Introductory lectures on psycho-analysis · Sigmund Freud
TWENTY-SEVENTH LECTURE TRANSFERENCE
Now that we are coming to the end of our discussions you will feel a certain expectation which must not be allowed to mislead you. You are probably thinking that I surely have not led you through all these complicated mazes of psycho-analysis only to dismiss you at the end without a word about the therapy, upon which after all the possibility of undertaking psycho-analytic work depends. As a matter of fact I could not possibly leave out this aspect of it; for some of the phenomena belonging to it will teach you a new fact, without knowledge of which you would be quite unable to assimilate properly your understanding of the diseases we have been studying. I know you do not expect directions in the technique of practising analysis for therapeutic purposes; you only want to know in a general way by what means the psycho-analytic therapy works and to gain a general idea of what it accomplishes. And you have an undeniable right to learn this; nevertheless I am not going to tell you—I am going to insist upon your finding it out for yourselves.
Think for a moment! You have already learnt everything essential, from the conditions by which illness is provoked to all the factors which take effect within the diseased mind. Where is the opening in all this for therapeutic influence? First of all there is the hereditary disposition,—we do not often mention it because it is so strongly emphasized in other quarters and we have nothing new to say about it. But do not suppose that we underestimate it; as practitioners we are well aware of its power. In any event we can do nothing to change it; for us also it is a fixed datum in the problem, which sets a limit to our efforts. Next, there is the influence of the experiences of early childhood, which we are accustomed in analysis to rank as very important; they belong to the past, we cannot undo them. Then there is all that unhappiness in life which we have included under ‘privation in reality,’ from which all the absence of love in life proceeds—namely, poverty, family strife, mistaken choice in marriage, unfavourable social conditions, and the severity of the demands by which moral convention oppresses the individual.
There is indeed a wide opening for a very effective treatment in all this; but it would have to follow the course of the dispensations of Kaiser Joseph in the Viennese legend—the benevolent despotism of a potentate before whose will men bow and difficulties disappear! But who are we that we can exert such beneficence as a therapeutic measure? Poor as we are and without influence socially, with our living to earn by our medical practice, we are not even in a position to extend our efforts to penniless folk, as other physicians with other methods can do; our treatment takes too much time and labour for that. But perhaps you are still clinging on to one of the factors put forward, and believe you see an opening for our influence there. If the conventional restrictions imposed by society have had a part in the privations forced upon the patient, the treatment could give him the courage and even directly advise him to defy these obstacles, and to seize satisfactions and health for himself at the cost of failing to achieve an ideal which, though highly esteemed, is after all often set at naught by the world. Health is to be won by “free living,” then. There would be this blot upon analysis, to be sure, that it would not be serving general morality; what it gave to the individual it would take from the rest of the world.
But now, who has given you such a false impression of analysis? It is out of the question that part of the analytic treatment should consist of advice to “live freely”—if for no other reason because we ourselves tell you that a stubborn conflict is going on in the patient between libidinal desires and sexual repression, between sensual and ascetic tendencies. This conflict is not resolved by helping one side to win a victory over the other. It is true we see that in neurotics asceticism has gained the day; the result of which is that the suppressed sexual impulses have found a vent for themselves in the symptoms. If we were to make victory possible to the sensual side instead, the disregarded forces repressing sexuality would have to indemnify themselves by symptoms. Neither of these measures will succeed in ending the inner conflict; one side in either event will remain unsatisfied. There are but few cases in which the conflict is so unstable that a factor like medical advice can have any effect upon it, and these cases do not really require analytic treatment. People who can be so easily influenced by physicians would have found their own way to that solution without this influence. After all, you know that a young man living in abstinence who makes up his mind to illicit sexual intercourse, or an unsatisfied wife who seeks compensation with a lover, does not as a rule wait for the permission of a physician, still less of an analyst, to do so.
