Introductory lectures on psycho-analysis

The transference has this all-important, absolutely central significance for the cure in hysteria, anxiety-hysteria, and the obsessional neurosis, which are in consequence rightly grouped together as the ‘transference neuroses.’ Anyone who has grasped from analytic experience a true impression of the fact of transference can never again doubt the nature of the suppressed impulses which have manufactured an outlet for themselves in the symptoms; and he will require no stronger proof of their libidinal character. We may say that our conviction of the significance of the symptoms as a substitutive gratification of the Libido was only finally and definitely established by evaluating the phenomenon of transference.

Now, however, we are called upon to correct our former dynamic conception of the process of cure and to bring it into agreement with the new discovery. When the patient has to fight out the normal conflict with the resistances which we have discovered in him by analysis, he requires a powerful propelling force to influence him towards the decision we aim at, leading to recovery. Otherwise it might happen that he would decide for a repetition of the previous outcome, and allow that which had been raised into consciousness to slip back again under repression. The outcome in this struggle is not decided by his intellectual insight—it is neither strong enough nor free enough to accomplish such a thing—but solely by his relationship to the physician. In so far as his transference bears the positive sign, it clothes the physician with authority, transforms itself into faith in his findings and in his views. Without this kind of transference or with a negative one, the physician and his arguments would never even be listened to. Faith repeats the history of its own origin; it is a derivative of love and at first it needed no arguments. Not until later does it admit them so far as to take them into critical consideration if they have been offered by someone who is loved. Without this support arguments have no weight with the patient, never do have any with most people in life. A human being is therefore on the whole only accessible to influence, even on the intellectual side, in so far as he is capable of investing objects with Libido; and we have good cause to recognize, and to fear, in the measure of his narcissism a barrier to his susceptibility to influence, even by the best analytic technique.

The capacity for the radiation of Libido towards other persons in object investment must, of course, be ascribed to all normal people; the tendency to transference in neurotics, so-called, is only an exceptional intensification of a universal characteristic. Now it would be very remarkable if a human character-trait of this importance and universality had never been observed and made use of. And this has really been done. Bernheim, with unerring perspicacity, based the theory of hypnotic manifestations upon the proposition that all human beings are more or less open to suggestion, are ‘suggestible.’ What he called suggestibility is nothing else but the tendency to transference, rather too narrowly circumscribed so that the negative transference did not come within its scope. But Bernheim could never say what suggestion actually was nor how it arises; it was an axiomatic fact to him and he could give no explanation of its origin. He did not recognize the dependence of ‘suggestibility’ on sexuality, on the functioning of the Libido. And we have to admit that we have only abandoned hypnosis in our methods in order to discover suggestion again in the shape of transference.

But now I will pause and let you take up the thread. I observe that an objection is invading your thoughts with such violence that it would deprive you of all power of attention if it were not given expression. “So now at last you have confessed that you too work with the aid of suggestion like the hypnotists. We have been thinking so all along. But then, what is the use of all these roundabout routes by way of past experiences, discovering the unconscious material, interpreting and retranslating the distortions, and the enormous expenditure of time, trouble, and money, when after all the only effective agent is suggestion? Why do you not suggest directly against the symptoms, as others do who are honest hypnotists? And besides, if you are going to make out that by these roundabout routes you have made numerous important psychological discoveries, which are concealed in direct suggestion, who is to vouch for their validity? Are not they too the result of suggestion, of unintentional suggestion, that is? Cannot you impress upon the patient what you please and whatever seems good to you in this direction also?”

What you charge me with in this way is exceedingly interesting and must be answered. But I cannot do that to-day; our time is up. Till next time, then. You will see that I shall be answerable to you. To-day I must finish what I began. I promised to explain to you through the factor of the transference why it is that our therapeutic efforts have no success in the narcissistic neuroses.

I can do it in a few words, and you will see how simply the riddle is solved, and how well everything fits together. Experience shows that persons suffering from the narcissistic neuroses have no capacity for transference, or only insufficient remnants of it. They turn from the physician, not in hostility, but in indifference. Therefore they are not to be influenced by him; what he says leaves them cold, makes no impression on them, and therefore the process of cure which can be carried through with others, the revivification of the pathogenic conflict and the overcoming of the resistance due to the repressions, cannot be effected with them. They remain as they are. They have often enough undertaken attempts at recovery on their own account which have led to pathological results; we can do nothing to alter this.

