Part 8
Most of the subjects, however, belonging to medical training, will not be of any use to him and although all this knowledge is highly valuable for those who need it, it would not assist the analyst to understand a neurotic condition nor to alleviate it. In case the objection is made here that specialists in other fields of medical endeavor, also do not need all the details they acquire in the course of their training, it must be said that such a case could not be considered analogous. For many branches of medicine, such facts as, for example, Pathology presents, are of great importance. The analyst, however, reaches out for a variety of experiences, with different phenomena, underlying different laws. Although philosophy may succeed in bridging the chasm between body and soul, as far as our own experience is concerned, this chasm, nevertheless, exists, presenting itself in an especially striking light, as regards our practical endeavors.
It seems unjust and impractical to force a person to take a roundabout route via medical training, if this person be bent upon relieving another individual from the agonies of a phobia or a fixed idea. Moreover, such a procedure would be ineffective, as long as psychoanalysis in general is not suppressed.
Just imagine that somewhere in the country, there is a certain mountain top that can be reached by two different roads, the one being short and straight, and the other long and winding. An attempt is made to block the short road by a “no-trespass” sign. There is some chance of this sign being respected, if the short road is steep and difficult to climb, whereas the long road is easy to travel. However, if the detour should be the more difficult road, you can easily surmise how little the trespassing sign would be respected.
I am very much afraid it will be just as difficult to force the laymen to study medicine, as it is for me to induce physicians to study psychoanalysis. Human nature is like that.
“If you are correct in your assumption that analytical treatment cannot be administered without a special training, but that on the other hand the medical curriculum could not bear the burden of psychoanalytical training, and that medical knowledge, to the greatest extent, is superfluous for the analyst, how will we ever achieve the ideal medical personality, the physician who can cope with all the demands of his profession?”
I am unable to foresee how to solve these difficulties, and I do not feel called upon to make any suggestions. I only perceive two things clearly: firstly, that the analysis seems to constitute a dilemma, but certainly the neurotic is also a dilemma; secondly, that for the time being, all interests would be served if physicians resolve to tolerate a class of therapeutists who will relieve them of the arduous treatment of those tremendously frequent psychical neuroses, in addition benefiting the patients by remaining in constant contact with them.
“Is that your last word in reference to the problem of lay-analyses, or is there something else?”
There is a third interest to be considered:—that of science. Although what I have to say in that respect may not mean much to you, it nevertheless means a good deal to me.
We do not consider it advisable that psychoanalysis be swallowed up by medicine, finally to be shelved in a text-book of psychiatry, under the chapter heading of Therapy, together with such other treatments as Hypnotic Suggestion, Auto Suggestion, Persuasion which, due to lack of knowledge, were indebted for their short lives to the indolence and ignorance of the broad masses. Psychoanalysis deserves a better fate, which, let us hope, it will really attain.
As the Psychology of the Depths, the teaching of the Unconscious, psychoanalysis may prove indispensable to all sciences which deal with the development of human culture, and such of its great achievements as art, religion, and civilized society. Psychoanalysis has already appreciably assisted these sciences in the solution of their problems. But all this is insignificant, compared to what may be achieved through psychoanalysis in the future, when students of History, Psychology of Religion, and Etymology, will avail themselves to the fullest extent of the assistance psychoanalysis will be able to render them.
The employment of psychoanalysis for the treatment of neuroses is only one of its possibilities, and time may yet prove that this is not even the most important of them. At any rate, it would be unfair to sacrifice all other advantages of psychoanalysis, simply because there is just one phase where the application of psychoanalysis encroaches upon the preserves of medicine.
Here another aspect manifests itself which cannot be interfered with, without causing damage. If the representatives of the different sciences should really take up the study of psychoanalysis, to apply it in their own spheres of interest, it would not suffice for them to merely avail themselves of such results as have been recorded in psychoanalytical literature. They will have to come to an understanding of psychoanalysis in the only way possible, that is, by submitting themselves to analysis.
Thus, to the neurotics in need of analysis, a second class of persons would be added: those who undergo analysis for intellectual reasons and who would welcome that intensification of their efficiency which would result incidentally from analysis. To undertake these analyses, a number of analysts would be necessary for whom medical knowledge would be of specially limited importance. However, these instructor-analysts—as they ought to be called—are in need of an especially thorough training, which they can only obtain if they are given opportunities to study interesting and convincing cases. Inasmuch as healthy persons do not feel the necessity and curiosity to be analysed, neurotics would have to be the objects of study for the instructor-analysts. Their study would be guided by expert analysts, with a special eye to their future, non-medical work. Of course, all this necessitates a certain amount of freedom of action, and would not brook petty interference.
