We cannot in every case get so far as this on the simple principle of letting the patient talk; few patients have their psychic material so much on the surface. Furthermore, many persons have a positive resistance against speaking freely about what occurs to them on the spur of the moment; it is often too painful to tell the doctor whom perhaps they do not entirely trust; in other cases because apparently nothing occurs to them, they force themselves to speak of matters about which they are more or less indifferent. This habit of not talking to the point by no means proves that patients consciously conceal their unpleasant contents, for such irrelevant speaking can occur quite unconsciously. In such cases it sometimes helps the patient if he is told that he must not force himself, that he must only seize upon the very first thoughts that present themselves, no matter how unimportant or ridiculous they may seem. In certain cases even these instructions are of no use, and then the doctor is obliged to have recourse to other expedients. One of these is the employment of the association test, which usually gives excellent information as to the chief momentary tendencies of the individual.
A second expedient is dream analysis; this is the real instrument of psychoanalysis. We have already experienced so much opposition to dream analysis that a brief exposition of its principles is necessary. The interpretation of dreams, as well as the meaning given to them, is, as we know, in bad odour. It is not long since that oneirocritics were practised and believed in; nor is the time long past when even the most enlightened human beings were entirely under the ban of superstition. It is therefore comprehensible that our age should still retain a certain lively fear of those superstitions which have but recently been partially overcome. To this timidity in regard to superstition, the opposition to dream analysis is in a large measure due; but analysis is in no wise to blame for this. We do not select the dream as our object because we pay it the homage of superstitious admiration, but because it is a psychic product that is independent of the patient's consciousness. We ask for the patient's free thoughts, but he gives us little, or nothing; or at best something forced or irrelevant. Dreams are free thoughts, free phantasies, they are not forced, and they are psychic phenomena just as much as thoughts are.
It may be said of the dream that it enters into the consciousness as a complex structure, the connection between the elements of which is not conscious. Only by afterwards joining associations to the separate pictures of the dream, can the origin of these pictures, in certain recollections of the near and more remote past, be proved. One asks oneself: "Where have I seen or heard that?" And by the same process of free association comes the memory that one has actually experienced certain parts of the dream, some of them yesterday, some at an earlier date. This is well known, and every one will probably agree to it. Thus far the dream presents itself, as a rule, as an incomprehensible composition of certain elements which are not in the first instance conscious, but which are later recognised by the process of free association. This might be disputed on the ground that it is an a priori statement. I must remark, however, that this conception conforms to the only generally recognised working hypothesis as to the genesis of dreams, namely, the derivation of the dream from experiences and thoughts of the recent past. We are, therefore, upon known ground. Not that certain dream parts have under all circumstances been known to the individual, so that one might ascribe to them the character of being conscious; on the contrary, they are frequently, even generally, unrecognisable. Not until later do we remember having consciously experienced this or that dream part. We may therefore regard the dream from this point of view as a product that comes from a subconscious origin. The technical unfolding of these subconscious sources is a mode of procedure that has always been instinctively employed. One simply tries to remember whence the dream parts come. Upon this most simple principle the psychoanalytic method of solving dreams is based. It is a fact that certain dream parts are derived from our waking life and, indeed, from experiences which, owing to their notorious lack of importance, would frequently have been consigned to certain oblivion, and were therefore well on their way towards becoming definitely subconscious. Such dream parts are the results of subconscious representations (images).
The principles according to which psychoanalysis solves dreams are therefore exceedingly simple, and have really been known for a long time. The further procedure follows the same path logically and consistently. If one spends considerable time over a dream, which really never happens outside psychoanalysis, one can succeed in finding more and more recollections for the separate dream parts. It is, however, not always possible to discover recollections for certain other parts; and then one must leave them for the time being, whether one likes it or not. When I speak of "recollections" I naturally do not mean merely memories of certain concrete experiences, but also of their inter-related meanings. The collected recollections are known as the dream material. With this material one proceeds according to a scientific method that is universally valid. If one has any experimental material to work up, one compares its separate parts and arranges them according to their similarities. Exactly the same course is pursued in dealing with the dream material; one gathers together its common characteristics, whether these be formal or material. In doing this one must absolutely get rid of certain prejudices. I have always observed that the beginner expects to find some tendency or other according to which he endeavours to mould his material. I have noticed this particularly in the cases of colleagues who were previously more or less violent opponents of psychoanalysis, owing to their well-known prejudices and misunderstandings. When fate willed that I should analyse them, and they consequently gained at last an insight into the method of analysis, it was demonstrated that the first mistake which they had been apt to make in their own psychoanalytic practice was that they forced the material into accord with their own preconceived opinions; that is, they allowed their former attitude towards psychoanalysis, which they were not able to appreciate objectively, but only according to subjective phantasies, to have its influence upon their material. If one goes so far as to venture upon the task of examining the dream material, one must permit no comparison to frighten one away. The material consists, as a general rule, of very unequal images, from which it is under some circumstances most difficult to obtain the "tertium comparationis." I must forego giving you detailed examples of this, since it is quite impossible to introduce such extensive material into a lecture.
One pursues, then, the same method in classifying the unconscious content, as is used everywhere in comparing materials for the purpose of drawing conclusions from them. One objection has often been made, namely: why should the dream have a subconscious content at all? This objection is unscientific in my opinion. Every psychological moment has its own history. Every sentence that I utter has, besides the meaning consciously intended by me, a meaning that is historical; and this last may be entirely different from the conscious meaning. I am purposely expressing myself somewhat paradoxically. I certainly should not take it upon myself to explain each sentence according to its individual-historical meaning. That is easier in the case of larger and more complex formations. Every one is certainly convinced of the fact that a poem—in addition to its manifest contents—is also particularly characteristic of its author, in its form, subject-matter, and the history of its origin. Whereas the poet gave skilful expression to a fleeting mood in his song, the historian of literature sees in it and beyond it, things which the poet would never have suspected. The analysis which the literary critic makes of the subject-matter furnished by the poet may be compared with psychoanalysis in its method, even to the very errors which occur therein. The psychoanalytic method may be aptly compared with historical analysis and synthesis. Let us assume, for instance, that we do not understand the meaning of the rite of baptism as it is practised in our churches to-day. The priest tells us that baptism means the reception of the child into the Christian community. But we are not satisfied with this. Why should the child be sprinkled with water, etc.? In order that we may understand this rite we must gather together materials for comparison from the history of the rite, that is, from the memories of mankind appertaining to it; and this must be done from various points of view.
Firstly—Baptism is clearly a rite of initiation, a consecration. Therefore those memories, above all, must be assembled which preserve the rites of initiation.
Secondly—The act of baptism is performed with water. This especial form of procedure proves the necessity of welding together another chain of memories concerning rites in which water was used.
Thirdly—The child is sprinkled with water when it is christened. In this case we must gather together all the forms of the rite, where the neophyte is sprinkled or where the child is submerged, etc.