On the basis of our clinical observations of these patients we stated that they must have abandoned the investment of objects with Libido and transformed object-Libido into Ego-Libido. By this we differentiated them from the first group of neurotics (hysteria, anxiety, and obsessional neurosis). Their behaviour during the attempt to cure them confirms this suspicion. They produce no transference, and are, therefore, inaccessible to our efforts, not to be cured by us.

You know what we are going to discuss to-day. When I admitted that the influence of the psycho-analytic therapy is essentially founded upon transference, i.e. upon suggestion, you asked me why we do not make use of direct suggestion, and you linked this up with a doubt whether, in view of the fact that suggestion plays such a large part, we can still vouch for the objectivity of our psychological discoveries. I promised to give you a comprehensive answer.

Direct suggestion is suggestion delivered directly against the forms taken by the symptoms, a struggle between your authority and the motives underlying the disease. In this struggle you do not trouble yourself about these motives, you only require the patient to suppress the manifestation of them in the form of symptoms. In the main it makes no difference whether you place the patient under hypnosis or not. Bernheim, with his characteristic acuteness, repeatedly stated that suggestion was the essence of the manifestations of hypnotism, and that hypnosis itself was already a result of suggestion, a suggested condition; he preferred to use suggestion in the waking state, which can achieve the same results as suggestion in hypnosis.

Now which shall I take first, the results of experience or theoretical considerations?

Let us begin with experience. I sought out Bernheim in Nancy in 1889 and became a pupil of his; I translated his book on suggestion into German. For years I made use of hypnotic treatment, first with prohibitory suggestions and later combined with Breuer’s system of the fullest enquiry into the patient’s life; I can therefore speak from wide experience about the results of the hypnotic or suggestive therapy. According to an old medical saying an ideal therapy should be rapid, reliable and not disagreeable to the patient; Bernheim’s method certainly fulfilled two of these requirements. It was much more rapid, that is, incomparably more rapid in its course than the analytic, and it involved the patient in no trouble or discomfort. For the physician it eventually became monotonous; it meant treating every case in the same way, always employing the same ritual to prohibit the existence of the most diverse symptoms, without being able to grasp anything of their meaning or significance. It was a sort of mechanical drudgery—hodman’s work—not scientific work; it was reminiscent of magic, conjuring, and hocus-pocus, yet in the patient’s interests one had to ignore that. In the third desideratum, however, it failed; it was not reliable in any respect. It could be employed in certain cases only and not in others; with some much could be achieved by it, and with others very little, one never knew why. But worse than its capricious nature was the lack of permanence in the results; after a time, if one heard from the patient again, the old malady had reappeared or had been replaced by another. Then one could begin to hypnotize again. In the background there was the warning of experienced men against robbing the patient of his independence by frequent repetitions of hypnosis, and against accustoming him to this treatment as though it were a narcotic. It is true, on the other hand, that at times everything fell out just as one could wish; one obtained complete and lasting success with little difficulty; but the conditions of this satisfactory outcome remained hidden. In one case, when I had completely removed a severe condition by a short hypnotic treatment, it recurred unchanged after the patient (a woman) had developed ill feeling against me without just cause; then after a reconciliation I was able to effect its disappearance again and this time far more thoroughly; but it reappeared again when she had a second time become hostile to me. Another time I had the following experience; during the treatment of an especially obstinate attack in a patient whom I had several times relieved of nervous symptoms, she suddenly threw her arms round my neck. Whether one wished to do so or not, this kind of thing finally made it imperative to enquire into the problem of the nature and source of one’s suggestive authority.

So much for experience; it shows that in abandoning direct suggestion we have given up nothing irreplaceable. Now let us link on to the facts a few comments. The exercise of the hypnotic method makes as little demand for effort on the part of the patient as it does on the physician. The method is in complete harmony with the view of the neuroses generally accepted by the majority of medical men. The practitioner says to the nervous person: “There is nothing the matter with you; it is merely nervousness, therefore a few words from me will scatter all your troubles to the winds in five minutes.” But it is contrary to all our beliefs about energy in general that a minimal exertion should be able to remove a heavy load by approaching it directly without the assistance of any suitably-devised appliance. In so far as the circumstances are at all comparable, experience shows that this trick cannot be performed successfully with the neuroses. I know, however, that this argument is not unassailable; there are such things as explosions.

