Part 14

Two institutes serve this purpose by giving instruction in psychoanalysis. The first is in Berlin, in charge of Dr. Max Eitigon of the local organization. The second is maintained by the Vienna Psychoanalytical Society, with great sacrifice. The authorities, up to now, have thrown many obstacles in the path of the young institute. A third institute will be opened in London, by the local organization there and will be under the direction of Dr. E. Jones.

In all these institutes, the disciples themselves are analysed, and are then given theoretical instruction in all subjects important for them. When permitted to analyse their first, simple cases, they have the advantage of being under the supervision of more experienced analysts. The course usually requires about two years, but even after this period, a disciple is still a beginner, and not by far to be considered a master. What else the young analyst needs, he acquires thorough practice, and by intercourse with older colleagues.

The preparatory work for the analytical training is not at all simple: the work is hard, the responsibility tremendous.

Whoever attended such a course, has been analysed himself, has grasped the Psychology of the Unconscious, as far as it can be taught today, is sufficiently versed in the science of sex, and has acquired the difficult technique of psychoanalysis, including the art of interpretation, the method of combating resistances and the manner in which to handle transferences, can no longer be considered a layman, in the field of psychoanalysis. He is able to treat neurotic disturbances and will, in time, be in a position to achieve all that may be expected of this therapy.

VII

“You have explained to me, at great length, what psychoanalysis is, and what knowledge is necessary to practise it with a chance for success. It certainly could not have hurt me to listen to you.

“However, I do not see how your informations are expected to influence my personal view. Neuroses, it would appear, are a certain form of disturbance, and psychoanalysis a certain method to treat such cases—a special medical treatment, as it were.

“I understand that it is the rule that any physician who intends to specialize in the one phase or the other of his science is not satisfied with the training he received before winning his diploma, but rather goes on studying the intricacies of his special field. This is especially a necessity, in case he intends to establish himself in a big city, the only place which opens a satisfactory field for specialists. Anybody who is going to specialize in surgical work, will practise, for a few years, in the surgical ward. Corresponding specialized work will be taken up by the eye or the nose and throat specialist, and the psychiatrist may forever remain on the staff of a city or county institution or a private sanitarium.

“The same method of development may be expected of the psychoanalyst. Whoever decides to take up this new medical specialty, after finishing his studies proper, will have to attend those institutes, for the duration of two years, which you have mentioned before, provided it really takes as long as that to gain the necessary knowledge. He will then also learn that it would be to his advantage to join a psychoanalytical society, in order to remain in contact with his colleagues.

“I really cannot understand why there is any necessity for raising this question of lay-analyses?”

Any physician, proceeding along the lines you suggested, shall be welcome to us. As a matter of fact, four-fifths of those whom I consider my disciples, are physicians. However, permit me to enlighten you as to relations, as they actually developed between physicians and psychoanalysis, and what development they appear to be taking in the future.

Past developments do not give physicians any right to claim a monopoly of psychoanalysis. As a matter of fact, physicians, in the past, have done about everything to damage psychoanalysis, beginning with superficial mockery and going even so far as to indulge in serious defamation. Of course, you may correctly say that all this belongs to the past, and should not have any influence on the future. I fully agree, but I am afraid that the future will not live up to your expectations.

At this point, permit me to interpret for you the term of “quack,” not in the way it is legally employed, but rather in the sense in which it should be logically applied. As far as the law is concerned, a “quack” is an individual who treats sick people, without being in the possession of a diploma. I, however, would rather qualify the term “quack” in this way: A “quack” is anybody who undertakes the treatment of a disease, without having the indispensable knowledge and ability.

On the basis of this definition, I venture to assert that—not only in the European countries—physicians, as far as psychoanalysis is concerned, constitute the majority of “quacks.” Frequently, physicians will employ psychoanalysis, without having studied it, and without sufficiently understanding it.

