Part 12

“Well, that is about the most ludicrous statement you have made so far! I simply don’t believe it! The patient, suffering so intensely, complaining so heartrendingly, sacrificing so much to be cured, actually does not want to get well! Is it possible you really mean what you say?”

I mean every word of it! What I have just stated is the truth. Not the whole truth, but a good deal of it. The patient wants, yet does not want, to get well. Because his “I” has lost its unity of purpose, it is preventing him from summing up undivided will power. Were the state of affairs a different one, our patient would not be a neurotic!

The results of his repression have simply invaded his “I,” firmly holding their ground there, so to speak. The “I” is wielding just as little influence over these effects as over the repression itself. Usually, the “I” is not at all aware of the prevailing state of affairs. These patients are of a peculiar type, putting difficulties in our way which we do not expect to encounter. All our social institutions are organized to fit individuals with a unified, normal “I,” which may be classified as either good or bad. This “I” either functions properly, or is impeded by some overwhelming influence. Thus, the forensic alternative: mentally responsible or not responsible.

But all these standard terms do not fit the neurotic!

Doubtless, it is difficult to adapt the demands of social life to their psychological condition. During the War, this was proved to a great extent.

Were those neurotics who shirked from military duty, pretending illness, simulants or not?

They were both!

As soon as such patients were treated as simulants, by making it uncomfortable for them to indulge in sickness, they recuperated; and as soon as allegedly cured patients had been returned to the rank and file, they once more became ill. There was simply no way to deal effectively with them.

Analogous to this is the case of the neurotic in everyday life.

They complain about their sickness, at the same time exploiting it to the limit. As a matter of fact, if an attempt is made to cure them of their ailment, they will protect this most cherished possession of theirs with the selfsame fervor with which a lioness defends her offspring. But there would be no sense in blaming neurotics for the contradictory behavior they display.

“Would it not be best, then, not to treat such difficult people at all? Simply leave them to themselves? It seems to me that it cannot possibly be worthwhile to spend as much effort on them as appears necessary, according to what you say.”

I do not agree with you on this point.

Doubtless, it seems wiser to simply submit to the complications which life presents, rather than to fight them. Not each and every one of the neurotics we treat may be worth the exertions of an analysis, but there are surely enough worthwhile individuals among them. It must be our goal to decrease the number of persons who are forced to face the exasperations of civilized life with a soul insufficiently prepared. To this end, we must collect experience upon experience, and come to fully grasp many problems. Every analysis is bound to prove instructive, yielding new knowledge, aside from the personal benefit it may confer upon an individual patient.

“Supposing that the ‘I’ of a patient developed such tendencies which would make him wish to retain the sickness of which he complains, would not these tendencies be justified, on the basis of certain reasons and motives? It is impossible for me to understand why somebody should want to be sick. What satisfaction could he derive from that?”

Just remember the war neurotics who were exempt from duty, because they were considered sick. In everyday life, sickness may be successfully employed as a screen, behind which to hide professional insufficiencies, or—in the circle of family life—as a means to induce relatives to make sacrifices, demonstrations of affection, or to foist one’s will upon them, generally. All this is quite obvious and comes under the term “sickness profit” (analogous to war profit). It is remarkable, however, that the neurotic, or rather his “I,” proves unable to grasp the connection of such motives with their logical consequences.

The influence of such tendencies to gain “sickness profit” is combated, by forcing the “I” to become aware of them. But there are still other, more obscure motives, for holding on to sickness, which cannot be disposed so easily. As a matter of fact, these reasons cannot be understood, without venturing once more into the sphere of psychological theories.

“Oh, go right ahead! A little theory, more or less—what does it matter?”

When I explained to you the relations between the “I” and the “It,” I withheld from you an important part of the soul apparatus. You see, within the “I” itself, there persists a particular faction which we call the “Super-Ego.”

This “Super-Ego” enjoys a privileged position between the “I” and the “It.” It belongs to the “I,” sharing with it its intricate psychological make-up. On the other hand, it entertains very close relations with the “It.” The “Super-Ego” is in reality the record of first impressions as conceived by the “It”; it is the heir of the dissolved Œdipus Complex.

This “Super-Ego,” as a matter of fact, is able to oppose the “I,” act towards it as if it were something inferior and, in general, treat it almost with contempt. For the “I” it is just as important to remain in agreement with the “Super-Ego” as with the “It.” Disagreement between the “Super-Ego” and the “I” is of far-reaching consequences for the soul life.

Doubtless, you have already surmised that the “Super-Ego” is the agent of that phenomenon which we call our conscience.

For the maintenance of healthy soul life, it is very important that the “Super-Ego” develop normally, that is, becomes sufficiently impersonal. It is just this development which is insufficient in the neurotic, because his Œdipus Complex was not properly transformed. His “Super-Ego,” in regard to the “I,” still assumes the rôle of the strict father to the child, with the morality of the “I” manifesting itself in a primitive manner by meekly submitting to punishment, meted out by the “Super-Ego.” Sickness is resorted to, as the means of this “self-punishment.” The neurotic, behaving as if under a burden of guilt accepts sickness as a punishment to assuage this feeling of delinquency.

“That sounds very mysterious. But the most remarkable thing seems to be that the patient remains unconscious of the power of his conscience.”

Well, we are only now beginning to appreciate the importance of all these vital conditions. That is the reason why my explanations were so puzzling to you. But now, I believe I can continue.

All those agents which oppose the recuperation of a patient, we term the “resistance” of the patient. While “sickness profit” is the source of such resistance, the “unconscious feeling of guilt” represents the resistance of the “Super-Ego” of which, as the strongest factor, we are very much in fear.

But there are other manifestations of resistance which become evident in the process of treatment.

If the “I,” at an early period, was induced through fear, to take recourse to a repression, this fear still persists, manifesting itself now as a resistance, as soon as the “I” approaches that which was repressed. It is easy enough to realize that difficulties may be encountered, if a certain tendency, which for decades has proceeded along a specific course, is suddenly expected to swing into a new path opened to it.

Such a condition may be termed the resistance of the “It.”