In the light of the knowledge we have obtained through psycho-analysis, the difference between hypnotic and psycho-analytic suggestion may be described as follows: The hypnotic therapy endeavours to cover up and as it were to whitewash something going on in the mind, the analytic to lay bare and to remove something. The first works cosmetically, the second surgically. The first employs suggestion to interdict the symptoms; it reinforces the repressions, but otherwise it leaves unchanged all the processes that have led to symptom-formation. Analytic therapy takes hold deeper down nearer the roots of the disease, among the conflicts from which the symptoms proceed; it employs suggestion to change the outcome of these conflicts. Hypnotic therapy allows the patient to remain inactive and unchanged, consequently also helpless in the face of every new incitement to illness. Analytic treatment makes as great demands for efforts on the part of the patient as on the physician, efforts to abolish the inner resistances. The patient’s mental life is permanently changed by overcoming these resistances, is lifted to a higher level of development, and remains proof against fresh possibilities of illness. The labour of overcoming the resistances is the essential achievement of the analytic treatment; the patient has to accomplish it and the physician makes it possible for him to do this by suggestions which are in the nature of an education. It has been truly said therefore, that psycho-analytic treatment is a kind of re-education.

I hope I have now made clear to you the difference between our method of employing suggestion therapeutically and the method which is the only possible one in hypnotic therapy. Since we have traced the influence of suggestion back to the transference, you also understand the striking capriciousness of the effect in hypnotic therapy, and why analytic therapy is within its limits dependable. In employing hypnosis we are entirely dependent upon the condition of the patient’s transference and yet we are unable to exercise any influence upon this condition itself. The transference of a patient being hypnotized may be negative, or, as most commonly, ambivalent, or he may have guarded himself against his transference by adopting special attitudes; we gather nothing about all this. In psycho-analysis we work upon the transference itself, dissipate whatever stands in the way of it, and manipulate the instrument which is to do the work. Thus it becomes possible for us to derive entirely new benefits from the power of suggestion; we are able to control it; the patient alone no longer manages his suggestibility according to his own liking, but in so far as he is amenable to its influence at all, we guide his suggestibility.

Now you will say that, regardless of whether the driving force behind the analysis is called transference or suggestion, the danger still remains that our influence upon the patient may bring the objective certainty of our discoveries into doubt; and that what is an advantage in therapy is harmful in research. This is the objection that has most frequently been raised against psycho-analysis; and it must be admitted that, even though it is unjustified, it cannot be ignored as unreasonable. If it were justified, psycho-analysis after all would be nothing else but a specially well-disguised and particularly effective kind of suggestive treatment; and all its conclusions about the experiences of the patient’s past life, mental dynamics, the Unconscious, and so on, could be taken very lightly. So our opponents think; the significance of sexual experiences in particular, if not the experiences themselves, we are supposed to have “put into the patient’s mind,” after having first concocted these conglomerations in our own corrupt minds. These accusations are more satisfactorily refuted by the evidence of experience than by the aid of theory. Anyone who has himself conducted psycho-analyses has been able to convince himself numberless times that it is impossible to suggest things to a patient in this way. There is no difficulty, of course, in making him a disciple of a particular theory, and thus making it possible for him to share some mistaken belief possibly harboured by the physician. He behaves like anyone else in this, like a pupil; but by this one has only influenced his intellect, not his illness. The solving of his conflicts and the overcoming of his resistances succeeds only when what he is told to look for in himself corresponds with what actually does exist in him. Anything that has been inferred wrongly by the physician will disappear in the course of the analysis; it must be withdrawn and replaced by something more correct. One’s aim is, by a very careful technique, to prevent temporary successes arising through suggestion; but if they do arise no great harm is done, for we are not content with the first result. We do not consider the analysis completed unless all obscurities in the case are explained, the gaps in memory filled out, and the original occasions of the repressions discovered. When results appear prematurely, one regards them as obstacles rather than as furtherances of the analytic work, and one destroys them again by continually exposing the transference on which they are founded. Fundamentally it is this last feature which distinguishes analytic treatment from that of pure suggestion, and which clears the results of analysis from the suspicion of being the results of suggestion. In every other suggestive treatment the transference is carefully preserved and left intact; in analysis it is itself the object of the treatment and is continually being dissected in all its various forms. At the conclusion of the analysis the transference itself must be dissolved; if success then supervenes and is maintained it is not founded on suggestion, but on the overcoming of the inner resistances effected by the help of suggestion, on the inner change achieved within the patient.