Fourthly—We must recollect all the reminiscences in mythology and all the superstitious customs which are in any respect similar to the symbolic act of baptism.
In this manner we obtain a comparative study of the act of baptism. Thus we ascertain the elements from which baptism is derived; we further ascertain its original meaning, and at the same time make the acquaintance of a world rich in religious mythology, which makes clear to us all the multifarious and derived meanings of the act of baptism. Thus the analyst deals with the dream. He gathers together historical parallels for each dream part, even though they be very remote and attempts to construct the psychological history of the dream and the meanings that underlie it. By this monographic elaboration of the dream one gains, exactly as in the analysis of the act of baptism, a deep insight into the wonderfully subtle and significant network of subconscious determinations; an insight which, as I have said, can only be compared with the historical understanding of an act that we used only to consider from a very one-sided and superficial point of view.
I cannot disguise the fact that in practice, especially at the beginning of an analysis, we do not in all cases make complete and ideal analyses of dreams, but that we more generally continue to gather together the dream associations until the problem which the patient hides from us becomes so clear that even he can recognize it. This problem is then subjected to conscious elaboration until it is cleared up as far as possible, and once again we stand before a question that cannot be answered.
You will now ask what course is to be pursued when the patient does not dream at all; I can assure you that hitherto all patients, even those who claimed never to have dreamed before, began to dream when they went through analysis. But on the other hand it frequently occurs that patients who began by dreaming vividly are suddenly no longer able to remember their dreams. The empirical and practical rule, which I have hitherto regarded as binding, is that the patient, if he does not dream, has sufficient conscious material, which he keeps back for certain reasons. A common reason is: "I am in the doctor's hands and am quite willing to be treated by him. But the doctor must do the work, I shall remain passive in the matter."
Sometimes the resistances are of a more serious character. For instance, persons who cannot admit certain morally grave sides to their characters, project their deficiencies upon the doctor by calmly presuming that he is more or less deficient morally, and that for this reason they cannot communicate certain unpleasant things to him. If, then a patient does not dream from the beginning or ceases to dream he retains material which is susceptible of conscious elaboration. Here the personal relation between the doctor and his patient may be regarded as the chief hindrance. It can prevent them both, the doctor as well as the patient, from seeing the situation clearly. We must not forget that, as the doctor shows, and must show, a searching interest in the psychology of his patient, so, too, the patient, if he has an active mind, gains some familiarity with the psychology of the doctor and assumes a corresponding attitude towards him. Thus the doctor is blind to the mental attitude of the patient to the exact extent that he does not see himself and his own subconscious problems. Therefore I maintain that a doctor must be analysed before he practises analysis. Otherwise the practice of analysis can easily be a great disappointment to him, because he can, under certain circumstances, reach a point where further progress is impossible, a situation which may make him lose his head. He is then readily inclined to assume that psychoanalysis is nonsense, so as to avoid the admission that he has run his vessel ashore. If you are sure of your own psychology you can confidently tell your patient that he does not dream because there is still conscious material to be disposed of. I say that one must be sure of one's self in such cases, for the opinions and unsparing criticisms to which one sometimes has to submit, can be excessively disturbing to one who is unprepared to meet them. The immediate consequence of such a loss of personal balance on the part of the doctor is that he begins to argue with his patient, in order to maintain his influence over him; and this, of course, renders all further analysis impossible.
I have told you that, in the first instance, dreams need only be used as sources of material for analysis. At the beginning of an analysis it is not only unnecessary, but also unwise, to make a so-called complete interpretation of a dream; for it is very difficult indeed to make a complete and really exhaustive interpretation. The interpretations of dreams that one sometimes reads in psychoanalytic publications are often one-sided, and not infrequently contestable formulations. I include among these certain one-sided sexual reductions of the Viennese school. In view of the comprehensive many-sidedness of the dream material one must beware, above all, of one-sided formulations. The many-sidedness of the meaning of a dream, not its singleness of meaning, is of the utmost value, especially at the beginning of the psychoanalytic treatment. Thus, for instance, a patient had the following dream not long after her treatment had begun: "She was in a hotel in a strange city. Suddenly a fire broke out; and her husband and her father, who were with her, helped her in the work of saving others." The patient was intelligent, extraordinarily sceptical, and absolutely convinced that dream analysis was nonsense. I had difficulty in inducing her to give dream analysis even one trial. Indeed I saw at once that I could not inform my patient of the real content of the dream under these circumstances because her resistances were much too great. I selected the fire, the most conspicuous occurrence of the dream, as the starting point for obtaining her free associations. The patient told me that she had recently read in a newspaper that a certain hotel in Z. had been burnt down; that she remembered the hotel because she had once lived in it. At the hotel she had made the acquaintance of a man, and from this acquaintance a somewhat questionable love affair developed. In connection with this story the fact came out that she had already had quite a number of similar adventures, all of which had a certain frivolous character. This important bit of past history was brought out by the first free association with a dream-part. It would have been impossible in this case to make clear to the patient the very striking meaning of the dream. With her frivolous mental attitude, of which her scepticism was only a special instance, she could have calmly repelled any attempt of this kind. But after the frivolity of her mental attitude was recognised and proved to her, by the material that she herself had furnished, it was possible to analyse the dreams which followed much more thoroughly.
It is, therefore, advisable in the beginning to make use of dreams for the purpose of reaching the important subconscious material by means of the patient's free associations in connection with them. This is the best and most cautious method, especially for those who are just beginning to practise analysis. An arbitrary translation of the dreams is absolutely unadvisable. That would be a superstitious practice based on the acceptance of well-established symbolic meanings. But there are no fixed symbolic meanings. There are certain symbols that recur frequently, but we are not able to get beyond general statements. For instance, it is quite incorrect to assume that the snake, when it appears in dreams, has a merely phallic meaning; just as incorrect as it is to deny that it may have a phallic meaning in some cases. Every symbol has more than one meaning. I can therefore not admit the correctness of exclusively sexual interpretations, such as appear in some psychoanalytic publications, for my experience has made me regard them as one-sided and therefore insufficient. As an example of this I will tell you a very simple dream of a young patient of mine. It was as follows: "I was going up a flight of stairs with my mother and sister. When we reached the top I was told that my sister was soon to have a child."
I shall now show you how, on the strength of the hitherto prevailing point of view, this dream may be translated so that it receives a sexual meaning. We know that the incest phantasy plays a prominent part in the life of a neurotic. Hence the picture "with my mother and sister" might be regarded as an allusion in this direction. The "stairs" have a sexual meaning that is supposedly well established; they represent the sexual act because of the rhythmic climbing of steps. The child that my patient's sister is expecting is nothing but the logical result of these premises. The dream, translated thus, would be a clear fulfilment of infantile desires which as we know play an important part in Freud's theory of dreams.
