Part 5

“What may those events be which analysis must unearth for therapeutic purposes?”

Events of various nature.

In the first place, impressions strong enough to permanently influence the awakening sex life of the child, such as observation of sexual intercourse between adults or personal sexual experiences with an adult or some other child—occurrences not at all rare. Then, overhearing the conversation of adults, at a time when the child did not fully comprehend the significance, but which, when the child came to grasp the real meaning, conveyed to him knowledge to be coveted because of the air of secrecy and mystery attached to it. Furthermore, utterances and actions of the child himself, demonstrating a decidedly tender or else hateful inclination toward other persons. It is of special importance, in the course of the analysis, to revive cases of forgotten personal sexual indulgence, and the interference of adults which served to terminate these habits.

“It seems to be my turn, now, to ask a question which I have had on my mind for a long time. What do you call ‘sexual indulgence’ of a child, during his period of early sexuality which, as you say, is a time that was completely overlooked before the advent of psychoanalysis?”

Of course that which is usual and essential in this indulgence had not been overlooked. This is not so remarkable, because it simply couldn’t be overlooked. Sexual tendencies of the child find their expression mainly in masturbation. That this childish “naughtiness” is extraordinarily common was always known to adults. It is considered a grave sin, to be energetically suppressed.

But please do not ask me how such “immoral” tendencies in children—and children admit that they indulge in them because they give them pleasure!—can co-exist with that inborn purity and non-sensuality of which we love to prate. You had better ask our opponents to solve this puzzle for you.

A much more important problem is facing us now:—What is the position to take towards sexual indulgence in early childhood?

There is not the slightest doubt as to the responsibility incurred by suppressing such actions and, on the other hand, one dare not permit it to go on, limitless.

It appears that sexuality of children is unrestricted among peoples of low civilization and in the lower strata of civilized people. Such tolerance may amount to a strong protection against the possibility of neuroses cropping up in later years, but the question is whether there does not then remain a concurrent, extraordinary loss in regard to an individual’s aptness for cultural achievements. It seems we are facing a case of Scylla and Charybdis there.

However, I shall leave it to you to decide whether such interest, as the study of sex life may have for neurotics, would tend to create an atmosphere, favorable for the awakening of libidinous desires.

VI

“I think I know now what your intentions are:—You wish to show me just what knowledge is necessary for the practice of psychoanalysis, so that I may be able to judge whether physicians alone shall be permitted to apply this method. Up to now, you have mainly discussed psychology, and a little biology or sex science, without a decided medical slant. However, I may not have heard everything yet.”

Certainly not. There are still a number of gaps to be filled. But may I ask you a favor? Will you be good enough to describe to me how you imagine psychoanalytical treatment is applied? Just pretend as if it were up to you to analyse a patient.

“Well, I may make quite a mess of this! It is surely not my intention to settle the argument between us, on the basis of such an experiment. However, I shall do as you ask. After all, the responsibility falls upon your shoulders.

“Now then: I assume that the patient comes to see me and embarks upon a recital of his complaints. I promise him to cure, or at least improve, his condition, provided that he will follow my instructions. Then, I would ask him to tell me, in all frankness, what he knows, what ideas enter his mind. I should also request him to make a clean breast of everything, even though there may be things which he would hate to mention. Am I adhering to your methods?”

You are! But, in addition you should have the patient tell you all his thoughts, even if they seem unimportant to him or lacking in sense.

“Very well.—The patient, then, starts to relate his story and I listen. And what next? Oh, yes, his information will make it possible for me to conclude what impressions, experiences and desires he may have repressed, because he came face to face with them at a time when his ‘I’ was still weak and too intimidated to face the dilemma squarely.

“After I have told that to the patient, he will reconstruct the old situations and correct his reactions to them with my assistance. Thus, the repressions, his ‘I’ had been forced to resort to, will disappear and he is cured.—Is that correct?”

Very good, indeed.—I already foresee that more people are going to reproach me for having trained a non-medical man to practise psychoanalysis. I surely must admit that you digested what I told you.

“I have only repeated what you told me, like reciting something that has been committed to memory.

“But I do not feel able to clearly visualize how I really would go about it. I cannot understand why such an analysis should require an hour or more a day, for a period of months. As a rule, the average human being has not met with so many experiences. And as far as repressions during childhood are concerned, I assume that these are probably identical in all cases.”

There are many new experiences to make in the course of an analysis.

For example: You would find that it is not so simple at all, from the information a patient may volunteer, to draw conclusions as to those of his experiences which he has forgotten, the urges which he once repressed.