That which probably prevents single effects of suggestion from arising during the treatment is the struggle that is incessantly being waged against the resistances, which know how to transform themselves into a negative (hostile) transference. Nor will we neglect to point to the evidence that a great many of the detailed findings of analysis, which would otherwise be suspected of being produced by suggestion, are confirmed from other, irreproachable sources. We have unimpeachable witnesses on these points, namely, dements and paranoiacs, who are of course quite above any suspicion of being influenced by suggestion. All that these patients relate in the way of phantasies and translations of symbols, which have penetrated through into their consciousness, corresponds faithfully with the results of our investigations into the Unconscious of transference neurotics, thus confirming the objective truth of the interpretations made by us which are so often doubted. I do not think you will find yourselves mistaken if you choose to trust analysis in these respects.

We now need to complete our description of the process of recovery by expressing it in terms of the Libido-theory. The neurotic is incapable of enjoyment or of achievement—the first because his Libido is attached to no real object, the last because so much of the energy which would otherwise be at his disposal is expended in maintaining the Libido under repression, and in warding off its attempts to assert itself. He would be well if the conflict between his Ego and his Libido came to an end, and if his Ego again had the Libido at its disposal. The task of the treatment, therefore, consists in the task of loosening the Libido from its previous attachments, which are beyond the reach of the Ego, and in making it again serviceable to the Ego. Now where is the Libido of a neurotic? Easily found: it is attached to the symptoms, which offer it the substitutive satisfaction that is all it can obtain as things are. We must master the symptoms then, dissolve them—just what the patient asks of us. In order to dissolve the symptoms it is necessary to go back to the point at which they originated, to review the conflict from which they proceeded, and with the help of propelling forces which at that time were not available to guide it towards a new solution. This revision of the process of repression can only partially be effected by means of the memory-traces of the processes which led up to repression. The decisive part of the work is carried through by creating—in the relationship to the physician, in “the transference”—new editions of those early conflicts, in which the patient strives to behave as he originally behaved, while one calls upon all the available forces in his soul to bring him to another decision. The transference is thus the battlefield where all the contending forces must meet.

All the Libido and the full strength of the opposition against it are concentrated upon the one thing, upon the relationship to the physician; thus it becomes inevitable that the symptoms should be deprived of their Libido; in place of the patient’s original illness appears the artificially-acquired transference, the transference-disorder; in place of a variety of unreal objects of his Libido appears the one object, also ‘phantastic,’ of the person of the physician. This new struggle which arises concerning this object is by means of the analyst’s suggestions lifted to the surface, to the higher mental levels, and is there worked out as a normal mental conflict. Since a new repression is thus avoided, the opposition between the Ego and the Libido comes to an end; unity is restored within the patient’s mind. When the Libido has been detached from its temporary object in the person of the physician it cannot return to its earlier objects, but is now at the disposal of the Ego. The forces opposing us in this struggle during the therapeutic treatment are on the one hand the Ego’s aversion against certain tendencies on the part of the Libido, which had expressed itself in repressing tendencies; and on the other hand the tenacity or ‘adhesiveness’ of the Libido, which does not readily detach itself from objects it has once invested.

The therapeutic work thus falls into two phases; in the first all the Libido is forced away from the symptoms into the transference and there concentrated, in the second the battle rages round this new object and the Libido is made free from it. The change that is decisive for a successful outcome of this renewed conflict lies in the preclusion of repression, so that the Libido cannot again withdraw itself from the Ego by a flight into the Unconscious. It is made possible by changes in the Ego ensuing as a consequence of the analyst’s suggestions. At the expense of the Unconscious the Ego becomes wider by the work of interpretation which brings the unconscious material into consciousness; through education it becomes reconciled to the Libido and is made willing to grant it a certain degree of satisfaction; and its horror of the claims of its Libido is lessened by the new capacity it acquires to expend a certain amount of the Libido in sublimation. The more nearly the course of the treatment corresponds with this ideal description the greater will be the success of the psycho-analytic therapy. Its barriers are found in the lack of mobility in the Libido, which resists being released from its objects, and in the rigidity of the patient’s narcissism, which will not allow more than a certain degree of object-transference to develop. Perhaps the dynamics of the process of recovery will become still clearer if we describe it by saying that, in attracting a part of it to ourselves through transference, we gather in the whole amount of the Libido which has been withdrawn from the Ego’s control.