Now I have analysed this with the aid of the following process of reasoning: If I say that the stairs are a symbol for the sexual act, whence do I obtain the right to regard the mother, the sister, and the child as concrete; that is, as not symbolic? If, on the strength of the claim that dream pictures are symbolic, I give to certain of these pictures the value of symbols, what right have I to exempt certain other dream parts from this process? If, therefore, I attach symbolic value to the ascent of the stairs, I must also attach a symbolic value to the pictures that represent the mother, the sister, and the child. Therefore I did not translate the dream, but really analysed it. The result was surprising. I will give you the free associations with the separate dream-parts, word for word, so that you can form your own opinions concerning the material. I should state in advance that the young man had finished his studies at the university a few months previously; that he found the choice of a profession too difficult to make; and that he thereupon became a neurotic. In consequence of this he gave up his work. His neurosis took, among other things, a decidedly homosexual form.
The patient's associations with his mother are as follows: "I have not seen her for a long time, a very long time. I really ought to reproach myself for this. It is wrong of me to neglect her so." "Mother," then, stands here for something which is neglected in an inexcusable manner. I said to the patient: "What is that?" And he replied, with considerable embarrassment, "My work."
With his sister he associated as follows: "It is years since I have seen her. I long to see her again. Whenever I think of her I recall the time when I took leave of her. I kissed her with real affection; and at that moment I understood for the first time what love for a woman can mean." It is at once clear to the patient that his sister represents "love for woman."
With the stairs he has this association: "Climbing upwards; getting to the top; making a success of life; being grown up; being great." The child brings him the ideas: "New born; a revival; a regeneration; to become a new man."
One only has to hear this material in order to understand at once that the patient's dream is not so much the fulfilment of infantile desires, as it is the expression of biological duties which he has hitherto neglected because of his infantilism. Biological justice, which is inexorable, sometimes compels the human being to atone in his dreams for the duties which he has neglected in real life.
This dream is a typical example of the prospective and teleological function of dreams in general, a function that has been especially emphasised by my colleague Dr. Maeder. If we adhered to the one-sidedness of sexual interpretation, the real meaning of the dream would escape us. Sexuality in dreams is, in the first instance, a means of expression, and by no means always the meaning and the object of the dream. The unfolding of the prospective or teleological meaning of dreams is of particular importance as soon as analysis is so far advanced that the eyes of the patient are more easily turned upon the future, than upon his inner life and upon the past.
In connection with the application of symbolism, we can also learn from the example furnished us by this dream, that there can be no fixed and unalterable dream symbols, but at best a frequent repetition of fairly general meanings. So far as the so-called sexual meaning of dreams, in particular, is concerned, my experience has led me to lay down the following practical rules:
If dream analysis at the beginning of the treatment shows that the dream has an undoubted sexual meaning, this meaning is to be taken realistically; that is, it is proved thereby that the sexual problem itself must be subjected to a careful revision. If, for instance, an incest phantasy is clearly shown to be a latent content of the dream, one must subject the patient's infantile relations towards his parents and his brothers and sisters, as well as his relations towards other persons who are fitted to play the part of his father or mother in his mind, to a careful examination on this basis. But if a dream that comes in a later stage of the analysis has, let us say, an incest phantasy as its essential content, a phantasy that we have reason to consider disposed of, concrete value must not be attached to it under all circumstances; it must be regarded as symbolic. In this case symbolic value, not concrete value, must be attached to the sexual phantasy. If we did not go beyond the concrete value in this case, we should keep reducing the patient to sexuality, and this would arrest the progress of the development of his personality. The patient's salvation is not to be found by thrusting him back again into primitive sexuality; this would leave him on a low plane of civilisation whence he could never obtain freedom and complete restoration to health. Retrogression to a state of barbarism is no advantage at all for a civilised human being.
The above-mentioned formula, according to which the sexuality of a dream is a symbolic or analogous expression, naturally also holds good in the case of dreams occurring in the beginning of an analysis. But the practical reasons that have induced us not to take into consideration the symbolic value of this sexual phantasy, owe their existence to the fact that a genuine realistic value must be given to the abnormal sexual phantasies of a neurotic, in so far as the latter suffers himself to be influenced in his actions by these phantasies. Experience teaches us that these phantasies not only hinder him from adapting himself suitably to his situation, but that they also lead him to all manner of really sexual acts, and occasionally even to incest. Under these circumstances, it would be of little use to consider the symbolic content of the dream only; the concrete content must first be disposed of.
These arguments are based upon a different conception of the dream from that put forward by Freud; for, indeed, my experience has forced me to a different conception. According to Freud, the dream is in its essence a symbolic veil for repressed desires which are in conflict with the ideals of the personality. I am obliged to regard the dream structure from a different point of view. The dream for me is, in the first instance, the subliminal picture of the psychological condition of the individual in his waking state. It presents a résumé of the subliminal association material which is brought together by the momentary psychological situation. The volitional meaning of the dream which Freud calls the repressed desire, is, for me, essentially a means of expression. The activity of the consciousness, speaking biologically, represents the psychological effort which the individual makes in adapting himself to the conditions of life. His consciousness endeavours to adjust itself to the necessities of the moment, or, to put it differently: there are tasks ahead of the individual, which he must overcome. In many cases the solution is unknown; and for this reason the consciousness always tries to find the solution by the way of analogous experience. We always try to grasp what is unknown and in the future, according to our mental understanding of what has gone before. Now we have no reasons for assuming that the unconscious follows other laws than those which apply to conscious thought. The unconscious, like the conscious, gathers itself about the biological problems and endeavours to find solutions for these by analogy with what has gone before, just as much as the conscious does. Whenever we wish to assimilate something that is unknown, we arrive at it by a process of comparison. A simple example of this is the well-known fact that, when America was discovered by the Spaniards, the Indians took the horses of the conquerors, which were strange to them, for large pigs, because pigs were familiar to their experience. This is the mental process which we always employ in recognising unknown things; and this is the essential reason for the existence of symbolism. It is a process of comprehension by means of analogy. The apparently repressed desires, contained in the dream, are volitional tendencies which serve as language-material for subconscious expression. So far as this particular point is concerned, I am in full accord with the views of Adler, another member of Freud's school. With reference to the fact that subconscious materials of expression are volitional elements or tendencies, I may say that this is dependent upon the archaic nature of dream thinking, a problem with which I have already dealt in previous researches.[174]
Owing to our different conception of the structure of the dream, the further course of analysis also gains a different complexion from that which it had until now. The symbolic valuation given to sexual phantasies in the later stages of analysis necessarily leads less to the reduction of the patient's personality into primitive tendencies, than to the extension and further development of his mental attitude; that is, it tends to make his thinking richer and deeper, thus giving him what has always been one of the most powerful weapons that a human being can have in his struggle to adapt himself to life. By following this new course logically, I have come to the conclusion that these religious and philosophical motive forces—the so-called metaphysical needs of the human being—must receive positive consideration at the hands of the analyst. Though he must not destroy the motive forces that underlie them, by reducing them to their primitive, sexual roots, he must make them serve biological ends as psychologically valuable factors. Thus these instincts assume once more those functions that have been theirs from time immemorial.
