Part 3

All these delusions are utter nonsense, as he himself very well knows. He has never done any harm to anybody, but if he really were a fugitive from justice, this obsession, this feeling of contrition could not be stronger.

To take another case:—this time of a female patient, who is suffering in an entirely different way, presenting entirely different symptoms. We will assume that she is a pianiste, who suddenly experiences cramps in her fingers and discovers herself unable to play. As soon as she thinks of attending a social affair, she immediately feels the necessity of obeying a recurrent natural need, making it impossible for her to leave her own house. Thus, she has been forced to give up mingling with her friends, or attend dances, the theatre, or concerts.

At the most inopportune moments, she becomes the victim of headaches or other painful sensations. Eventually, after meals, she feels impelled to yield to nausea, a condition which, if prolonged, may become dangerous. Finally, she becomes absolutely unable to stand any of those little excitements which cannot be eliminated from daily life. Upon such occasions, she readily faints. As these spells are frequently complicated with muscular spasms, such attacks assume the aspect of dreadful afflictions.

Still other patients become subject to disturbances in a sphere where bodily functions coördinate with manifestations of sentiment. If men, they find themselves unable to give physiological expression to those tender urges that induce them to gravitate towards the other sex. On the other hand, all these physiological reactions may be at their command when not aimed at the person they cherish most. Then, there are still other cases, when bonds of sensuality will tie them to persons whom they actually despise and of whom they have the most earnest desire to free themselves. Or their sensuality imposes urges upon them whose fulfillment causes them to shudder.

If they be women, such patients, on account of fear or disgust, or from some other restraint of unknown origin, become unable to perform those functions which their sex imposes upon them. In cases where they have yielded to the prompting of passion, they discover that that gratification is withheld from them which nature normally offers as a reward for such complacency.

Sooner or later, all such persons come to consider themselves as sick and appeal to physicians, expecting to be cured of their nervous ailments. Physicians have classified these manifestations, diagnosing them differently, according to their own personal point of view. These ailments are listed under such terms as neurasthenia, psychasthenia, phobias and neuroses of different kinds, and with that sweeping term hysterics. The parts of the body inducing such disturbances are examined: the heart, the stomach, the intestines, the sex organs, and all are found to be in the best of condition. The physician then advises the patient to change his mode of living, to take a vacation, to exercise. Thus, with perhaps the aid of mild stimulants, the patient’s condition may, or may not, be temporarily relieved.

Eventually, the patient is informed that there are certain practitioners who specialize in the treatment of just such ailments, and thus they come to be psychoanalysed.

Mr. Referee, whom we will assume is present, has impatiently listened, while we have given an account of the nervous disturbances with which one may be afflicted. Mr. Referee suddenly becomes attentive, expressing his growing interest in these words: “Well, now at last we shall see what the psychoanalyst will do with the patient, whom physicians could not help.”

To all appearances, nothing takes place between patient and psychoanalyst except that they talk with each other. The psychoanalyst does not take recourse to any instruments, while examining the patient, nor does he write out prescriptions. If it can be arranged, he will not even take the patient out of his usual surroundings, or upset his daily routine in any way, while treating him. Such a procedure is, of course, not of indispensable necessity, quite frequently proving impossible to arrange. Usually the analyst simply makes an appointment with his patient, then lets him talk, listens to him, lets him talk again and listens once more.

Mr. Referee now clearly manifests relief but, at the same time, his face also assumes a disdainful expression. Apparently, he thinks: “Is that all? ‘Words, words, words,’ as Prince Hamlet says. Is psychoanalysis perhaps some sort of magic rite, employing mere words with which to chase away a patient’s ailment?”

Quite right! It surely would be magic if it would only work faster. One of the indispensable essentialities of magic is quickness, sudden results. But psychoanalytical treatment demands months, sometimes even years. Proceeding at such a snail’s pace, it loses the character of anything resembling magic.

As far as “words, words, words” are concerned, they are surely not to be looked down upon. Words, after all, are a powerful instrument, the means by which we express our feelings to each other, the agent through which we influence one another. Words are able to benefit us in the extreme, or liable to hurt us to the quick. Doubtless, “in the beginning was the Deed” and the Word came only later. Under certain circumstances, the reduction of the Deed to the mere Word may even prove a cultural achievement. At any rate, the Word was originally an implement of sorcery, a magic manifestation which even today still retains much of its old potency.

Mr. Referee now remarks: “Assuming that the patient is not any better prepared for the understanding of psychoanalytical treatment, than I myself, how are you going to induce him to believe in the Magic of the Word, that is to deliver him from his sufferings?”

Of course, some preparatory work is necessary, but that is easily accomplished in a simple manner. The patient is asked to be absolutely frank with the psychoanalyst, not to withhold intentionally anything that crowds itself into his mind, and to overcome gradually all such influences as may exert themselves to prevent certain of his thoughts or memories from being communicated to the psychoanalyst.