A patient may tell you something which, at the moment, has just as little sense for you as for him. You will have to make up your mind that the material which the patient lays before you, in accordance with the instruction you gave him, must be interpreted in a special way. Analogous, perhaps, to the treatment iron ore receives for the purpose of extracting from it valuable steel by some special process. In retaining this picture, for the purpose of comparison, you must know that tons and tons of iron ore contain only very little of the valuable steel for which you are looking. This is one reason which would account for the fact that psychoanalytical treatment is such a long drawn-out process.

“But how is this ‘iron ore’ to be converted, to apply your comparison once more?”

By assuming that the information and ideas of a patient are nothing but distorted pictures of those impressions and experiences you are trying to unearth. Hints, as it were, from which you would have to conclude what is really behind them. To press it into a formula: the information a patient yields, be it memories, ideas or dreams, will have to be interpreted first. This interpretation, of course, must be guided by the expectations you formed of the case on the basis of professional knowledge, while listening to the patient’s recital.

“‘Interpretation’! What a dreadful word! I do not like to hear this term because, in applying it, you are depriving me of all confidence. If everything depends on my interpretation, who is going to assure me that my interpretation is correct? Such a state of affairs, according to my mind, simply means that everything is left to fancies and whims.”

Just a moment, now! Things are not as bad as all that. Why exclude processes of your own soul from the same rule which you are ready to admit to that of others?

Provided you have acquired a certain self-discipline and are in the possession of sufficient information, your interpretations will not be influenced by personal peculiarities, and are bound to prove correct.

Do not draw the conclusion from this that it is my opinion that the personality of the analyst does not make any difference, for this phase of the analysis. A certain sensitiveness for that which was unconsciously repressed, is necessary; also an aptness with which everybody is not equally endowed. Most of all, it is here where the absolute necessity for a thorough and searching self-analysis of the analyst is proved, for the purpose of precluding any prejudice that may drag a distorted element into the interpretation.

One thing, of course, still remains: Personal Equation, which, as an element of individuality, is destined to play a much more important part in psychoanalysis than anywhere else. Although an abnormal man may develop into an expert physicist, an analyst will always be handicapped by his own anomalies, when it comes to conceive pictures of soul life, free from distortions.

Inasmuch as it is impossible to prove to anybody his anomalies, general unanimity in the matter of Psychology of the Depths will prove especially difficult to achieve. There are even a handful of psychologists who claim it to be practically impossible ever to achieve such unanimity, and who also insist that every fool is entitled to proclaim his special brand of foolishness as wisdom.

I admit I am more optimistically inclined. After all, our experiences prove that, even in psychology, harmony of opinion may be achieved to a tolerably satisfactory degree. No doubt, each individual realm of science presents its own individual difficulties which have to be eliminated. Moreover, there are some aspects of the art of interpretation, as applied in analysis which, like some other knowledge, may be acquired by study. For example, those aspects pertaining to the peculiarly indirect representation by symbols.

“To be frank with you: I have lost all ambition, even to dabble theoretically with the application of psychoanalysis. Heaven knows what further surprises are still in store for me!”

You are perfectly correct to abandon such an intention.

You have already convinced yourself how much training and practice is necessary. And once you have found the correct interpretations, a new problem presents itself. It is then up to you to lay in wait and virtually pounce upon the correct, the psychological moment, if you wish to acquaint your patient of your interpretations with the idea of benefiting him.

“How to tell what is the psychological moment?”

That is a matter of extreme tact which, by the way, may be greatly improved through experience. You would commit a very grave error if you would fling your interpretation, as soon as it had been ascertained, at the patient. This would only lead to resistance, refusal, indignation, but never result in his “I” getting a firm hold of whatever it was that caused his repressions. It is an iron clad rule to permit your patient to approach this elusive cause of repression close enough, to make it possible for him to obtain an immediate and strong grip on it, under the correctly timed guidance of the interpretation you may suggest.

“I am very much afraid that I would never master this art. But suppose that I observe this rule strictly, then what?”

Then it will be your lot to make a discovery which you did not expect to make.

“What kind of a discovery?”

That you had an entirely wrong opinion about your patient. That there is no reason in the world for you to depend on his coöperation or complacency. That, as a matter of fact, your patient is resolved to raise as many obstacles as possible against your combined exertions. With one word: that he does not altogether want to get well!

“Well, that is about the most ludicrous statement you have made so far! I simply don’t believe it! The patient, suffering so intensely, complaining so heartrendingly, sacrificing so much to be cured, actually does not want to get well! Is it possible you really mean what you say?”