Just as primitive man was able, with the aid of religious and philosophical symbol, to free himself from his original state, so, too, the neurotic can shake off his illness in a similar way. It is hardly necessary for me to say, that I do not mean by this, that the belief in a religious or philosophical dogma should be thrust upon the patient; I mean simply that he has to reassume that psychological attitude which, in an earlier civilisation, was characterised by the living belief in a religious or philosophical dogma. But the religious-philosophical attitude does not necessarily correspond to the belief in a dogma. A dogma is a transitory intellectual formulation; it is the result of the religious-philosophical attitude, and is dependent upon time and circumstances. This attitude is itself an achievement of civilization; it is a function that is exceedingly valuable from a biological point of view, for it gives rise to the incentives that force human beings to do creative work for the benefit of a future age, and, if necessary, to sacrifice themselves for the welfare of the species.
Thus the human being attains the same sense of unity and totality, the same confidence, the same capacity for self-sacrifice in his conscious existence that belongs unconsciously and instinctively to wild animals. Every reduction, every digression from the course that has been laid down for the development of civilisation does nothing more than turn the human being into a crippled animal; it never makes a so-called natural man of him. My numerous successes and failures in the course of my analytic practice have convinced me of the invariable correctness of this psychological orientation. We do not help the neurotic patient by freeing him from the demand made by civilisation; we can only help him by inducing him to take an active part in the strenuous task of carrying on the development of civilisation. The suffering which he undergoes in performing this duty takes the place of his neurosis. But, whereas the neurosis and the complaints that accompany it are never followed by the delicious feeling of good work well done, of duty fearlessly performed, the suffering that comes from useful work, and from victory over real difficulties, brings with it those moments of peace and satisfaction which give the human being the priceless feeling that he has really lived his life.
CHAPTER VIII
ON PSYCHOANALYSIS[175]
After many years' experience I now know that it is extremely difficult to discuss psychoanalysis at public meetings and at congresses. There are so many misconceptions of the matter, so many prejudices against certain psychoanalytic views, that it becomes an almost impossible task to reach mutual understanding in public discussion. I have always found a quiet conversation on the subject much more useful and fruitful than heated discussions coram publico. However, having been honoured by an invitation from the Committee of this Congress as a representative of the psychoanalytic movement, I will do my best to discuss some of the fundamental theoretical conceptions of psychoanalysis. I must limit myself to this part of the subject because I am quite unable to place before my audience all that psychoanalysis means and strives for, all its various applications, its psychology, its theoretical tendencies, its importance for the realm of the so-called "Geisteswissenschaften," e.g. Mythology, Comparative Religion, Philosophy, &c. But if I am to discuss certain theoretical problems fundamental to psychoanalysis, I must presuppose my audience to be well acquainted with the development and main results of psychoanalytic researches. Unfortunately, it often happens that people believe themselves entitled to judge psychoanalysis who have not even read the literature. It is my firm conviction that no one is competent to form a judgment concerning the subject until he has studied the fundamental works on psychoanalysis.
In spite of the fact that Freud's theory of neurosis has been worked out in great detail, it cannot be said to be, on the whole, very clear or easily accessible. This justifies my giving you a very short abstract of his fundamental views concerning the theory of neurosis.
You are aware that the original theory that hysteria and the related neuroses take their origin in a trauma or shock of sexual character in early childhood, was given up about fifteen years ago. It soon became obvious that the sexual trauma could not be the real cause of a neurosis, since trauma is found so universally; there is scarcely a human being who has not had some sexual shock in early youth, and yet comparatively few have incurred a neurosis in later life. Freud himself soon became aware that several of the patients who related an early traumatic event, had only invented the story of a so-called trauma; it had never taken place in reality, and was a mere creation of phantasy. Moreover, on further investigation it became quite obvious that even a trauma which had actually occurred was not always responsible for the whole of the neurosis, although it does sometimes look as if the structure of the neurosis depended entirely upon the trauma. If a neurosis were the inevitable consequence of a trauma it would be quite incomprehensible why neurotics are not incomparably more numerous.
This apparently heightened shock-effect was clearly based upon the exaggerated and morbid phantasy of the patient. Freud also saw that this same phantasy manifested itself in relatively early bad habits, which he called infantile perversities. His new conception of the ætiology of a neurosis was based upon this further understanding and traced the neurosis back to some sexual activity in early infancy; this conception led on to his recent view that the neurotic is "fixed" to a certain period of his early infancy, because he still seems to preserve some trace of it, direct or indirect, in his mental attitude. Freud also makes the attempt to classify or to differentiate the neuroses, including dementia præcox, according to the stage of the infantile development in which the fixation took place.
From the standpoint of this theory, the neurotic appears to be entirely dependent upon his infantile past, and all his troubles in later life, his moral conflicts, and deficiencies, seem to be derived from the powerful influence of that period. The therapy and its main preoccupation are in full accord with this view, and are chiefly concerned with the unravelling of this infantile fixation, which is understood as an unconscious attachment of the sexual libido to certain infantile phantasies and habits.
This is, so far as I can see, the essence of Freud's theory. But this conception neglects the following important question: What is the cause of this fixation of the libido to the old infantile phantasies and habits? We have to remember that almost all persons have at some time had infantile phantasies and habits exactly corresponding to those of a neurotic, but they do not become fixed to them; consequently, they do not become neurotic later on. The ætiological secret of the neurosis, therefore, does not consist in the mere existence of infantile phantasies, but lies in the so-called fixation. The manifold statements of the existence of infantile sexual phantasies in neurotic cases are worthless, in so far as they attribute an ætiological value to them, for the same phantasies can be found in normal individuals as well, a fact which I have often proved. It is only the fixation which seems to be characteristic. It is important to demand the nature of the proofs of the real existence of this infantile fixation. Freud, an absolutely sincere and thorough empiricist, would never have evolved this hypothesis had he not had sufficient grounds for it. The grounds are found in the results of the psychoanalytic investigations of the unconscious. Psychoanalysis discloses the unconscious existence of manifold phantasies, which have their end root in the infantile past and turn around the so-called "Kern-complex," or nucleus-complex, which may be designated in male individuals as the Œdipus-complex and in females as the Electra-complex. These terms convey their own meaning exactly. The whole tragic fate of Œdipus and Electra took place within the narrow confines of the family, just as the child's fate lies wholly within the family boundaries. Hence the Œdipus conflict is very characteristic of an infantile conflict, so also is the Electra conflict. The existence of these conflicts in infancy is largely proven by means of psychoanalytic experience. It is in the realm of this complex that the fixation is supposed to have taken place. Through the highly potent and effective existence of the nucleus-complex in the unconscious of neurotics, Freud was led to the hypothesis, that the neurotic has a peculiar fixation or attachment to it. Not the mere existence of this complex—for everybody has it in the unconscious—but the very strong attachment to it is what is typical of the neurotic. He is far more influenced by this complex than the normal person; many examples in confirmation of this statement will be found in every one of the recent psychoanalytic histories of neurotic cases.