There is not one of us but does not know that there are certain things which we hate to tell anybody else, or which we are utterly unable to express at all. These are the so-called “most intimate” things. We also surmise—and this proves the great progress that has been made in the psychological understanding of our Selves—that there are some other things which we hate to admit to ourselves, which we try to hide from ourselves and which, once they are accidentally touched upon, we immediately endeavor to crowd out of our thoughts.

Doubtless, the root of a very remarkable psychological problem manifests itself in the fact that there are certain of our thoughts which we try to hide from our very own Self! That would seem to indicate that our very own Self is not an indivisible unit, as we have always considered it! Rather, that there is a certain something which may rise in opposition to our very own Self! Vaguely, then, we surmise that our own Self and our soul life may be two different things! If, now, the patient submits to the demand of psychoanalysis to express everything in words that comes to his mind, he comes to believe that an interchange of thoughts, under such extraordinary conditions, is liable to lead to extraordinary results.

“I understand you very well,” Mr. Referee says. “You simply assume that everybody suffering from a nervous disturbance is harboring something that depresses him, some dark secret, perhaps, and by inducing him to impart this secret to you, you relieve him of that depression, thus alleviating his suffering. That, after all, is the very principle of the Confessional which the Catholic church has employed for centuries to wield her influence over her communicants.”

Yes and no, is our answer to this. The Confessional, to a certain extent, may be considered as belonging into the realm of psychoanalysis; leading up to it, as it were. However, the Confessional as such is far removed from coinciding with the very being of psychoanalysis, and it is unable to explain the results of psychoanalytical treatment. In the Confessional, the sinner tells what he knows, but in the Analysis, the neurotic is expected to reveal much more. Besides, there are no known cases where the Confessional proved effective enough to remedy direct symptoms of ailments.

“Then I don’t understand you after all,” Mr. Referee interjects. “What do you mean by stating that the neurotic is ‘expected to reveal more’ in the course of psychoanalytical treatment? Of course, I can very well imagine that you, as a psychoanalyst, may wield a greater influence over your patient than the Father Confessor over a penitent, for the simple reason that you become better acquainted with him, employing your growing influence to talk unhealthy thoughts out of your patient, as it were, disseminating his apprehensions, and so forth. Frankly, it appears most remarkable to me that by such a procedure, it should be possible to alleviate purely physical manifestations, such as nausea, diarrhœa, and cramps. I know that such results are possible by taking recourse to hypnosis. Most probably, through prolonged association with your patient, you gradually succeed in establishing hypnotic relations between you and him. By this I mean that you inadvertently come to exert upon him a suggestive influence. Thus, the miracle wrought by your therapy is nothing other than the result of hypnotic suggestion. However, as far as I know, results by hypnotic therapy are procured much quicker than by psychoanalysis which you yourself admit takes months, and sometimes even years.”

After all, Mr. Referee does not seem to be so utterly uninformed and helplessly at sea as we had considered him in the beginning. Doubtless, he is eagerly bent upon grasping the essence of psychoanalysis, on the basis of certain knowledge which he has acquired. He endeavors to connect psychoanalysis with something he already knows.

Thus, he forces upon us the difficult task of explaining to him that he will never succeed in comprehending psychoanalysis in this way, because psychoanalysis is a process sui generis, something new and peculiar, understandable only with the assistance of new conceptions, or presumptions.

However, we still owe our inquisitive friend a reply to a point raised by him.

What you, Mr. Referee, mentioned before about the personal influence exerted by the psychoanalyst on his patient, should not go without comment. Such an influence actually prevails in the analysis, playing an important rôle. However, this influence is utterly unlike the influence induced by hypnosis.

I shall have to prove to you that the situations in these two cases decidedly differ from each other. However, for the time being, the statement may suffice that this personal influence—this “suggestive element” if you wish—is not drawn upon for the purpose of suppressing symptoms of nervous afflictions analogous to treatment by hypnotic suggestions. Besides, it is absolutely wrong to assume that this “suggestive element” is the agent and promoter of analytical treatment. It may be that such is the case right at the beginning of the treatment. Later, however, this very same “suggestive element” proves itself an opposing factor, forcing us to resort to extensive counter-measures.

Just let me explain to you how thoroughly opposed the technique of analysis is to anything and everything resembling the hypnotic technique of diverting or dissipating a patient’s apprehensions.

Assumed that our patient is obsessed with an intense feeling of being guilty of, say, some horrible crime, we do not advise him to stifle the qualms of his conscience simply on the strength of the fact that there is no doubt as to his innocence. He himself has already proceeded along this trend of reasoning, but to no avail. On the contrary, we try to impress him with the possibility that there may be something tangible at the bottom of so profound a feeling of guilt, and that it may be possible to detect this disturbing something.

“I should be greatly astonished,” Mr. Referee interrupts, “if you could really assuage your patient’s feeling of guilt by agreeing that there may be some tangible reason for his apprehension. But what is the mode of procedure which is applied in your analysis, and to what treatment do you subject your patient?”

III