Freud - Complete Works (576 page)

Introductory Lectures On Psycho-Analysis

3473

   These are a few of the findings
which have hitherto been reached from the application of
psycho-analysis to the narcissistic disorders. No doubt there are
not yet enough of them and they still lack the precision which can
only be attained from established familiarity with a new field. We
owe all of them to a use of the concept of ego-libido or
narcissistic libido, by whose help we can extend to the
narcissistic neuroses the views which have proved their value with
the transference neuroses. Now, however, you will ask whether it is
possible that we shall succeed in subsuming all the disturbances of
the narcissistic illnesses and of the psychoses under the libido
theory, whether we look upon the libidinal factor in mental life as
universally guilty of the causation of illness, and need never
attribute the responsibility for it to changes in the functioning
of the self-preservative instinct. Well, Ladies and Gentlemen, this
question seems to me to call for no urgent reply, and, above all,
not to be ripe for judgement. We can confidently leave it over in
expectation of the progress of our scientific work. I should not be
surprised if it turned out that the power to produce pathogenic
effects was in fact a prerogative of the libidinal instincts, so
that the libido theory could celebrate its triumph all along the
line from the simplest ‘actual’ neurosis to the most
severe alienation of the personality. We after all know that it is
a characteristic feature of the libido that it struggles against
submitting to the reality of the universe - to Ananke. But I regard
it as extremely probable that the ego-instincts are carried along
secondarily by the pathogenic instigation of the libido and forced
into functional disturbances. Nor can I think that it would be a
disaster to the trend of our researches, if what lies before us is
the discovery that in severe psychoses the ego-instincts themselves
have gone astray as a primary fact. The future will give the answer
- to you, at any rate.

Introductory Lectures On Psycho-Analysis

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   Let me once more, however, return
for a moment to anxiety, to throw light on a last obscurity that we
left there. I have said that there is something that does not tally
with the relation (so thoroughly recognized apart from this)
between anxiety and libido: the fact, namely, that realistic
anxiety in face of a danger seems to be a manifestation of the
self-preservative instinct - which, after all, can scarcely be
disputed. How would it be, though, if what was responsible for the
affect of anxiety was not the egoistic ego-instincts but the
ego-libido? After all, the state of anxiety is in every instance
inexpedient, and its inexpedience becomes obvious if it reaches a
fairly high pitch. In such cases it interferes with action, whether
flight or defence, which alone is expedient and alone serves the
cause of self-preservation. If, therefore, we attribute the
affective portion of realistic anxiety to ego-libido and the
accompanying action to the self-preservative instinct, we shall
have got rid of the theoretical difficulty. After all, you do not
seriously believe that one runs away because one feels anxiety? No.
One feels anxiety and one runs away for a common motive, which is
roused by the perception of danger. People who have been through a
great mortal danger tell us that they were not at all afraid but
merely acted - for instance, that they aimed their rifle at the
wild beast - and that is unquestionably what was most
expedient.

Introductory Lectures On Psycho-Analysis

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LECTURE XXVII

TRANSFERENCE

LADIES AND
GENTLEMEN
, - Since we are now drawing towards the end of our
discussions, there is a particular expectation which will be in
your minds and which should not be disappointed. You no doubt
suppose that I would not have led you through thick and thin of the
subject-matter of psycho-analysis only to dismiss you at the end
without saying a word about therapy, on which, after all, the
possibility of practising psycho-analysis at all is based. The
subject, moreover, is one that I cannot withhold from you, since
what you learn in connection with it will enable you to make the
acquaintance of a new fact in whose absence your understanding of
the illnesses investigated by us will remain most markedly
incomplete.

   You do not, I know, expect me to
initiate you into the technique by which analysis for therapeutic
ends should be carried out. You only want to know in the most
general way the method by which psycho-analytic therapy operates
and what, roughly, it accomplishes. And you have an indisputable
right to learn this. I shall not, however, tell it you but shall
insist on your discovering it for yourselves.

   Think it over! You have learnt
all that is essential about the determinants of falling ill as well
as all the factors that come into effect
after
the patient
has fallen ill. Where do these leave room for any therapeutic
influence? In the first place there is hereditary disposition. We
have not talked about it very often because it is emphatically
stressed from other directions and we have nothing new to say about
it. But do not suppose that we underestimate it; precisely as
therapists we come to realize its power clearly enough. In any case
we can do nothing to alter it; we too must take it as something
given, which sets a limit to our efforts. Next there is the
influence of early experiences in childhood, to which we are in the
habit of giving prominence in analysis: they belong to the past and
we cannot undo them. Then comes everything that we have summarized
as ‘real frustration’ - the misfortunes of life from
which arise deprivation of love, poverty, family quarrels,
ill-judged choice of a partner in marriage, unfavourable social
circumstances, and the strictness of the ethical standards to whose
pressure the individual is subject. Here, to be sure, there would
be handles enough for a very effective therapy, but it would have
to be of the kind which Viennese folklore attributes to the Emperor
Joseph - the benevolent interference of a powerful personage before
whose will people bow and difficulties vanish. But who are we, that
we should be able to adopt benevolence of this kind as an
instrument of our therapy? Poor ourselves and socially powerless,
and compelled to earn our livelihood from our medical activity, we
are not even in a position to extend our efforts to people without
means, as other doctors with other methods of treatment are after
all able to do. Our therapy is too time-consuming and too laborious
for that to be possible. Perhaps, however, you are clutching at one
of the factors I have mentioned and believe that there you have
found the point at which our influence can make its attack. If the
ethical restrictions demanded by society play a part in the
deprivation imposed on the patient, treatment can, after all, give
him the courage, or perhaps a direct injunction, to disregard those
barriers and achieve satisfaction and recovery while forgoing the
fulfilment of an ideal that is exalted, but so often not adhered
to, by society. The patient will thus become healthy by
‘living a full life’ sexually. This, it is true, casts
a shadow on analytic treatment for not serving general morality.
What it has given to the individual it will have taken from the
community.