We must admit that this conception is a very plausible one, because the hypothesis of fixation is based upon the well-known fact, that certain periods of human life, and particularly infancy, do sometimes leave determining traces for ever. The only question is whether this principle is a sufficient explanation or not. If we examine persons who have been neurotic from infancy it seems to be confirmed, for we see the nucleus-complex as a permanent and powerful activity throughout the whole life. But if we take cases which never show any considerable traces of neurosis except at the particular time when they break down, and there are many such, this principle becomes doubtful. If there is such a thing as fixation, it is not permissible to base upon it a new hypothesis, claiming that at times during certain epochs of life the fixation becomes loosened and ineffective, while at others it suddenly becomes strengthened and effective. In such cases we find the nucleus-complex as active and as potent as in those which apparently support the theory of fixation. Here a critical attitude is peculiarly justifiable, when we consider the often-repeated observation that the moment of the outbreak of the disease is by no means indifferent; as a rule it is most critical. It usually occurs at the moment when a new psychological adjustment, that is, a new adaptation, is demanded. Such moments facilitate the outbreak of a neurosis, as every experienced neurologist knows. This fact seems to me extremely significant. If the fixation were indeed real we should expect to find its influence constant, i.e. a neurosis continuous throughout life. This is obviously not the case. The psychological determination of a neurosis is only partially due to an early infantile predisposition; it is due to a certain actual cause as well. And if we carefully examine the kind of infantile phantasies and events to which the neurotic individual is attached, we shall be obliged to agree that there is nothing in them specific for neurosis. Normal individuals have pretty much the same kind of internal and external experiences, and are attached to them to an even astonishing degree, without developing a neurosis. You will find primitive people, especially, very much bound to their infantility. It now begins to look as if this so-called fixation were a normal phenomenon, and that the importance of infancy for the later mental attitude is natural and prevails everywhere. The fact that the neurotic seems to be markedly influenced by his infantile conflicts, shows that it is less a matter of fixation than of a peculiar use which he makes of his infantile past. It looks as if he exaggerated its importance, and attributed a very great artificial value to it (Adler, a pupil of Freud's, expresses a very similar view). It would be unjust to say that Freud confined himself to the hypothesis of fixation; he also was conscious of the impression I have just discussed. He called this phenomenon of reactivation or secondary exaggeration of infantile reminiscences "regression." But in Freud's conception it appears as if the incestuous desires of the Œdipus-complex were the real cause of the regression to infantile phantasies. If this were the case, we should have to postulate an unexpected intensity of the primary incestuous tendencies. This view led Freud to his recent comparison between the so-called psychological "incest-barrier" in children and the "incest-taboo" in primitive man. He supposes that a real incestuous desire has led the primitive man to the invention of a protective law; while to me it looks as if the incest-taboo is one among numerous taboos of all sorts, and due to the typical superstitious fear of primitive man, a fear existing independently of incest and its interdiction. I am able to attribute as little particular strength to incestuous desires in childhood as in primitive humanity. I do not even seek the reason for regression in primary incestuous or any other sexual desires. I must state that a purely sexual ætiology of neurosis seems to me much too narrow. I base this criticism upon no prejudice against sexuality, but upon an intimate acquaintance with the whole problem.
Therefore I suggest that the psychoanalytic theory should be liberated from the purely sexual standpoint. In place of it I should like to introduce an energic view-point into the psychology of neurosis.
All psychological phenomena can be considered as manifestations of energy, in the same way as all physical phenomena are already understood as energic manifestations since Robert Mayer discovered the law of the conservation of energy. This energy is subjectively and psychologically conceived as desire. I call it libido, using the word in the original meaning of this term, which is by no means only sexual. Sallustius applies the term exactly in the way we do here: "Magis in armis et militaribus equis, quam in scortis et conviviis libidinem habebant."
From a broader standpoint libido can be understood as vital energy in general, or as Bergson's élan vital. The first manifestation of this energy in the suckling is the instinct of nutrition. From this stage the libido slowly develops through manifold varieties of the act of sucking into the sexual function. Hence I do not consider the act of sucking as a sexual act. The pleasure in sucking can certainly not be considered as sexual pleasure, but as pleasure in nutrition, for it is nowhere proved that pleasure is sexual in itself. This process of development continues into adult life and is connected with a constantly increased adaptation to the external world. Whenever the libido, in the process of adaptation, meets an obstacle, an accumulation takes place which normally gives rise to an increased effort to overcome the obstacle. But if the obstacle seems to be insurmountable, and the individual renounces the overcoming of it, the stored-up libido makes a regression. In place of being employed in the increased effort, the libido now gives up the present task and returns to a former and more primitive way of adaptation. We meet with the best examples of such regressions very frequently in hysterical cases where a disappointment in love or marriage gives rise to the neurosis. There we find the well-known disturbances of nutrition, resistance against eating, dyspeptic symptoms of all sorts, etc. In these cases the regressive libido, turning away from its application to the work of adaptation, holds sway over the function of nutrition and provokes considerable disturbance. Such cases are obvious examples of regression. Similar effects of regression are to be found in cases where there are no troubles in the function of nutrition, and here we readily find a regressive revival of reminiscences of a time long past. We find a revival of the images of the parents, of the Œdipus-complex. Here things and events of infancy—never before important—suddenly become so. They are regressively reanimated. Take away the obstacle in the path of life and this whole system of infantile phantasies at once breaks down and becomes again as inactive and as ineffective as before. But do not let us forget that, to a certain extent, it is at work influencing us always and everywhere. I cannot forbear to mention that this view comes very near Janet's hypothesis of the substitution of the "parties supérieures" of a function by its "parties inférieures." I would also remind you of Claparède's conception of neurotic symptoms as emotional reflexes of a primitive nature.
Therefore I no longer find the cause of a neurosis in the past, but in the present. I ask, what is the necessary task which the patient will not accomplish? The whole list of his infantile phantasies does not give me any sufficient ætiological explanation, because I know that these phantasies are only puffed up by the regressive libido, which has not found its natural outlet into a new form of adjustment to the demands of life.
You may ask why the neurotic has a special inclination not to accomplish his necessary tasks. Here let me point out that no living being adjusts itself easily and smoothly to new conditions. The principle of the minimum of effort is valid everywhere.