In considering this question people usually overlook the essential point of the whole difficulty—namely, that the pathogenic conflict in a neurotic must not be confounded with a normal struggle between conflicting impulses all of which are in the same mental field. It is a battle between two forces of which one has succeeded in coming to the level of the preconscious and conscious part of the mind, while the other has been confined on the unconscious level. That is why the conflict can never have a final outcome one way or the other; the antagonists meet each other as little as the whale and the polar bear in the well-known story. An effective decision can be reached only when they confront each other on the same ground. And, in my opinion, to accomplish this is the sole task of the treatment. Besides this, I can assure you that you are quite misinformed if you imagine that advice and guidance concerning conduct in life forms an integral part of the analytic method. On the contrary, so far as possible we refrain from playing the part of mentor; we want nothing better than that the patient should find his own solutions for himself. To this end we expect him to postpone all vital decisions affecting his life, such as choice of career, business enterprises, marriage or divorce, during treatment and to execute them only after it has been completed. Now confess that you had imagined something very different. Only with certain very young or quite helpless and defenceless persons is it impossible to keep within such strict limitations as we should wish. With them we have to combine the positions of physician and educator; we are then well aware of our responsibility and act with the necessary caution.
You must not be led away by my eagerness to defend myself against the accusation that in analytic treatment neurotics are encouraged to “live a free life” and conclude from it that we influence them in favour of conventional morality. That is at least as far removed from our purpose as the other. We are not reformers, it is true; we are merely observers; but we cannot avoid observing with critical eyes, and we have found it impossible to give our support to conventional sexual morality or to approve highly of the means by which society attempts to arrange the practical problems of sexuality in life. We can demonstrate with ease that what the world calls its code of morals demands more sacrifices than it is worth, and that its behaviour is neither dictated by honesty nor instituted with wisdom. We do not absolve our patients from listening to these criticisms; we accustom them to an unprejudiced consideration of sexual matters like all other matters; and if after they have become independent by the effect of the treatment they choose some intermediate course between unrestrained sexual licence and unconditional asceticism, our conscience is not burdened whatever the outcome. We say to ourselves that anyone who has successfully undergone the training of learning and recognizing the truth about himself is henceforth strengthened against the dangers of immorality, even if his standard of morality should in some respect deviate from the common one. Incidentally, we must beware of overestimating the importance of abstinence in affecting neurosis; only a minority of pathogenic situations due to privation and the subsequent accumulation of Libido thereby induced can be relieved by the kind of sexual intercourse that is procurable without any difficulty.
So you cannot explain the therapeutic effect of psycho-analysis by supposing that it permits patients free sexual indulgence; you must look round for something else. I think that one of the remarks I made while I was disposing of this conjecture on your part will have put you on the right track. Probably it is the substitution of something conscious for something unconscious, the transformation of the unconscious thoughts into conscious thoughts, that makes our work effective. You are right; that is exactly what it is. By extending the unconscious into consciousness the repressions are raised, the conditions of symptom-formation are abolished, and the pathogenic conflict exchanged for a normal one which must be decided one way or the other. We do nothing for our patients but enable this one mental change to take place in them; the extent to which it is achieved is the extent of the benefit we do them. Where there is no repression or mental process analogous to it to be undone there is nothing for our therapy to do.
The aim of our efforts may be expressed in various formulas—making conscious the unconscious, removing the repressions, filling in the gaps in memory; they all amount to the same thing. But perhaps you are dissatisfied with this declaration; you imagined the recovery of a nervous person rather differently, that after he had been subjected to the laborious process of psycho-analysis he would emerge a different person altogether, and then you hear that the whole thing only amounts to his having a little less that is unconscious and a little more that is conscious in him than before. Well, you probably do not appreciate the importance of an inner change of this kind. A neurotic who has been cured has really become a different person, although at bottom of course he remains the same—that is, he has become his best self, what he would have been under the most favourable conditions. That, however, is a great deal. Then when you hear of all that has to be done, of the tremendous exertion required to carry out this apparently trifling change in his mental life, the significance attached to these differences between the various mental levels will appear more comprehensible to you.
I will digress a moment to enquire whether you know what ‘a causal therapy’ means? This name is given to a procedure which puts aside the manifestations of a disease and looks for a point of attack in order to eradicate the cause of the illness. Now is psycho-analysis a causal therapy or not? The answer is not a simple one, but it may give us an opportunity to convince ourselves of the futility of such questions. In so far as psycho-analytic therapy does not aim immediately at removing the symptoms it is conducted like a causal therapy. In other respects you may say it is not, for we have followed the causal chain back far beyond the repressions to the instinctive predispositions, their relative intensity in the constitution, and the aberrations in the course of their development. Now suppose that it were possible by some chemical means to affect this mental machinery, to increase or decrease the amount of Libido available at any given moment, or to reinforce the strength of one impulse at the expense of another—that would be a causal therapy in the literal sense, and our analysis would be the indispensable preliminary work of reconnoitring the ground. As you know, there is at present no question of any such influence upon the processes of the Libido; our mental therapy makes its attack at another point in the concatenation, not quite at the place where we perceive the manifestations to be rooted, but yet comparatively far behind the symptoms themselves, at a place which becomes accessible to us in very remarkable circumstances.
