Introductory lectures on psycho-analysis · Sigmund Freud
TWENTY-EIGHTH LECTURE THE ANALYTIC THERAPY
Now ask yourselves how many surgical operations would be successful if they had to be conducted in the presence of the patient’s entire family poking their noses into the scene of the operation and shrieking aloud at every cut. In psycho-analytic treatment the intervention of the relatives is a positive danger and, moreover, one which we do not know how to deal with. We are armed against the inner resistances of the patient, which we recognize as necessary, but how can we protect ourselves against these outer resistances? It is impossible to get round the relatives by any sort of explanation, nor can one induce them to hold aloof from the whole affair; one can never take them into one’s confidence because then we run the danger of losing the patient’s trust in us, for he—quite rightly, of course—demands that the man he confides in should take his part. Anyone who knows anything of the dissensions commonly splitting up family life will not be astonished in his capacity of analyst to find that those nearest to the patient frequently show less interest in his recovery than in keeping him as he is. When as so often occurs the neurosis is connected with conflicts between different members of a family, the healthy person does not make much of putting his own interest before the patient’s recovery. After all, it is not surprising that the husband does not favour a treatment in which, as he correctly supposes, his sins will all come to light; nor do we wonder at this, but then we cannot blame ourselves when our efforts remain fruitless and are prematurely broken off because the husband’s resistance is added to that of the sick wife. We had simply undertaken something which, under the existing conditions, it was impossible to carry out.
Instead of describing many cases to you I will tell you of one only, in which I had to suffer for the sake of professional conscientiousness. I took a young girl—many years ago—for analytic treatment; for a considerable time previously she had been unable to go out of doors on account of a dread, nor could she stay at home alone. After much hesitation the patient confessed that her thoughts had been a good deal occupied by some signs of affection that she had noticed by chance between her mother and a well-to-do friend of the family. Very tactlessly—or else very cleverly—she then gave the mother a hint of what had been discussed during the analysis; she did this by altering her behaviour to her mother, by insisting that no one but her mother could protect her against the dread of being alone, and by holding the door against her when she attempted to leave the house. The mother herself had formerly been very nervous, but had been cured years before by a visit to a hydropathic establishment—or, putting it otherwise, we may say she had there made the acquaintance of the man with whom she had established a relationship that had proved satisfying in more than one respect.
Made suspicious by her daughter’s passionate demands the mother suddenly _understood_ what the girl’s dread signified. She had become ill in order to make her mother a prisoner and rob her of the freedom necessary for her to maintain her relations with her lover. The mother’s decision was instantly taken; she put an end to the harmful treatment. The girl was sent to a home for nervous patients, and for many years was there pointed out as an “unhappy victim of psycho-analysis”; for just as long I was pursued by damaging rumours about the unfortunate results of the treatment. I maintained silence because I supposed myself bound by the rules of professional secrecy. Years later I learned from a colleague who had visited the home and there seen the girl with agoraphobia that the intimacy between the mother and the wealthy man was common knowledge, and that in all probability it was connived at by the husband and father. To this “secret” the girl’s cure had been sacrificed.
In the years before the war, when the influx of patients from many countries made me independent of the goodwill or disfavour of my native city, I made it a rule never to take for treatment anyone who was not _sui juris_, independent of others in all the essential relations of life. Every psycho-analyst cannot make these stipulations. Perhaps you will conclude from my warnings about relatives that one should take the patient out of his family circle in the interests of analysis, and restrict this therapy to those living in private institutions. I could not support this suggestion, however; it is far more advantageous for the patients—those who are not in a condition of severe prostration, at least—to remain during the treatment in those circumstances in which they have to struggle with the demands that their ordinary life makes on them. But the relatives ought not to counteract this advantage by their behaviour, and above all should not oppose their hostility to one’s professional efforts. But how are you going to induce people who are inaccessible to you to take up this attitude? You will naturally also conclude that the social atmosphere and degree of cultivation of the patient’s immediate surroundings have considerable influence upon the prospects of the treatment.
This is a gloomy outlook for the efficacy of psycho-analysis as a therapy, even if we may explain the overwhelming majority of our failures by taking into account these disturbing external factors! Friends of analysis have advised us to counterbalance a collection of failures by drawing up a statistical enumeration of our successes. I have not taken up this suggestion either. I brought forward the argument that statistics would be valueless if the units collated were not alike, and the cases which had been treated were in fact not equivalent in many respects. Further, the period of time that could be reviewed was too short for one to be able to judge of the permanence of the cures; and of many cases it would be impossible to give any account. They were persons who had kept both their illness and their treatment secret, and whose recovery in consequence had similarly to be kept secret. The strongest reason against it, however, lay in the recognition of the fact that in matters of therapy humanity is in the highest degree irrational, so that there is no prospect of influencing it by reasonable arguments.
A novelty in therapeutics is either taken up with frenzied enthusiasm, as for instance when Koch first published his results with tuberculin; or else it is regarded with abysmal distrust, as happened for instance with Jenner’s vaccination, actually a heaven-sent blessing, but one which still has its implacable opponents. A very evident prejudice against psycho-analysis made itself apparent. When one had cured a very difficult case one would hear: “That is no proof of anything; he would have got well of himself after all this time.” And when a patient who had already gone through four cycles of depression and mania came to me in an interval after the melancholia and three weeks later again began to develop an attack of mania, all the members of the family, and also all the high medical authorities who were called in, were convinced that the fresh attack could be nothing but a consequence of the attempted analysis. Against prejudice one can do nothing, as you can now see once more in the prejudices that each group of the nations at war has developed against the other. The most sensible thing to do is to wait and allow them to wear off with the passage of time. A day comes when the same people regard the same things in quite a different light from what they did before; why they thought differently before remains a dark secret.
It is possible that the prejudice against the analytic therapy has already begun to relax. The continual spread of analytic doctrine and the numbers of medical men taking up analytic treatment in many countries seem to point in that direction. As a young man I was caught in just such a storm of indignation roused in the medical profession by the hypnotic suggestion-treatment, which nowadays is held up in opposition to psycho-analysis by the “sober-minded.” As a therapeutic instrument, however, hypnotism did not bear out the hopes placed in it; we psycho-analysts may claim to be its rightful heirs and should not forget how much encouragement and theoretic enlightenment we owe to it. The harmful effects reported of psycho-analysis are essentially confined to transitory manifestations of an exacerbation of the conflict, which may occur when the analysis is clumsily handled, or when it is broken off suddenly. You have heard an account of what we do with our patients, and you can form your own judgement whether our efforts are likely to lead to lasting injury. Misuse of analysis is possible in various ways: the transference especially, in the hands of an unscrupulous physician, is a dangerous instrument. But no medical remedy is proof against misuse; if a knife will not cut, neither will it serve a surgeon.
Ideas discussed in this chapter
Text from Project Gutenberg, public domain in the United States.