A sensitive and somewhat inharmonious character, as a neurotic always is, will meet special difficulties and perhaps more unusual tasks in life than a normal individual, who as a rule has only to follow the well-established line of an ordinary life. For the neurotic there is no established way, for his aims and tasks are apt to be of a highly individual character. He tries to follow the more or less uncontrolled and half-conscious way of normal people, not fully realizing his own critical and very different nature, which imposes upon him more effort than the normal person is required to exert. There are neurotics who have shown their increased sensitiveness and their resistance against adaptation in the very first weeks of life, in their difficulty in taking the mother's breast, and in their exaggerated nervous reactions, &c. For this portion of a neurotic predisposition it will always be impossible to find a psychological ætiology, for it is anterior to all psychology. But this predisposition—you may call it "congenital sensitiveness" or by what name you like—is the cause of the first resistances against adaptation. In such case, the way of adaptation being blocked, the biological energy we call libido does not find its appropriate outlet or activity and therefore replaces an up-to-date and suitable form of adaptation by an abnormal or primitive one.
In neurosis we speak of an infantile attitude or the predominance of infantile phantasies and desires. In so far as infantile impressions and desires are of obvious importance in normal people they are equally influential in neurosis, but they have here no ætiological significance, they are reactions merely, being chiefly secondary and regressive phenomena. It is perfectly true, as Freud states, that infantile phantasies determine the form and further development of neurosis, but this is not ætiology. Even when we find perverted sexual phantasies of which we can prove the existence in childhood, we cannot consider them of ætiological significance. A neurosis is not really originated by infantile sexual phantasies and the same must be said of the sexualism of neurotic phantasy in general. It is not a primary phenomenon based upon a perverted sexual disposition, but merely secondary and a consequence of a failure to apply the stored-up libido in a suitable way. I realize that this is a very old view, but this does not prevent its being true. The fact that the patient himself very often believes that this infantile phantasy is the real cause of the neurosis, does not prove that he is right in his belief, or that a theory following the same belief is right either. It may look as if it were so, and I must confess that indeed very many cases do have that appearance. At all events, it is perfectly easy to understand how Freud came to this view. Every one having any psychoanalytic experience will agree with me here.
To sum up: I cannot see the real ætiology of a neurosis in the various manifestations of infantile sexual development and their corresponding phantasies. The fact that they are exaggerated and put into the foreground in neurosis is a consequence of the stored-up energy or libido. The psychological trouble in neurosis, and neurosis itself, can be considered as an act of adaptation that has failed. This formulation might reconcile certain views of Janet's with Freud's view, that a neurosis is—under a certain aspect—an attempt at self-cure; a view which can be and has been applied to many diseases.
Here the question arises whether it is still advisable to bring to light all the patient's phantasies by analysis, if we now consider them as of no ætiological significance. Psychoanalysis hitherto has proceeded to the unravelling of these phantasies because they were considered to be ætiologically significant. My altered view concerning the theory of neurosis does not change the procedure of psychoanalysis. The technique remains the same. We no longer imagine we are unearthing the end-root of the disease, but we have to pull up the sexual phantasies because the energy which the patient needs for his health, that is, for his adaptation, is attached to them. By means of psychoanalysis the connexion between the conscious and the libido in the unconscious is re-established. Thus you restore this unconscious libido to the command of conscious intention. Only in this way can the formerly split-off energy become again applicable to the accomplishment of the necessary tasks of life. Considered from this standpoint, psychoanalysis no longer appears to be a mere reduction of the individual to his primitive sexual wishes, but it becomes clear that, if rightly understood, it is a highly moral task of immense educational value.
CHAPTER IX
ON SOME CRUCIAL POINTS IN PSYCHOANALYSIS[176]
Correspondence between Dr. Jung and Dr. Loÿ appearing in "Psychotherapeutische Zeitfragen." Published by Dr. Loÿ, Sanatorium L'abri, Territet-Montreux, Switzerland, 1914.
I
From Dr. Loÿ.
12th January, 1913.
What you said at our last conversation was extraordinarily stimulating. I was expecting you to throw light upon the interpretation of my own and my patients' dreams from the standpoint of Freud's "Interpretation of Dreams." Instead, you put before me an entirely new conception: the dream as a means of re-establishing the moral equipoise, fashioned in the realm below the threshold of consciousness. That indeed is a fruitful conception. But still more fruitful appears to me your other suggestion. You regard the problems of psychoanalysis as much deeper than I had ever thought: it is no longer merely a question of getting rid of troublesome pathological symptoms; the analysed person gets to understand not his anxiety-experiences alone, but his whole self most completely, and by means of this understanding he can build up and fashion his whole life anew. But he himself must be the builder, the Analyst only furnishes him with the necessary tools.
To begin with, I would ask you to consider what justification there is for the original procedure of Breuer and Freud, now entirely given up both by Freud himself and by you, but practised by Frank, for instance, as his only method: I mean "the abreaction of the inhibited effects under light hypnosis." Why have you given up the cathartic method? More particularly, has light hypnosis in psychocatharsis a different value from suggestion during sleep, long customary in treatment by suggestion? that is, has it only the value which the suggestionist contributes, or does it claim to possess only the value which the patient's belief bestows upon it? Or, again, is suggestion in the waking-state equivalent to suggestion in hypnoidal states? This Bernheim now asserts to be the case, after having used suggestion for many years exclusively in hypnosis. You will tell me we must talk of psychoanalysis, not of suggestion. But I really mean this: is not the suggestion, by means of which the psychocatharsis in the hypnoidal state produces therapeutic effects, (modified naturally, by the patients' age, etc.) the main factor in the therapeutic success of the psychocatharsis? Frank, in his "Affektstörungen," says: "these partial adjustments of effect, suggestibility and suggestion, are almost altogether omitted in the psychocathartic treatment in light sleep, in so far as the content of the reproduced presentations is concerned." Is that really true? Frank himself adds: "How can meditation upon the dreams of youth in itself lead to the discharge of the stored-up anxiety, whether in hypnoidal states or under any other conditions? Must one not suppose, with much greater probability, that the anxiety-states would become more pronounced through such concentration upon them?" [I have noticed that myself, and much more than I at all liked.] One does indeed say to the patient: "First we must stir up, then afterwards comes peace." And it does come. But does it not come in spite of the stirring-up process, because gradually, by means of frequent talks under light hypnosis, the patient gets such confidence in the doctor that he becomes susceptible to direct suggestion, and that produces at first improvement and finally, cure? I go still further: in an analysis in the waking-state, is not the patient's belief that the method employed will cure him, coupled with his ever-growing trust in the doctor, a main cause of his cure? And I ask even further: in every systematically carried-out therapeutic treatment, is not faith in it, trust in the doctor, a main factor in its success? I will not indeed say the only factor, for one cannot deny that the physical, dietetic and chemical procedures, when properly selected, have a real effect in securing a cure, over and above the obvious effect of their indirect suggestion.