Perhaps you do not believe in these strictly theoretical endeavors of psychoanalysis, and are not ready to admit their importance, in connection with the practical side of the problem of lay-analyses. In that case, let me remind you that there is another field for the application of psychoanalysis, outside the hunting ground of the “quack”—a field which physicians will hardly claim as their own. I allude to the application of psychoanalysis to pedagogy.
As soon as a child manifests the first signs of an undesirable development, by being moody, stubborn and inattentive, neither the child specialist nor the school physician will be able to do anything for him; not even when a child shows such clear signs of nervous disturbances as timidity, lack of appetite, vomiting, and sleeplessness. A treatment which combines analytical influence with pedagogic measures and is applied by persons who are not above delving into the child’s own world and who understand how to penetrate the soul life of the child, will succeed not only in dissolving nervous disturbances, but also in reversing incipient traits of character.
The importance which we were forced to attach to apparently unimportant neurotic conditions of children, in view of the fact that they very often serve as a disposition for disturbances in later life, would prove that the analyses of children constitute a splendid means of prophylaxis. Although psychoanalysis still has its enemies, I do not know what means are at their disposal to hinder the activity of a pedagogic analyst, or analytical pedagogue, and I doubt whether this could be done so easily.
To return once more to the problem of the analytical treatment of adults, suffering from nervous disturbances, we have not yet exhausted all points of view. Civilized life of today exerts an almost unbearable pressure, which necessitates corrective measures. Does it seem too fantastic to expect that psychoanalysis, in spite of the many difficulties it encounters, should be called upon to furnish this corrective agent? Maybe some American millionaire will one day donate enough money for the psychoanalytical training of the social workers of his country, thus creating an emergency corps, to fight neurotic conditions brought about by present-day life.
“You mean some sort of a new Salvation Army?”
Why not? After all, our fancy always follows existing patterns. The stream of eager students that will then flood towards Europe, will, of course, have to pass Vienna, because there the development of psychoanalysis may have prematurely died, on account of governmental interference. You smile? I’m not saying this to sway your judgment. I know you don’t believe me, and I surely cannot guarantee that my predictions will come true. But there is one thing I know: it is not at all important what the opinions of individuals and of individual governments may be, in respect to the problem of lay-analyses. All this can only have limited effects. What is really important is that potentialities for the development of psychoanalysis cannot be affected by ordinances and prohibitions.
AN AUTOBIOGRAPHICAL STUDY
I
Several of the contributors to this series of “Autobiographical Studies”[2] have begun by expressing their misgivings at the unusual difficulties of the task they have undertaken. The difficulties in my case are, I think, even greater; for I have already more than once published papers upon the same lines as the present one, papers which, from the nature of the subject, have dealt more with personal considerations than is usual or than would otherwise have been necessary.
I gave my first account of the development and subject-matter of psychoanalysis in five lectures which I delivered in 1909 before Clark University at Worcester, Mass., where I had been invited to attend the celebration of the twentieth anniversary of the foundation of that body.[3] Only recently I gave way to the temptation of making a contribution of a similar kind to an American collective publication dealing with the opening years of the twentieth century, since its editors had shown their recognition of the importance of psychoanalysis by allotting a special chapter to it.[4] Between these two dates appeared a paper, “On the History of the Psycho-Analytic Movement,”[5] which, in fact, contains the essence of all that I can say on the present occasion. Since I must not contradict myself and since I have no wish to repeat myself exactly, I must endeavor to construct a narrative in which subjective and objective attitudes, biographical and historical interests, are combined in a new proportion.
I was born on May 6th, 1856, at Freiberg in Moravia, a small town in what is now Czecho-Slovakia. My parents were Jews, and I have remained a Jew myself. I have reason to believe that my father’s family were settled for a long time on the Rhine (at Cologne), that, as a result of a persecution of the Jews during the fourteenth or fifteenth century, they fled eastwards, and that, in the course of the nineteenth century, they migrated back from Lithuania through Galicia into German Austria. When I was a child of four I came to Vienna, and I went through the whole of my education there. At the Gymnasium I was at the top of my class for seven years; I enjoyed special privileges there, and was scarcely obliged to pass any examinations. Although we lived in very limited circumstances, my father insisted that, in my choice of a profession, I should follow my own inclinations. Neither at that time, nor indeed in my later life, did I feel any particular predilection for the career of a physician. I was moved, rather, by a sort of curiosity, which was, however, directed more towards human concerns than towards natural objects; nor had I recognized the importance of observation as one of the best means of gratifying it. At the same time, the theories of Darwin, which were then of topical interest, strongly attracted me, for they held out hopes of an extraordinary advance in our understanding of the world; and it was hearing Goethe’s beautiful essay on Nature read aloud at a popular lecture just before I left school that decided me to become a medical student.