I mean every word of it! What I have just stated is the truth. Not the whole truth, but a good deal of it. The patient wants, yet does not want, to get well. Because his “I” has lost its unity of purpose, it is preventing him from summing up undivided will power. Were the state of affairs a different one, our patient would not be a neurotic!

The results of his repression have simply invaded his “I,” firmly holding their ground there, so to speak. The “I” is wielding just as little influence over these effects as over the repression itself. Usually, the “I” is not at all aware of the prevailing state of affairs. These patients are of a peculiar type, putting difficulties in our way which we do not expect to encounter. All our social institutions are organized to fit individuals with a unified, normal “I,” which may be classified as either good or bad. This “I” either functions properly, or is impeded by some overwhelming influence. Thus, the forensic alternative: mentally responsible or not responsible.

But all these standard terms do not fit the neurotic!

Doubtless, it is difficult to adapt the demands of social life to their psychological condition. During the War, this was proved to a great extent.

Were those neurotics who shirked from military duty, pretending illness, simulants or not?

They were both!

As soon as such patients were treated as simulants, by making it uncomfortable for them to indulge in sickness, they recuperated; and as soon as allegedly cured patients had been returned to the rank and file, they once more became ill. There was simply no way to deal effectively with them.

Analogous to this is the case of the neurotic in everyday life.

They complain about their sickness, at the same time exploiting it to the limit. As a matter of fact, if an attempt is made to cure them of their ailment, they will protect this most cherished possession of theirs with the selfsame fervor with which a lioness defends her offspring. But there would be no sense in blaming neurotics for the contradictory behavior they display.

“Would it not be best, then, not to treat such difficult people at all? Simply leave them to themselves? It seems to me that it cannot possibly be worthwhile to spend as much effort on them as appears necessary, according to what you say.”

I do not agree with you on this point.

Doubtless, it seems wiser to simply submit to the complications which life presents, rather than to fight them. Not each and every one of the neurotics we treat may be worth the exertions of an analysis, but there are surely enough worthwhile individuals among them. It must be our goal to decrease the number of persons who are forced to face the exasperations of civilized life with a soul insufficiently prepared. To this end, we must collect experience upon experience, and come to fully grasp many problems. Every analysis is bound to prove instructive, yielding new knowledge, aside from the personal benefit it may confer upon an individual patient.

“Supposing that the ‘I’ of a patient developed such tendencies which would make him wish to retain the sickness of which he complains, would not these tendencies be justified, on the basis of certain reasons and motives? It is impossible for me to understand why somebody should want to be sick. What satisfaction could he derive from that?”

Just remember the war neurotics who were exempt from duty, because they were considered sick. In everyday life, sickness may be successfully employed as a screen, behind which to hide professional insufficiencies, or—in the circle of family life—as a means to induce relatives to make sacrifices, demonstrations of affection, or to foist one’s will upon them, generally. All this is quite obvious and comes under the term “sickness profit” (analogous to war profit). It is remarkable, however, that the neurotic, or rather his “I,” proves unable to grasp the connection of such motives with their logical consequences.

The influence of such tendencies to gain “sickness profit” is combated, by forcing the “I” to become aware of them. But there are still other, more obscure motives, for holding on to sickness, which cannot be disposed so easily. As a matter of fact, these reasons cannot be understood, without venturing once more into the sphere of psychological theories.

“Oh, go right ahead! A little theory, more or less—what does it matter?”

When I explained to you the relations between the “I” and the “It,” I withheld from you an important part of the soul apparatus. You see, within the “I” itself, there persists a particular faction which we call the “Super-Ego.”

This “Super-Ego” enjoys a privileged position between the “I” and the “It.” It belongs to the “I,” sharing with it its intricate psychological make-up. On the other hand, it entertains very close relations with the “It.” The “Super-Ego” is in reality the record of first impressions as conceived by the “It”; it is the heir of the dissolved Œdipus Complex.

This “Super-Ego,” as a matter of fact, is able to oppose the “I,” act towards it as if it were something inferior and, in general, treat it almost with contempt. For the “I” it is just as important to remain in agreement with the “Super-Ego” as with the “It.” Disagreement between the “Super-Ego” and the “I” is of far-reaching consequences for the soul life.

Doubtless, you have already surmised that the “Super-Ego” is the agent of that phenomenon which we call our conscience.