II
From Dr. Jung.
28th January, 1913.
With regard to your question as to the applicability of the cathartic method, the following is my standpoint: every method is good if it serves its purpose, including every method of suggestion, even Christian Science, Mental Healing, etc. "A truth is a truth, when it works." It is quite another question whether a scientific physician can answer for it to his conscience should he sell little bottles of Lourdes-water because that suggestion is at times very useful. Even the so-called highly scientific suggestion-therapy employs the wares of the medicine-man and the exorcising Schaman. And please, why should it not? The public is not even now much more advanced and continues to expect miracles from the doctor. And truly those doctors should be deemed clever—worldly-wise in every respect—who understand the art of investing themselves with the halo of the medicine-man. Not only have they the biggest practices—they have also the best results. This is simply because countless physical maladies (leaving out of count the neuroses) are complicated and burdened with psychic elements to an extent scarcely yet suspected. The medical exorcist's whole behaviour betrays his full valuation of the psychic element when he gives the patient the opportunity of fixing his faith firmly upon the doctor's mysterious personality. Thus does he win the sick man's mind, which henceforth helps him indeed to restore his body also to health. The cure works best when the doctor really believes in his own formulæ, otherwise he may be overcome by scientific doubt and so lose the correct, convincing tone. I, too, for a time practised hypnotic suggestion enthusiastically. But there befell me three dubious incidents which I want you to note:—
1. Once there came to me to be hypnotised for various neurotic troubles a withered peasant-woman of some fifty years old. She was not easy to hypnotise, was very restless, kept opening her eyes—but at last I did succeed. When I waked her after about half an hour she seized my hand and with many words testified to her overflowing gratitude. I said: "But you are by no means cured yet, so keep your thanks till the end of the treatment." She: "I am not thanking you for that, but—(blushing and whispering)—because you have been so decent." So she said, looked at me with a sort of tender admiration and departed. I gazed long at the spot where she had stood—and asked myself, confounded, "So decent?"—good heavens! surely she hadn't imagined, somehow or other.... This glimpse made me suspect for the first time that possibly the loose-minded person, by means of that notorious feminine (I should at that time have said "animal") directness of instinct, understood more about the essence of hypnotism than I with all my knowledge of the scientific profundity of the text-books. Therein lay my harmlessness.
2. Next came a pretty, coquettish, seventeen-year-old girl with a harassed, suspicious mother. The young daughter had suffered since early girlhood from enuresis nocturna, which, among other difficulties, hindered her from going to a boarding-school abroad.
At once I thought of the old woman and her wisdom. I tried to hypnotise the girl; she laughed affectedly and prevented hypnosis for twenty minutes. Of course I kept quiet and thought: I know why you laugh; you have already fallen in love with me, but I will give you proof of my decency in gratitude for your wasting my time with your challenging laughter. I succeeded in hypnotising her. Success followed at once. The enuresis stopped, and I therefore informed the young lady later that, instead of Wednesday, I would not see her again for hypnosis till the following Saturday. On Saturday she arrived with a cross countenance, presaging failure. The enuresis had come back again. I remembered my wise old woman, and asked: "When did the enuresis return?" She (unsuspecting), "Wednesday night." I thought to myself, There it is again, she wants to show me that I simply must see her on Wednesdays too; not to see me for a whole long week is too much for a tender, loving heart. But I was quite resolved to give no help to such annoying romancing, so I said, "To continue the hypnosis would be quite wrong under these circumstances. We must drop it for quite three weeks, to give the enuresis a chance to stop. Then come again for treatment." In my malicious heart I knew I should then be on my holiday and so the course of hypnotic treatment would come to an end. After the holidays my locum tenens told me the young lady had been there with the news that the enuresis had vanished, but her disappointment at not seeing me was very keen. The old woman was right, thought I.
3. The third case gave my joy in suggestion its death-blow. This was the manner of it. She was a lady of sixty-five who came stumbling into the consulting-room with a crutch. She had suffered from pain in the knee-joint for seventeen years, and this at times kept her in bed for many weeks. No doctor had been able to cure her, and she had tried every possible remedy of present-day medicine. After I had suffered the stream of her narrative to flow over me for some ten minutes, I said, "I will try to hypnotise you, perhaps that will do you good." She, "Oh yes, please do!" leaned her head on one side and fell asleep before ever I said or did anything. She passed into somnambulism and showed every form of hypnosis you could possibly desire. After half an hour I had the greatest difficulty in waking her; when at last she was awake she jumped up: "I am well, I am all right, you have cured me." I tried to make timid objections, but her praises drowned me. She could really walk. Then I blushed and said, embarrassed, to my colleagues: "Look! behold the wondrously successful hypnotic therapy." That day saw the death of my connection with treatment by suggestion; the therapeutic praise won by this case shamed and humiliated me. When, a year later, at the beginning of my hypnotic course, the good old lady returned, this time with the pain in her back, I was already sunk in hopeless cynicism; I saw written on her forehead that she had just read the notice of the re-opening of my clinic in the newspaper, that vexatious romanticism had provided her with a convenient pain in the back so that she might have a pretext for seeing me, and again let herself be cured in the same theatrical fashion. This proved true in every particular.
As you will understand, a man possessed of scientific conscience cannot endure such cases without embarrassment. There ripened in me the resolve to renounce suggestion altogether rather than to allow myself passively to be transformed into a miracle-worker. I wanted to understand what really went on in the souls of people. It suddenly seemed to me incredibly childish to think of dispelling an illness with charms, and that this should be the only result of our scientific endeavours for a psychotherapy. Thus for me the discovery of Breuer and Freud was a veritable deliverance. I took up their method with unalloyed enthusiasm and soon recognised how right Freud was, when at a very early date, indeed so far back as the Studien ueber Hysterie, he began to direct a searchlight upon the accompanying circumstances of the so-called trauma. I too soon discovered that certainly some traumata with an obvious etiological tinge are opportunely present. But the greater number appeared highly improbable. So many of them seemed so insignificant, even so normal, that at most one could regard them as just providing the opportunity for the neurosis to appear. But what especially spurred my criticism was the fact that so many traumata were simply inventions of phantasy which had never really existed. This perception was enough to make me sceptical about the whole trauma-theory. (But I have dealt with these matters in detail in my lectures on the theory of psychoanalysis).[177] I could no longer suppose that the hundred and one cathartic experiences of a phantastically puffed-up or entirely invented trauma were anything but the effect of suggestion. It is well enough if it helps. If one only had not a scientific conscience and that impulsion towards the truth! I found in many cases, especially when dealing with more mentally gifted patients, that I must recognise the therapeutic limitations of this method. It is, of course, a definite plan, and convenient for the doctor, since it makes no particular demands upon his intellect for new adaptations. The theory and practice are both of the pleasantest simplicity: "The neurosis is caused by a trauma. The trauma is abreacted." When the abreaction takes place under hypnotism, or with other magical accessories (dark room, peculiar lighting, and the rest), I remember once more the wise old woman, who opened my eyes not merely to the magic influence of the mesmeric gestures, but also to the essential character of hypnotism itself. But what alienated me once for all from this relatively efficacious indirect method of suggestion, based as it is upon an equally efficacious false theory, was the perception I obtained at the same time that, behind the confused deceptive intricacies of neurotic phantasies, there stands a conflict, which may be best described as a moral one. With this there began for me a new era of understanding. Research and therapy now coincided in the attempt to discover the causes and the rational solution of this conflict. That is what psychoanalysis meant to me. Whilst I had been getting this insight, Freud had built up his sexual theory of the neurosis, and therewith had brought forward an enormous number of questions for discussion, all of which I thought deserved the profoundest consideration. Thus I have had the good fortune of co-operating with Freud for a long time, and working with him in the investigation of the problem of sexuality in neurosis. You, perhaps, know from some of my earlier work that I was always dubious somewhat concerning the significance of sexuality.[178] This has now become the exact point where I am no longer altogether of Freud's opinion.
