Part 33

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.

INDEX

ABEL, C., 150, 194

ABRAHAM, K., 275, 346

Act: accidental, 48 sexual, 271, 297, 326 introductory, 257, 260, 271 symptomatic, 48, 209, 215

Actions, erroneous performance of, 62

Actual neuroses, 322–7

ADLER, A., 201, 318, 339

‘Advantage through illness,’ 320

Ætiology of neuroses, 216, 287–93, 295, 303–5, 308, 313, 322

Affects: anxiety and, 330, 337 in dreams, 181–2 James-Lange theory of, 331 repression and, 336, 341–2

Agoraphobia, 224, 229, 334, 386

ALEXANDER, the Great, 14 dream of, 69, 200

Altruism, 348

Ambivalence, 279, 357, 370, 377

Amnesia: of childhood, 168, 239, 263, 274 of neuroses, 239, 240

Anal-erotism, 265, 268

Anal-sadistic stage of libido-development, 275–6, 289

ANDREAS, LOU, 265

Anthropophyteia, 137–8

Antithetical sense of primal words, 150, 194

Anus, 257, 265

Anxiety, 225, 328–44, 359 development of, 330, 338, 342 ‘free-floating,’ 332, 334 in children, 338 in dreams, 181–3, 230

Anxiety-equivalents, 334

Anxiety-hysteria, 229, 244, 252, 304, 334, 372