When, in 1873, I first joined the University, I was met by some appreciable disappointments. Above all, I found that I was expected to feel myself inferior and an alien, because I was a Jew. I refused absolutely to do the first of these things. I have never been able to see why I should feel ashamed of my descent or, as people were beginning to say, of my race. I put up, without much regret, with my nonadmission to the community; for it seemed to me that in spite of this exclusion an active fellow-worker could not fail to find some nook or cranny in the frame-work of humanity. These first impressions at the University, however, had one consequence which was afterwards to prove important; for at an early age I was made familiar with the fate of being in the Opposition and of being put under the ban of the “compact majority.” The foundations were thus laid for a certain degree of independence of judgment.
I was compelled, moreover, during my first years at the University, to make the discovery that the peculiarities and limitations of my gifts denied me all success in many of the departments of science into which my youthful eagerness had plunged me. Thus I learned the truth of Mephistopheles’ warning:
“Vergebens, dass ihr ringsum wissenschaftlich schweift, Ein jeder lernt nur, was er lernen kann.”[6]
At length, in Ernst Brücke’s physiological laboratory, I found rest and satisfaction—and men, too, whom I could respect and take as my models. Brücke gave me a problem to work out in the histology of the nervous system; I succeeded in solving it to his satisfaction and in carrying the work further on my own account. I worked at this Institute, with short interruptions, from 1876 to 1882, and it was generally thought that I was marked out to fill the next post of Assistant that might fall vacant there. The various branches of medicine proper, apart from psychiatry, had no attraction for me. I was decidedly negligent in pursuing my medical studies, and it was not until 1881 that I took my somewhat belated degree as a Doctor of Medicine.
The turning point came in 1882, when my teacher, for whom I felt the highest possible esteem, corrected my father’s generous improvidence by strongly advising me, in view of my bad financial position, to abandon my theoretical career. I followed his advice, left the physiological laboratory and entered the General Hospital[7] as an “Aspirant.” I was soon afterwards promoted to being a junior physician, and worked in various departments of the hospital, amongst others for more than six months under Meynert, by whose work and personality I had been greatly struck while I was still a student.
In a certain sense I nevertheless remained faithful to the line of work upon which I had originally started. The subject which Brücke had proposed for my investigations had been the spinal cord of one of the lowest of the fishes (Ammocoetes Petromyzon); and I now passed on to the human central nervous system. Just at this time Flechsig’s discoveries of the non-simultaneity of the formation of the medullary sheaths were throwing a revealing light upon the intricate course of its tracts. The fact that I began by choosing the medulla oblongata as the one and only subject of my work was another sign of the continuity of my development. In complete contrast to the diffuse character of my studies during my earlier years at the University, I was now developing an inclination to concentrate my work exclusively upon a single subject or problem. This inclination has persisted and has since led to my being accused of one-sidedness.
I now became as active a worker in the Institute of Cerebral Anatomy as I had previously been in the physiological one. Some short papers upon the course of the tracts and the nuclear origins in the medulla oblongata date from these hospital years, and my results were regularly noted down by Edinger. One day Meynert, who had given me access to the laboratory even during the times when I was not actually working under him, proposed that I should definitely devote myself to the anatomy of the brain, and promised to hand over his lecturing work to me, as he felt he was too old to manage the newer methods. This I declined, in alarm at the magnitude of the task; it is possible, too, that I had guessed already that this great man was by no means kindly disposed towards me.
From the practical point of view, brain anatomy was certainly no better than physiology, and, with an eye to material considerations, I began to study nervous diseases. There were, at that time, few specialists in that branch of medicine in Vienna, the material for its study was distributed over a number of different departments of the hospital, there was no satisfactory opportunity of learning the subject, and one was forced to be one’s own teacher. Even Nothnagel, who had been appointed a short time before, on account of his book upon cerebral localization, did not single out neuropathology from among the other subdivisions of medicine. In the distance glimmered the great name of Charcot; so I formed a plan of first obtaining an appointment as Lecturer on Nervous Diseases in Vienna and of then going to Paris to continue my studies.
