you might say this would hardly follow. For we have followed the causal chain back far beyond the suppressions to the instinctive tendencies and their relative intensity as given by the const.i.tution of the patient, and finally the nature of the digression in the abnormal process of its development. a.s.sume for a moment that it were possible to influence these functions chemically, to increase or to decrease the quant.i.ty of the libido that happens to be present, to strengthen one impulse at the expense of another. This would be causal therapy in its true sense and our a.n.a.lysis would have furnished the indispensable preparatory work of reconnaissance. You know that there is as yet no possibility of so influencing the processes of the libido. Our psychic therapy interposes elsewhere, not exactly at those sources of the phenomena which have been disclosed to us, but sufficiently far beyond the symptoms, at an opening in the structure of the disease which has become accessible to us by means of peculiar conditions.
What must we do in order to replace the unconscious by the conscious in our patient? At one time we thought this was quite simple, that all we had to do was to reconstruct the unconscious and then tell the patient about it. But we already know this was a shortsighted error. Our knowledge of the unconscious has not the same value as his; if we communicate our knowledge to him it will not stand _in place of_ the unconscious within him, but will exist _beside_ it, and only a very small change will have been effected. We must rather think of the unconscious as _localized_, and must seek it in memory at the point where it came into existence by means of a suppression. This suppression must be removed before the subst.i.tution of the conscious for the unconscious can be successfully effected. How can such a suppression be removed? Here our task enters a second phase. First to find the suppression, then to remove the resistance by which this suppression is maintained.
How can we do away with resistance? In the same way--by reconstructing it and confronting the patient with it. For resistance arises from suppression, from the very suppression which we are trying to break up, or from an earlier one. It has been established by the counter-attack that was instigated to suppress the offensive impulse. And so now we do the very thing we intended at the outset: interpret, reconstruct, communicate--but now we do it in the right place. The counter-seizure of the idea or resistance is not part of the unconscious but of the ego, which is our fellow-worker. This holds true even if resistance is not conscious. We know that the difficulty arises from the ambiguity of the word "unconscious," which may connote either a phenomenon or a system.
That seems very difficult, but it is only a repet.i.tion, isn"t it? We were prepared for it a long time ago. We expect resistance to be relinquished, the counter-siege to collapse, when our interpretation has enabled the ego to recognize it. With what impulses are we able to work in such a case? In the first place, the patient"s desire to become well, which has led him to accommodate himself to co-operate with us in the task of the cure; in the second place, the help of his intelligence, which is supported by the interpretation we offer him. There is no doubt that after we have made clear to him what he may expect, the patient"s intelligence can identify resistances, and find their translation into the suppressions more readily. If I say to you, "Look up into the sky, you can see a balloon there," you will find it more readily than if I had just asked you to look up to see whether you could discover anything. And unless the student who for the first time works with a microscope is told by his teacher what he may look for, he will not see anything, even if it is present and quite visible.
And now for the fact! In a large number of forms of nervous illness, in hysteria, conditions of anxiety and compulsion neuroses, one hypothesis is correct. By finding the suppression, revealing resistance, interpreting the thing suppressed, we really succeed in solving the problem, in overcoming resistance, in removing suppression, in transforming the unconscious into the conscious. While doing this we gain the clearest impression of the violent struggle that takes place in the patient"s soul for the subjugation of resistance--a normal psychological struggle, in one psychic sphere between the motives that wish to maintain the counter-siege and those which are willing to give it up. The former are the old motives that at one time effected suppression; among the latter are those that have recently entered the conflict, to decide it, we trust, in the sense we favor. We have succeeded in reviving the old conflict of the suppression, in reopening the case that had already been decided. The new material we contribute consists in the first place of the warning, that the former solution of the conflict had led to illness, and the promise that another will pave the way to health; secondly, the powerful change of all conditions since the time of that first rejection. At that time the ego had been weak, infantile and may have had reason to denounce the claims of the libido as if they were dangerous. Today it is strong, experienced and is supported by the a.s.sistance of the physician. And so we may expect to guide the revived conflict to a better issue than a suppression, and in hysteria, fear and compulsion neuroses, as I have said before, success justifies our claims.
There are other forms of illness, however, in which our therapeutic procedure never is successful, even though the causal conditions are similar. Though this may be characterized topically in a different way, in them there was also an original conflict between the ego and libido, which led to suppression. Here, too, it is possible to discover the occasions when suppressions occurred in the life of the patient. We employ the same procedure, are prepared to furnish the same promises, give the same kind of help. We again present to the patient the connections we expect him to discover, and we have in our favor the same interval in time between the treatment and these suppressions favoring a solution of the conflict; yet in spite of these conditions, we are not able to overcome the resistance, or to remove the suppression. These patients, suffering from paranoia, melancholia, and dementia praec.o.x, remain untouched on the whole, and proof against psychoa.n.a.lytic therapy.
What is the reason for this? It is not lack of intelligence; we require, of course, a certain amount of intellectual ability in our patients; but those suffering from paranoia, for instance, who effect such subtle combinations of facts, certainly are not in want of it. Nor can we say that other motive forces are lacking. Patients suffering from melancholia, in contrast to those afflicted with paranoia, are profoundly conscious of being ill, of suffering greatly, but they are not more accessible. Here we are confronted with a fact we do not understand, which bids us doubt if we have really understood all the conditions of success in other neuroses.
In the further consideration of our dealings with hysterical and compulsion neurotics we soon meet with a second fact, for which we were not at all prepared. After a while we notice that these patients behave toward us in a very peculiar way. We thought that we had accounted for all the motive forces that could come into play, that we had rationalized the relation between the patient and ourselves until it could be as readily surveyed as an example in arithmetic, and yet some force begins to make itself felt that we had not considered in our calculations. This unexpected something is highly variable. I shall first describe those of its manifestations which occur frequently and are easy to understand.