I have preferred to answer your questions in rather non-sequent fashion. Whatever is still unanswered, let me now repeat: light hypnosis and complete hypnosis are but varying grades of intensity of unconscious attraction towards the hypnotist. Who can here venture to draw sharp distinctions? To a critical intelligence it is unthinkable that suggestibility and suggestion can be excluded in the cathartic method. They are present everywhere and are universal human attributes, even with Dubois and the psychoanalysts who think they work on purely rational lines. No technique, no self-deception avails here—the doctor works, nolens volens—and perhaps primarily—by means of his personality, that is by suggestion. In the cathartic treatment, what is of far more importance to the patient than the conjuring up of old phantasies is the being so often with the doctor, and having confidence and belief in him personally, and in his method. The belief, the self-confidence, perhaps also the devotion with which the doctor does his work, are far more important things to the patient (imponderabilia though they be) than the recalling of old traumata.[179]
Ultimately we shall some day know from the history of medicine everything that has ever been of service; then perhaps at last we may come to the really desirable therapy, to psychotherapy. Did not even the old materia medica of filth have brilliant cures?—cures which only faded away with the belief in it!
Because I recognise that the patient does attempt to lay hold of the doctor's personality, in spite of all possible rational safeguards, I have formulated the demand that the psychotherapeutist shall be held just as responsible for the cleanness of his own hands as is the surgeon. I hold it to be an absolutely indispensable preliminary that the psychoanalyst should himself first undergo an analysis, for his personality is one of the chief factors in the cure.
Patients read the doctor's character intuitively and they should find in him a human being, with faults indeed, but also a man who has striven at every point to fulfil his own human duties in the fullest sense. I think that this is the first healing factor. Many times I have had the opportunity of seeing that the analyst is successful with his treatment just in so far as he has succeeded in his own moral development. I think this answer will satisfy your question.
III
From Dr. Loÿ.
2nd February, 1913.
You answer several of my questions in a decidedly affirmative sense. You take it as proved that in the cures by the cathartic method the main rôle is played by faith in the doctor and in his method, and not by the "abreaction" of real or imaginary traumata. I also. Equally I am at one with your view that the cures of the old materia medica of filth, as well as the Lourdes cures, or those of the Mental Healers, Christian Scientists and Persuasionists, are to be attributed to faith in the miracle-worker, rather than to any of the methods employed.
Now comes the ticklish point: the augur can remain an augur so long as he himself believes the will of the gods is made manifest by the entrails of the sacrificial beast. When he no longer believes, he has to ask himself: Shall I continue to use my augur's authority to further the welfare of the State, or shall I make use of my newer, and (I hope) truer convictions of to-day? Both ways are possible. The first is called opportunism; the second the pursuit of truth, and scientific honour. For a doctor, the first way brings perhaps therapeutic success and fame; the second, reproach: such a man is not taken seriously. What I esteem most highly in Freud and his school is just this passionate desire for truth. But again, it is precisely here that people pronounce a different verdict: "It is impossible for the busy practitioner to keep pace with the development of the views of this investigator and his initiates." (Frank, "Affektstörungen Einleitung.")
One can easily disregard this little quip, but one must take more seriously one's self-criticism. We may have to ask ourselves whether, since science is an undivided, ever-flowing stream, we are justified in relinquishing on conscientious grounds any method or combination of methods by means of which we know cures can be achieved?
Looking more closely at the fundamental grounds of your aversion to the use of hypnosis (or semi-hypnosis, the degree matters nothing) in treatment by suggestion, (which as a matter of fact every doctor and every therapeutic method makes use of willy-nilly, no matter what it is called), it is clear that what has disgusted you in hypnotism is at bottom nothing but the so-called "transference" to the doctor, which you, with your unalloyed psychoanalytic treatment, can get rid of as little as any one else, for indeed it plays a chief part in the success of the treatment. Your insistence that the psychoanalyst must be answerable for the cleanness of his own hands—(here I agree with you unreservedly)——is an inevitable conclusion. But, after all, does anything more "augurish" really cling to the use made of hypnosis in psychotherapeutic treatment, than to the quite inevitable use made of the "transference to the doctor" for therapeutic ends? In either case we must perforce "take shares" in faith as a healing agent. As for the feeling which the patient—whether man or woman—entertains for the doctor, is there never anything in the background save conscious or unconscious sexual desire? In many cases your view is most certainly correct; more than one woman has been frank enough to confess that the beginning of hypnosis was accompanied by voluptuous pleasure. But this is not true in all instances—or how would you explain the underlying feeling in the hypnotising of one animal by another, e.g. snake and bird? Surely you can say that there the feeling of fear reigns, fear which is an inversion of the libido, such as comes upon the bride in that hypnoidal state before she yields to her husband wherein pure sexual desire rules, though possibly it contains an element of fear. However this may be, from your three cases I cannot draw any ethical distinction between the "unconscious readiness towards the hypnotist" and the "transference to the doctor" which should avail to condemn a combination of hypnotism and psychoanalysis as a method of treatment. You will ask why I cling to the use of hypnotism; or rather of hypnoidal states. Because I think there are cases that can be much more rapidly cured thereby, than through a purely psychoanalytic treatment. For example, in no more than five or six interviews I cured a fifteen-year-old girl who had suffered from enuresis nocturna from infancy, but was otherwise thoroughly healthy, gifted, and pre-eminent at school: she had previously tried all sorts of treatment without any result.
Perhaps I ought to have sought out the psychoanalytic connexion between the enuresis and her psychosexual attitude and explained it to her, etc., but I could not, she had only the short Easter holidays for treatment: so I just hypnotised her and the tiresome trouble vanished. It was a lasting cure.
In psychoanalysis I use hypnosis to help the patient to overcome "resistances."