In the course of the following years, while I continued to work as a junior physician, I published a number of clinical observations upon organic diseases of the nervous system. I gradually became familiar with the ground; I was able to localize the site of a lesion in the medulla oblongata so accurately that the pathological anatomist had no further information to add; I was the first person in Vienna to send a case for autopsy with a diagnosis of polyneuritis acuta. The fame of my diagnoses and their _post mortem_ confirmation brought me an influx of American physicians, to whom I lectured upon the patients in my department in a sort of pidgin-English. I understood nothing about the neuroses. On one occasion I introduced to my audience a neurotic suffering from a persistent headache as a case of chronic localized meningitis; they quite rightly rose in revolt against me, and my premature activities as a teacher came to an end. By way of excuse I may add that this happened at a time when greater authorities than myself in Vienna were in the habit of diagnosing neurasthenia as cerebral tumor.
In the spring of 1885 I was appointed Lecturer on Neuropathology on the ground of my histological and clinical publications. Soon afterwards, as the result of a warm testimonial from Brücke, I was awarded a Traveling Fellowship of considerable value. In the autumn of the same year I made the journey to Paris.
I became a student at the Salpêtrière, but as one of the crowd of foreign visitors, I had little attention paid me to begin with. One day in my hearing Charcot expressed his regret that since the war he had heard nothing from the German translator of his lectures; he went on to say that he would be glad if someone would undertake to translate the new volume of his lectures into German. I wrote to him and offered to do so; I can still remember a phrase in the letter, to the effect that I suffered only from _l’aphasie motrice_ and not from _l’aphasie sensorielle du français_. Charcot accepted the offer, I was admitted to the circle of his personal acquaintances, and from that time forward I took a full part in all that went on at the Clinic.
As I write these lines, a number of papers and newspaper-articles have reached me from France, which gave evidence of a violent objection to the acceptance of psychoanalysis, and which often make the most inaccurate assertions in regard to my relations with the French school. I read, for instance, that I made use of my visit to Paris to familiarize myself with the theories of Pierre Janet and then made off with my booty. I should therefore like to say explicitly that during the whole of my visit to the Salpêtrière, Janet’s name was never so much as mentioned.
What impressed me most of all while I was with Charcot were his latest investigations upon hysteria, some of which were carried out under my own eyes. He had proved, for instance, the genuineness of hysterical phenomena and their conformity to laws (“_introite et hic dii sunt_”), the frequent occurrence of hysteria in men, the production of hysterical paralyses and contractures by hypnotic suggestion and the fact that such artificial products showed, down to their smallest details, the same features as spontaneous attacks, which were often brought on traumatically. Many of Charcot’s demonstrations began by provoking in me and in other visitors a sense of astonishment and an inclination to scepticism, which we tried to justify by an appeal to one of the theories of the day. He was always friendly and patient in dealing with such doubts, but he was also most decided; it was in one of these discussions that (speaking of theory) he remarked, “_Ça n’empêche pas d’exister_,” a _mot_ which left an indelible mark upon my mind.
No doubt the whole of what Charcot taught us at that time does not hold good today: some of it has become doubtful, some has definitely failed to withstand the test of time. But enough is left over, and has found a permanent place in the storehouse of science. Before leaving Paris I discussed with the great man a plan for a comparative study of hysterical and organic paralyses. I wished to establish the thesis that in hysteria paralyses and anæsthesias of the various parts of the body are demarcated according to the popular idea of their limits and not according to anatomical facts. He agreed with this view, but it was easy to see that in reality he took no special interest in penetrating more deeply into the psychology of the neuroses. When all is said and done, it was from pathological anatomy that his work had started.
Before I returned to Vienna I stopped for a few weeks in Berlin, in order to gain a little knowledge of the general disorders of childhood. Kassowitz, who was at the head of a public institute in Vienna for the treatment of children’s diseases, had promised to put me in charge of a department for the nervous diseases of children. In Berlin I was given assistance and a friendly reception by Baginsky. In the course of the next few years I published, from the Kassowitz Institute, several monographs of considerable size on unilateral and bilateral cerebral palsies in children. And for that reason, at a later date (in 1897), Nothnagel made me responsible for dealing with the same subject in his great _Handbuch der allgemeinen und speziellen Therapie_.