For the maintenance of healthy soul life, it is very important that the “Super-Ego” develop normally, that is, becomes sufficiently impersonal. It is just this development which is insufficient in the neurotic, because his Œdipus Complex was not properly transformed. His “Super-Ego,” in regard to the “I,” still assumes the rôle of the strict father to the child, with the morality of the “I” manifesting itself in a primitive manner by meekly submitting to punishment, meted out by the “Super-Ego.” Sickness is resorted to, as the means of this “self-punishment.” The neurotic, behaving as if under a burden of guilt accepts sickness as a punishment to assuage this feeling of delinquency.

“That sounds very mysterious. But the most remarkable thing seems to be that the patient remains unconscious of the power of his conscience.”

Well, we are only now beginning to appreciate the importance of all these vital conditions. That is the reason why my explanations were so puzzling to you. But now, I believe I can continue.

All those agents which oppose the recuperation of a patient, we term the “resistance” of the patient. While “sickness profit” is the source of such resistance, the “unconscious feeling of guilt” represents the resistance of the “Super-Ego” of which, as the strongest factor, we are very much in fear.

But there are other manifestations of resistance which become evident in the process of treatment.

If the “I,” at an early period, was induced through fear, to take recourse to a repression, this fear still persists, manifesting itself now as a resistance, as soon as the “I” approaches that which was repressed. It is easy enough to realize that difficulties may be encountered, if a certain tendency, which for decades has proceeded along a specific course, is suddenly expected to swing into a new path opened to it.

Such a condition may be termed the resistance of the “It.”

The battle against all these resistances is our main work during the analytical treatment, in comparison with which the task of interpretation almost fades into insignificance. But by this battle and the ensuing defeat of resistances, the “I” of the patient is so transformed and strengthened that his future behavior, after the termination of the treatment, may be regarded with complete equanimity.

On the other hand, you will understand now why our treatment is so protracted. Expanse and multifariousness of the material are not as decisive factors as the question of whether the way is clear. Remember that the same course, which in times of peace, may be traveled in a few hours by railroad, may take an army, during wartime, weeks and weeks, because the resistance of the enemy must first be overcome. Battles to overcome resistance require time in soul life also. I am sorry to say that, up to now, all exertions to shorten the duration of analytical treatments to any appreciable degree, have proved unavailing. It seems that the best way to shorten the length of the treatment, is simply to apply it as correctly as possible.

“If I ever felt the temptation to dabble with your science and to attempt to analyze a patient, your information in reference to those resistances, that may be encountered, cured me thoroughly of any such ambition.

“But, tell me about the element of personal influence which you have admitted is present in the analysis. Is this not a valuable factor in the battle against resistance?”

I am glad that you bring this question up. This personal influence is our strongest dynamic weapon; it is the agent which we introduce as something new, into the analytical situation, thus lending it impetus.

This could never be accomplished by the intellectual substance of our interpretation alone because the patient, sharing all the prejudices of his environment, need not have more faith in us than our scientific critics. The neurotic coöperates with the analyst simply because he believes in him, and he believes in him because he gradually develops a certain sentimental trend toward the analyst. A child, also, believes only persons to whom it is attached.

I have already told you how we employ this especially great “suggestive” influence. Not to suppress the symptoms—it is here where the analytical method is utterly unlike any other psycho-therapeutical method!—but as a driving power to induce the “I” of the patient to defeat his resistances.

“And suppose you succeed? Would that insure easy sailing from then on?”

Such ought to be the case. But an unexpected complication arises.

It was perhaps the greatest surprise for the analyst to observe that the sentimental relations which the patient endeavors to establish, are of a very particular nature. Already the first physician who attempted analysis—it was not I—discovered this phenomenon, which served to bewilder him intensely. These sentimental relations are, to express it bluntly, of an amorous nature. Remarkable, isn’t it, if you take into consideration the fact that the analyst does nothing to invite such emotions, but rather endeavors to maintain distance, sentimentally speaking, between the patient and himself.

All this is so much more remarkable, as these odd sentimental relations utterly disregard all such obstacles, as difference in age, sex, and social strata. This amorousness appears fated. Not that it constitutes a characteristic otherwise alien to spontaneous love. You are well aware that the contrary of this may be only too frequently observed. Although it is the rule in the analytical situation, the latter, as such, cannot serve as a rational explanation for this development. To all appearances, nothing else should result from the relation between the patient and the analyst, than just a certain measure of respect, confidence, gratitude and humane sympathy. However, what really results from it is this condition of attachment, which in itself gives the impression of being some disorder.

“Well, I should say that such a development would tend to favor analytical purposes. If one is enamoured, one is complacent and ready to do almost anything for love’s sweet sake.”