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   But, Ladies and Gentlemen, who
has so seriously misinformed you? A recommendation to the patient
to ‘live a full life’ sexually could not possibly play
a part in analytic therapy - if only because we ourselves have
declared that an obstinate conflict is taking place in him between
a libidinal impulse and sexual repression, between a sensual and an
ascetic trend. This conflict would not be solved by our helping one
of these trends to victory over its opponent. We see, indeed, that
in neurotics asceticism has the upper hand; and the consequence of
this is precisely that the suppressed sexual tendency finds a way
out in symptoms. If, on the contrary, we were to secure victory for
sensuality, then the sexual repression that had been put on one
side would necessarily be replaced by symptom. Neither of these two
alternative decisions could end the internal conflict; in either
case one party to it would remain unsatisfied. There are only a few
cases in which the conflict is so unstable that a factor such as
the doctor’s taking sides could decide it; and such cases do
not in fact stand in need of analytic treatment. Anyone on whom the
doctor could have so much influence would have found the same way
out without the doctor. You must be aware that if an abstinent
young man decides in favour of illicit sexual intercourse or if an
unsatisfied wife seeks relief with another man, they have not as a
rule waited for permission from a doctor or even from their
analyst.

   In this connection people usually
overlook the one essential point - that the pathogenic conflict in
neurotics is not to be confused with a normal struggle between
mental impulses both of which are on the same psychological
footing. In the former case the dissension is between two powers,
one of which has made its way to the stage of what is preconscious
or conscious while the other has been held back at the stage of the
unconscious. For that reason the conflict cannot be brought to an
issue; the disputants can no more come to grips than, in the
familiar simile, a polar bear and a whale. A true decision can only
be reached when they both meet on the same ground. To make this
possible is, I think, the sole task of our therapy.

   Moreover, I can assure you that
you are misinformed if you suppose that advice and guidance in the
affairs of life play an integral part in analytic influence. On the
contrary, so for as possible we avoid the role of a mentor such as
this and there is nothing we would rather bring about than the
patient should make his decisions for himself. With this purpose,
too, we require him to postpone for the term of his treatment any
vital decisions on choice of a profession, business undertakings,
marriage or divorce, and only to put them in practice when the
treatment is finished. You must admit that all this is different
from what you pictured. Only in the case of some very youthful or
quite helpless or unstable individuals are we unable to put the
desired limitation of our role into effect. With them we have to
combine the functions of a doctor and an educator; but when this is
so we are quite conscious of our responsibility and behave with the
necessary caution.

Introductory Lectures On Psycho-Analysis

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   But you must not conclude from my
eagerness in defending myself against the charge that neurotics are
encouraged in analytic treatment to live a full life - you must not
conclude from this that we influence them in favour of conventional
virtue. That is at least as far from being the case. It is true
that we are not reformers but merely observers; nevertheless, we
cannot help observing with a critical eye and we have found it
impossible to side with conventional sexual morality or to form a
very high opinion of the manner in which society attempts the
practical regulation of the problems of sexual life. We can present
society with a blunt calculation that what is described as its
morality calls for a bigger sacrifice than it is worth and that its
proceedings are not based on honesty and do not display wisdom. We
do not keep such criticisms from our patients’ ears, we
accustom them to giving unprejudiced consideration to sexual
matters no less than to any others; and if, having grown
independent after the completion of their treatment, they decide on
their own judgement in favour of some midway position between
living a full life and absolute asceticism, we feel our conscience
clear whatever their choice. We tell ourselves that anyone who has
succeeded in educating himself to truth about himself is
permanently defended against the danger of immorality, even though
his standard of morality may differ in some respect from that which
is customary in society. Moreover, we must guard against
over-estimating the importance of the part played by the question
of abstinence in influencing neuroses. Only in a minority of cases
can the pathogenic situation of frustration and the subsequent
damming-up of libido be brought to an end by the sort of sexual
intercourse that can be procured without much trouble.

   Thus you cannot explain the
therapeutic effect of psycho-analysis by its permitting a full
sexual life. Look around, then, for something else. I fancy that,
while I was rejecting this suggestion of yours, one remark of mine
put you on the right track. What we make use of must no doubt be
the replacing of what is unconscious by what is conscious, the
translation of what is unconscious into what is conscious. Yes,
that is it. By carrying what is unconscious on into what is
conscious, we lift the repressions, we remove the preconditions for
the formation of symptoms, we transform the pathogenic conflict to
a normal one for which it must be possible somehow to find a
solution. All that we bring about in a patient is this single
psychical change: the length to which it is carried is the measure
of the help we provide. Where no repressions (or analogous
psychical processes) can be undone, our therapy nothing to
expect.

   We can express the aim of our
efforts in a variety of formulas: making conscious what is
unconscious, lifting repressions, filling gaps in the memory - all
these amount to the same thing. But perhaps you will be
dissatisfied by this admission. You had formed a different picture
of the return to health of a neurotic patient - that, after
submitting to the tedious hours of a psycho-analysis, he would
become another man; but the total result, so it seems, is that he
has rather less that is unconscious and rather more that is
conscious in him than he had before. The fact is that you are
probably under-estimating the importance of an internal change of
this kind. The neurotic who is cured has really become another man,
though a bottom, of course, he has remained the same; that is to
say, he has become what he might have become at best under the most
favourable conditions. But that is a very great deal. If you now
hear all that has to be done and what efforts it needs to bring
about this apparently trivial change in a man’s mental life,
you will no doubt begin to realize the importance of this
difference in psychical levels.