Do not tell me that this would display a lack of conscience, which you would not suspect in any physician. You might be tempted to say that, after all, a physician ought to know that a medical diploma does not constitute a “Letter of Marque,” and that a sick person should not be considered outlawed. As far as a physician is concerned, it should be taken for granted that he is proceeding in good faith, even if he makes a mistake.

However, facts are facts. Let us hope that it will be possible to explain these facts in a manner, which you apparently wish. I, for my part, shall try to explain to you how it is possible that a physician, in matters of psychoanalysis, takes liberties he would carefully avoid in any other specialized field.

In the first place, it must be taken in consideration that the training the medical student received is almost the very opposite of that which would be required of him, as a preparation for psychoanalysis. His attention has simply been focused upon facts which may be objectively ascertained, such as present themselves in anatomy, physics, and chemistry, and which must be understood properly and applied correctly, to achieve results.

As far as the psychological aspects of life are concerned, no interest is created in the medical student. The study of higher mental achievements is not considered to belong within the field of medicine, but rather into the realm of another science. Psychiatry alone is supposed to attend to disturbances of psychological functions, and it is only too well known in which way, and with what objective in view this is done: psychiatry simply tries to discover the physical reasons for psychological disturbances, treating them in turn like any other ailment.

Psychiatry is correct in that respect, and medical training apparently excellent. Should it be maintained that psychiatry is one-sided, it will be necessary to fix the point of view from which such a reproach may arise.

Inherently, all science is one-sided, and must be one-sided, inasmuch as any science is limited to certain subjects, points of view, and methods. It is a nonsense which I do not wish to support that one science may be played against any other. Physics after all, does not minimize the value of chemistry; it cannot replace the latter nor be substituted for it. And, surely, psychoanalysis is especially one-sided, as the science of the psychological Unconscious.

Thus, the right to one-sidedness should not be denied to medicine.

However, a more practical point of view is gained if observations are not made as to scientific medicine, but rather as to practical healing. Sick people, presenting complicated problems, should impress upon us the fact that psychological manifestations—be they ever so hard to comprehend—cannot be simply eliminated from the picture. The neurotic, more than any other patient, presents an undesirable complication. He offers a dilemma, not less embarrassing to medicine than to law. However, as long as such cases exist, they are a responsibility especially of medicine. Nevertheless, medical training, sorry to say, is not paying sufficient attention to such conditions,—doing nothing for them. Absolutely nothing at all!

As there are very close inter-relations between those things we consider physical and those which we look upon as psychological, it may be expected that the day will come when organic biology and chemistry will finally approach the understanding of neurotic manifestations. This day, to be sure, seems to be in the distant future. At present, such ailments are still unapproachable, from a medical angle.

If medical training would only deny information to the student in the field of neurosis, this would be tolerable. But medical training is doing more. It implants into the young student an incorrect and harmful point of view. Physicians, whose interest for psychological facts has not been awakened, have naturally a tendency of making little of such facts, going even so far as to decry them as unscientific. Conditions of neurotic character are hardly ever taken seriously by them, while their lack of knowledge serves to breed disrespect for psychological research. Thus, neurosis is not accorded sufficient attention.

Of course, these neurotics must be treated when they consult physicians, and new discoveries must be tried out right along. But why go in for a protracted period of preparation? It can be done without that! After all, who knows whether there is really any value to that which is taught in psychoanalytical institutes?

Thus, as usual, lack of information results in a most daring spirit of enterprise. Only true initiates are modest, because they realize how insufficient their knowledge is!

From all this, it follows that it is impossible to draw upon a comparison of psychoanalysis with other branches of medicine, as you attempted to do.

As far as surgery, and ophthalmology, are concerned, medical schools and post graduate courses offer sufficient opportunities for training. The psychoanalytical institutes are limited in number, young in years, and lack the aureola of authority. Medical science has not recognized them, nor does it give a hoot about them. On the other hand, the young physician who has been forced to believe his teachers, to such a degree, that he hardly ever had a chance to form his own judgment, will only be too glad to try his hand at playing the critic, in a field where there is no established authority as yet.