It is as well here to make clear that the distributions of the Libido which ensue during and by means of the analysis afford no direct inference of the nature of its disposition during the previous illness. Given that a case can be successfully cured by establishing and then resolving a powerful father-transference to the person of the physician, it would not follow that the patient had previously suffered in this way from an unconscious attachment of the Libido to his father. The father-transference is only the battlefield on which we conquer and take the Libido prisoner; the patient’s Libido has been drawn hither away from other ‘positions.’ The battlefield does not necessarily constitute one of the enemy’s most important strongholds; the defence of the enemy’s capital city need not be conducted immediately before its gates. Not until after the transference has been again resolved can one begin to reconstruct in imagination the dispositions of the Libido that were represented by the illness.

In the light of the Libido-theory there is a final word to be said about dreams. The dreams of a neurotic, like his “errors” and his free associations, enable us to find the meaning of the symptoms and to discover the dispositions of the Libido. The forms taken by the wish-fulfilment in them show us what are the wish-impulses that have undergone repression, and what are the objects to which the Libido has attached itself after withdrawal from the Ego. The interpretation of dreams therefore plays a great part in psycho-analytic treatment, and in many cases it is for lengthy periods the most important instrument at work. We already know that the condition of sleep in itself produces a certain relaxation of the repressions. By this diminution in the heavy pressure upon it the repressed desire is able to create for itself a far clearer expression in a dream than can be permitted to it by day in the symptoms. Hence the study of dreams becomes the easiest approach to a knowledge of the repressed Unconscious, which is where the Libido which has withdrawn from the Ego belongs.

The dreams of neurotics, however, differ in no essential from those of normal people; they are indeed perhaps not in any way distinguishable from them. It would be illogical to account for the dreams of neurotics in a way that would not also hold good of the dreams of normal people. We have to conclude therefore that the difference between neurosis and health prevails only by day; it is not sustained in dream-life. It thus becomes necessary to transfer to healthy persons a number of conclusions arrived at as a result of the connections between the dreams and the symptoms of neurotics. We have to recognize that the healthy man as well possesses those factors in mental life which alone can bring about the formation of a dream or of a symptom, and we must conclude further that the healthy also have instituted repressions and have to expend a certain amount of energy to maintain them; that their unconscious minds too harbour repressed impulses which are still suffused with energy, and that a part of the Libido is in them also withdrawn from the disposal of the Ego. The healthy man too is therefore virtually a neurotic, but the only symptom that he seems capable of developing is a dream. To be sure when you subject his waking life also to a critical investigation you discover something that contradicts this specious conclusion; for this apparently healthy life is pervaded by innumerable trivial and practically unimportant symptom-formations.

The difference between nervous health and nervous illness (neurosis) is narrowed down therefore to a practical distinction, and is determined by the practical result—how far the person concerned remains capable of a sufficient degree of capacity for enjoyment and active achievement in life. The difference can probably be traced back to the proportion of the energy which has remained free relative to that of the energy which has been bound by repression, i.e. it is a quantitative and not a qualitative difference. I do not need to remind you that this view provides a theoretical basis for our conviction that the neuroses are essentially amenable to cure, in spite of their being based on a constitutional disposition.

So much, therefore, in the way of knowledge of the characteristics of health may be inferred from the identity of the dreams dreamt by neurotic and by healthy persons. Of dreams themselves, however, a further inference must be drawn—namely, that it is not possible to detach them from their connection with neurotic symptoms; that we are not at liberty to believe that their essential nature is exhausted by compressing them into the formula of ‘a translation of thoughts into archaic forms of expression’; and that we are bound to conclude that they disclose dispositions of the Libido and objects of desire which are actually in operation and valid at the moment.

We have now come very nearly to the end. Perhaps you are disappointed that under the heading of psycho-analytic therapy I have limited myself to theory, and have told you nothing of the conditions under which the cure is undertaken, or of the results it achieves. I omit both, however: the first, because in fact I never intended to give you a practical training in the exercise of the analytic method; and the last, because I have several motives against it. At the beginning of these discussions I said emphatically that under favourable conditions we achieve cures that are in no way inferior to the most brilliant in other fields of medical therapy; I may perhaps add that these results could be achieved by no other method. If I said more I should be suspected of wishing to drown the depreciatory voices of our opponents by self-advertisement. Medical “colleagues” have, even at public congresses, repeatedly held out a threat to psycho-analysts that by publishing a collection of the failures and harmful effects of analysis they will open the eyes of the injured public to the worthlessness of this method of treatment. Apart from the malicious, denunciatory character of such a measure, however, a collection of that kind would not even be valid evidence upon which a correct estimate of the therapeutic results of analysis might be formed. Analytic therapy, as you know, is still young; it needed many years to elaborate the technique, which could only be done in the course of the work under the influence of increasing experience. On account of the difficulties of imparting instruction in the methods the beginner is thrown much more upon his own resources for development of his capacity than any other kind of specialist, and the results of his early years can never be taken as indicating the full possible achievements of analytic therapy.