What then have we to do in order to bring what is unconscious in the patient into consciousness? At one time we thought that would be very simple; all we need do would be to identify this unconscious matter and then tell the patient what it was. However, we know already that that was a short-sighted mistake. Our knowledge of what is unconscious in him is not equivalent to his knowledge of it; when we tell him what we know he does not assimilate it _in place of_ his own unconscious thoughts, but _alongside_ of them, and very little has been changed. We have rather to regard this unconscious material topographically; we have to look for it in his memory at the actual spot where the repression of it originally ensued. This repression must be removed, and then the substitution of conscious thought for unconscious thought can be effected straightaway. How is a repression such as this to be removed? Our work enters upon a second phase here; first, the discovery of the repression, and then the removal of the resistance which maintains this repression.
How can this resistance be got rid of? In the same way: by finding it out and telling the patient about it. The resistance too arises in a repression, either from the very one which we are endeavouring to dispel, or in one that occurred earlier. It is set up by the counter-charge which rose up to repress the repellent impulse. So that we now do just the same as we were trying to do before; we interpret, identify, and inform the patient; but this time we are doing it at the right spot. The counter-charge or the resistance is not part of the Unconscious, but of the Ego which co-operates with us, and this is so, even if it is not actually conscious. We know that a difficulty arises here in the ambiguity of the word ‘unconscious,’ on the one hand, as a phenomenon, on the other hand, as a system. That sounds very obscure and difficult; but after all it is only a repetition of what we have said before, is it not? We have come to this point already long ago.—Well then, we expect that this resistance will be abandoned, and the counter-charge withdrawn, when we have made the recognition of them possible by our work of interpretation.
What are the instinctive propelling forces at our disposal to make this possible? First, the patient’s desire for recovery, which impelled him to submit himself to the work in co-operation with us, and secondly, the aid of his intelligence which we reinforce by our interpretation. There is no doubt that it is easier for the patient to recognize the resistance with his intelligence, and to identify the idea in his Unconscious which corresponds to it, if we have first given him an idea which rouses his expectations in regard to it. If I say to you: “Look up at the sky and you will see a balloon,” you will find it much more quickly than if I merely tell you to look up and see whether you can see anything; a student who looks through a microscope for the first time is told by the instructor what he is to see; otherwise he sees nothing, although it is there and quite visible.
And now for the fact! In quite a number of the various forms of nervous illness, in the hysterias, anxiety conditions, obsessional neuroses, our hypothesis proves sound. By seeking out the repression in this way, discovering the resistances, indicating the repressed, it is actually possible to accomplish the task, to overcome the resistances, to break down the repression, and to change something unconscious into something conscious. As we do this we get a vivid impression of how, as each individual resistance is being mastered, a violent battle goes on in the soul of the patient—a normal mental struggle between two tendencies on the same ground, between the motives striving to maintain the counter-charge and those which are ready to abolish it. The first of these are the old motives which originally erected the repression; among the second are found new ones more recently acquired, which it is hoped will decide the conflict in our favour. We have succeeded in revivifying the old battle of the repression again, in bringing the issue, so long ago decided, up for revision again. The new contribution we make to it lies, first of all, in demonstrating that the original solution led to illness and in promising that a different one would pave the way to health, and secondly, in pointing out that the circumstances have all changed immensely since the time of that original repudiation of these impulses. Then, the Ego was weak, infantile, and perhaps had reason to shrink with horror from the claims of the Libido as being dangerous to it. To-day it is strong and experienced and moreover has a helper at hand in the physician. So we may expect to lead the revived conflict through to a better outcome than repression; and, as has been said, in hysteria, anxiety-neurosis, and the obsessional neurosis success in the main justifies our claims.