Many attempts at treatment made in the beginning of psycho-analysis were failures because they were undertaken with cases altogether unsuited to the procedure, which nowadays we should exclude by following certain indications. These indications, however, could only be discovered by trying. In the beginning we did not know that paranoia and dementia præcox, when fully developed, are not amenable to analysis; we were still justified in trying the method on all kinds of disorders. Most of the failures of those early years, however, were not due to the fault of the physician, or to the unsuitability in the choice of subject, but to unpropitious external conditions. I have spoken only of the inner resistances, those on the part of the patient, which are inevitable and can be overcome. The external resistances which the patient’s circumstances and surroundings set up against analysis have little theoretic interest but the greatest practical importance. Psycho-Analytic treatment is comparable to a surgical operation and, like that, for its success it has the right to expect to be carried out under the most favourable conditions. You know the preliminary arrangements a surgeon is accustomed to make—a suitable room, a good light, expert assistance, exclusion of the relatives, and so on. Now ask yourselves how many surgical operations would be successful if they had to be conducted in the presence of the patient’s entire family poking their noses into the scene of the operation and shrieking aloud at every cut. In psycho-analytic treatment the intervention of the relatives is a positive danger and, moreover, one which we do not know how to deal with. We are armed against the inner resistances of the patient, which we recognize as necessary, but how can we protect ourselves against these outer resistances? It is impossible to get round the relatives by any sort of explanation, nor can one induce them to hold aloof from the whole affair; one can never take them into one’s confidence because then we run the danger of losing the patient’s trust in us, for he—quite rightly, of course—demands that the man he confides in should take his part. Anyone who knows anything of the dissensions commonly splitting up family life will not be astonished in his capacity of analyst to find that those nearest to the patient frequently show less interest in his recovery than in keeping him as he is. When as so often occurs the neurosis is connected with conflicts between different members of a family, the healthy person does not make much of putting his own interest before the patient’s recovery. After all, it is not surprising that the husband does not favour a treatment in which, as he correctly supposes, his sins will all come to light; nor do we wonder at this, but then we cannot blame ourselves when our efforts remain fruitless and are prematurely broken off because the husband’s resistance is added to that of the sick wife. We had simply undertaken something which, under the existing conditions, it was impossible to carry out.

Instead of describing many cases to you I will tell you of one only, in which I had to suffer for the sake of professional conscientiousness. I took a young girl—many years ago—for analytic treatment; for a considerable time previously she had been unable to go out of doors on account of a dread, nor could she stay at home alone. After much hesitation the patient confessed that her thoughts had been a good deal occupied by some signs of affection that she had noticed by chance between her mother and a well-to-do friend of the family. Very tactlessly—or else very cleverly—she then gave the mother a hint of what had been discussed during the analysis; she did this by altering her behaviour to her mother, by insisting that no one but her mother could protect her against the dread of being alone, and by holding the door against her when she attempted to leave the house. The mother herself had formerly been very nervous, but had been cured years before by a visit to a hydropathic establishment—or, putting it otherwise, we may say she had there made the acquaintance of the man with whom she had established a relationship that had proved satisfying in more than one respect. Made suspicious by her daughter’s passionate demands the mother suddenly understood what the girl’s dread signified. She had become ill in order to make her mother a prisoner and rob her of the freedom necessary for her to maintain her relations with her lover. The mother’s decision was instantly taken; she put an end to the harmful treatment. The girl was sent to a home for nervous patients, and for many years was there pointed out as an “unhappy victim of psycho-analysis”; for just as long I was pursued by damaging rumours about the unfortunate results of the treatment. I maintained silence because I supposed myself bound by the rules of professional secrecy. Years later I learned from a colleague who had visited the home and there seen the girl with agoraphobia that the intimacy between the mother and the wealthy man was common knowledge, and that in all probability it was connived at by the husband and father. To this “secret” the girl’s cure had been sacrificed.