There are other forms of illness, however, with which our therapeutic treatment never is successful, in spite of the similarity of the conditions. In them also there was originally a conflict between Ego and Libido, leading to repression—although this conflict may be characterized by topographical differences from the conflict of the transference neuroses; in them too it is possible to trace out the point in the patient’s life at which the repressions occurred; we apply the same method, are ready to make the same assurances, offer the same assistance by telling the patient what to look out for; and here also the interval in time between the present and the point at which the repressions were established is all in favour of a better outcome of the conflict. And yet we cannot succeed in overcoming one resistance or in removing one of the repressions. These patients, paranoiacs, melancholics, and those suffering from dementia præcox, remain on the whole unaffected, proof against psycho-analytic treatment. What can be the cause of this? It is not due to lack of intelligence; a certain degree of intellectual capacity must naturally be stipulated for analysis, but there is no deficiency in this respect in, for instance, the very quick-witted deductive paranoiac. Nor are any of the other propelling forces regularly absent: melancholics, for instance, in contrast to paranoiacs, experience a very high degree of realization that they are ill and that their sufferings are due to this; but they are not on that account any more accessible to influence. In this we are confronted with a fact that we do not understand, and are therefore called upon to doubt whether we have really understood all the conditions of the success possible with the other neuroses.
When we keep to consideration of hysterical and obsessional neurotics we are very soon confronted with a second fact, for which we were quite unprepared. After the treatment has proceeded for a while we notice that these patients behave in a quite peculiar manner towards ourselves. We thought indeed that we had taken into account all the motive forces affecting the treatment and had reasoned out the situation between ourselves and the patient fully, so that it balanced like a sum in arithmetic; and then after all something seems to slip in which was quite left out of our calculation. This new and unexpected feature is in itself many-sided and complex; I will first of all describe some of its more frequent and simpler forms to you.
We observe then that the patient, who ought to be thinking of nothing but the solution of his own distressing conflicts, begins to develop a particular interest in the person of the physician. Everything connected with this person seems to him more important than his own affairs and to distract him from his illness. Relations with the patient then become for a time very agreeable; he is particularly docile, endeavours to show his gratitude wherever he can, exhibits a fineness of character and other good qualities which we had perhaps not anticipated in him. The analyst thus forms a very good opinion of the patient and values his luck in being able to render assistance to such an admirable personality. If the physician has occasion to see the patient’s relatives he hears with satisfaction that this esteem is mutual. The patient at home is never tired of praising the analyst and attributing new virtues to him. “He has quite lost his head over you; he puts implicit trust in you; everything you say is like a revelation to him,” say the relatives. Here and there one among this chorus having sharper eyes will say: “It is positively boring the way he never speaks of anything but you: he quotes you all the time.”
We will hope that the physician is modest enough to ascribe the patient’s estimate of his value to the hopes of recovery which he has been able to offer to him, and to the widening in the patient’s intellectual horizon consequent upon the surprising revelations entailed by the treatment and their liberating influence. The analysis too makes splendid progress under these conditions, the patient understands the suggestions offered to him, concentrates upon the tasks appointed by the treatment, the material needed—his recollections and associations—is abundantly available; he astonishes the analyst by the sureness and accuracy of his interpretations, and the latter has only to observe with satisfaction how readily and willingly a sick man will accept all the new psychological ideas that are so hotly contested by the healthy in the world outside. A general improvement in the patient’s condition, objectively confirmed on all sides, also accompanies this harmonious relationship in the analysis. But such fair weather cannot last for ever. There comes a day when it clouds over. There begin to be difficulties in the analysis; the patient says he cannot think of anything more to say. One has an unmistakable impression that he is no longer interested in the work, and that he is casually ignoring the injunction given him to say everything that comes into his mind and to yield to none of the critical objections that occur to him. His behaviour is not dictated by the situation of the treatment; it is as if he had not made an agreement to that effect with the physician; he is obviously preoccupied with something which at the same time he wishes to reserve to himself. This is a situation in which the treatment is in danger. Plainly a very powerful resistance has risen up. What can have happened?
If it is possible to clear up this state of things, the cause of the disturbance is found to consist in certain intense feelings of affection which the patient has transferred on to the physician, not accounted for by the latter’s behaviour nor by the relationship involved by the treatment. The form in which this affectionate feeling is expressed and the goal it seeks naturally depend upon the circumstances of the situation between the two persons. If one of them is a young girl and the other still a fairly young man, the impression received is that of normal love; it seems natural that a girl should fall in love with a man with whom she is much alone and can speak of very intimate things, and who is in the position of an adviser with authority—we shall probably overlook the fact that in a neurotic girl some disturbance of the capacity for love is rather to be expected. The farther removed the situation between the two persons is from this supposed example, the more unaccountable it is to find that nevertheless the same kind of feeling comes to light in other cases.
Text from Project Gutenberg, public domain in the United States.