In the years before the war, when the influx of patients from many countries made me independent of the goodwill or disfavour of my native city, I made it a rule never to take for treatment anyone who was not sui juris, independent of others in all the essential relations of life. Every psycho-analyst cannot make these stipulations. Perhaps you will conclude from my warnings about relatives that one should take the patient out of his family circle in the interests of analysis, and restrict this therapy to those living in private institutions. I could not support this suggestion, however; it is far more advantageous for the patients—those who are not in a condition of severe prostration, at least—to remain during the treatment in those circumstances in which they have to struggle with the demands that their ordinary life makes on them. But the relatives ought not to counteract this advantage by their behaviour, and above all should not oppose their hostility to one’s professional efforts. But how are you going to induce people who are inaccessible to you to take up this attitude? You will naturally also conclude that the social atmosphere and degree of cultivation of the patient’s immediate surroundings have considerable influence upon the prospects of the treatment.

This is a gloomy outlook for the efficacy of psycho-analysis as a therapy, even if we may explain the overwhelming majority of our failures by taking into account these disturbing external factors! Friends of analysis have advised us to counterbalance a collection of failures by drawing up a statistical enumeration of our successes. I have not taken up this suggestion either. I brought forward the argument that statistics would be valueless if the units collated were not alike, and the cases which had been treated were in fact not equivalent in many respects. Further, the period of time that could be reviewed was too short for one to be able to judge of the permanence of the cures; and of many cases it would be impossible to give any account. They were persons who had kept both their illness and their treatment secret, and whose recovery in consequence had similarly to be kept secret. The strongest reason against it, however, lay in the recognition of the fact that in matters of therapy humanity is in the highest degree irrational, so that there is no prospect of influencing it by reasonable arguments. A novelty in therapeutics is either taken up with frenzied enthusiasm, as for instance when Koch first published his results with tuberculin; or else it is regarded with abysmal distrust, as happened for instance with Jenner’s vaccination, actually a heaven-sent blessing, but one which still has its implacable opponents. A very evident prejudice against psycho-analysis made itself apparent. When one had cured a very difficult case one would hear: “That is no proof of anything; he would have got well of himself after all this time.” And when a patient who had already gone through four cycles of depression and mania came to me in an interval after the melancholia and three weeks later again began to develop an attack of mania, all the members of the family, and also all the high medical authorities who were called in, were convinced that the fresh attack could be nothing but a consequence of the attempted analysis. Against prejudice one can do nothing, as you can now see once more in the prejudices that each group of the nations at war has developed against the other. The most sensible thing to do is to wait and allow them to wear off with the passage of time. A day comes when the same people regard the same things in quite a different light from what they did before; why they thought differently before remains a dark secret.

It is possible that the prejudice against the analytic therapy has already begun to relax. The continual spread of analytic doctrine and the numbers of medical men taking up analytic treatment in many countries seem to point in that direction. As a young man I was caught in just such a storm of indignation roused in the medical profession by the hypnotic suggestion-treatment, which nowadays is held up in opposition to psycho-analysis by the “sober-minded.” As a therapeutic instrument, however, hypnotism did not bear out the hopes placed in it; we psycho-analysts may claim to be its rightful heirs and should not forget how much encouragement and theoretic enlightenment we owe to it. The harmful effects reported of psycho-analysis are essentially confined to transitory manifestations of an exacerbation of the conflict, which may occur when the analysis is clumsily handled, or when it is broken off suddenly. You have heard an account of what we do with our patients, and you can form your own judgement whether our efforts are likely to lead to lasting injury. Misuse of analysis is possible in various ways: the transference especially, in the hands of an unscrupulous physician, is a dangerous instrument. But no medical remedy is proof against misuse; if a knife will not cut, neither will it serve a surgeon.

I have now reached the end. It is more than a conventional formality when I say that I myself am heavily oppressed by the many defects of the lectures I have delivered before you. I regret most of all that I have so often promised to return again in another place to a subject that I had just touched upon shortly, and that then the context in which I could keep my word did not offer itself. I undertook to give you an account of a thing that is still unfinished, still developing, and now my short summary itself has become an incomplete one. In many places I laid everything ready for drawing a conclusion, and then I did not draw it. But I could not aim at making you experts in psycho-analysis; I only wished to put you in the way of some understanding of it, and to arouse your interest in it.