Freud - Complete Works (577 page)

Introductory Lectures On Psycho-Analysis

3478

   I will digress for a moment to
ask if you know what is meant by a causal therapy. That is how we
describe procedure which does not take the symptoms of an illness
as its point of attack but sets about removing its
causes
.
Well, then, is our psycho-analytic method a causal therapy or not?
The reply is not a simple one, but it may perhaps give us an
opportunity of realizing the worthlessness of a question framed in
this way. In so far as analytic therapy does not make it its first
task to remove the symptoms, it is behaving like a causal therapy.
In another respect, you may say, it is not. For we long ago traced
the causal chain back through the repressions to the instinctual
dispositions, their relative intensities in the constitution and
the deviations in the course of their development. Supposing, now,
that it was possible, by some chemical means, perhaps, to interfere
in this mechanism, to increase or diminish the quantity of libido
present at a given time or to strengthen one instinct at the cost
of another - this then would be a causal therapy in the true sense
of the word, for which our analysis would have carried out the
indispensable preliminary work of reconnaissance. At present, as
you know, there is no question of any such method of influencing
libidinal processes; with our psychical therapy we attack at a
different point in the combination - not exactly at what we know
are the roots of the phenomena, but nevertheless far enough away
from the symptoms, at a point which has been made accessible to us
by some very remarkable circumstances.

   What, then, must we do in order
to replace what is unconscious in our patients by what is
conscious? There was a time when we thought this was a very simple
matter: all that was necessary was for us to discover this
unconscious material and communicate it to the patient. But we know
already that this was a short-sighted error.
Our
knowledge
about the unconscious material is not equivalent to
his
knowledge; if we communicate our knowledge to him, he does not
receive it
instead of
his unconscious material but
beside
it; and that makes very little change in it. We must
rather picture this unconscious material topographically, we must
look for it in his memory at the place where it became unconscious
owing to a repression. The repression must be got rid of - after
which the substitution of the conscious material for the
unconscious can proceed smoothly. How, then, do we lift a
repression of this kind? Here our task enters a second phase.
First, the search for the repression and then the removal of the
resistance which maintains the repression.

Introductory Lectures On Psycho-Analysis

3479

   How do we remove the resistance?
In the same way: by discovering it and showing it to the patient.
Indeed, the resistance too is derived from a repression - from the
same one that we are endeavouring to resolve, or from one that took
place earlier. It was set up by the anticathexis which arose in
order to repress the objectionable impulse. Thus we now do the same
thing that we tried to do to begin with: interpret, discover and
communicate; but now we are doing it at the right place. The
anticathexis or the resistance does not form part of the
unconscious but of the ego, which is our collaborator, and is so
even if it is not conscious. As we know, the word
‘unconscious’ is being used here in two senses: on the
one hand as a phenomenon and on the other as a system. This sounds
very difficult and obscure; but is it not only repeating what we
have already said in earlier passages? We have long been prepared
for it. We expect that this resistance will be given up and the
anticathexis withdrawn when our interpretation has made it possible
for the ego to recognize it. What are the motive forces that we
work with in such a case? First with the patient’s desire for
recovery, which has induced him to take part with us in our joint
work, and secondly with the help of his intelligence, to which we
give support by our interpretation. There is no doubt that it is
easier for the patient’s intelligence to recognize the
resistance and to find the translation corresponding to what is
repressed if we have previously given him the appropriate
anticipatory ideas. If I say to you: ‘Look up at the sky!
There’s a balloon there!’ you will discover it much
more easily than if I simply tell you to look up and see if you can
see anything. In the same way, a student who is looking through a
microscope for the first time is instructed by his teacher as to
what he will see; otherwise he does not see it at all, though it is
there and visible.

Introductory Lectures On Psycho-Analysis

3480

   And now for the fact! In a whole
number of nervous diseases - in hysteria, anxiety states,
obsessional neurosis - our expectation is fulfilled. By searching
for the repression in this way, by uncovering the resistances, by
pointing out what is repressed, we really succeed in accomplishing
our task - that is, in overcoming the resistances, lifting the
repression and transforming the unconscious material into
conscious. In doing so we gain the clearest impression of the way
in which a violent struggle takes place in the patient’s mind
about the overcoming of each resistance - a
normal
mental
struggle, on the same psychological ground, between the motives
which seek to maintain the anticathexis and those which are
prepared to give it up. The former are the old motives which in the
past put the repression into effect; among the latter are the newly
arrived ones which, we may hope, will decide the conflict in our
favour. We have succeeded in reviving the old conflict which led to
repression and in bringing up for revision the process that was
then decided. The new material that we produce includes, first the
reminder that the earlier decision led to illness and the promise
that a different path will lead to recovery, and, second, the
enormous change in all the circumstances that has take place since
the time of the original rejection. Then the ego was feeble,
infantile, and may perhaps have had grounds for banning the demands
of the libido as a danger. To-day it has grown strong and
experienced, and moreover has a helper at and in the shape of the
doctor. Thus we may expect to lead the revived conflict to a better
outcome than that which ended in repression, and, as I have said,
in hysteria and in the anxiety and obsessional neuroses success
proves us in general to be correct,

   There are, however, other forms
of illness in which, in spite of the conditions being the same, our
therapeutic procedure is never successful. In them, too, it had
been a question of an original conflict between the ego and the
libido which led to repression - though this may call for a
different topographical description; in them, too, it is possible
to trace the points in the patient’s life at which the
repressions occurred; we make use of the same procedure, are ready
to make the same promises and give the same help by the offer of
anticipatory ideas; and once again the lapse of time between the
repressions and the present day favours a different outcome to the
conflict. And yet we do not succeed in lifting a single resistance
or getting rid of a single repression. These patients, paranoics,
melancholics, sufferers from dementia praecox, remain on the whole
unaffected and proof against psycho-analytic therapy. What can be
the reason for this? Not any lack of intelligence. A certain amount
of intellectual capacity is naturally required in our patients; but
there is certainly no lack of it in, for instance, the extremely
shrewd combinatory paranoics. Nor do any of the other motives seem
to be absent. Thus the melancholics have a very high degree of
consciousness, absent in paranoics, that they are ill and that that
is why they suffer so much; but this does not make them more
accessible. We are faced here by a fact which we do not understand
and which therefore leads us to doubt whether we have really
understood all the determinants of our possible success with the
other neuroses.

Introductory Lectures On Psycho-Analysis

3481

   If we continue to concern
ourselves only with our hysterics and obsessional neurotics, we are
soon met by a second fact for which we were not in the least
prepared. For after a while we cannot help noticing that these
patients behave in a quite peculiar manner to us. We believed, to
be sure, that we had reckoned with all the motives concerned in the
treatment, that we had completely rationalized the situation
between us and the patients so that it could be looked over at a
lance like a sum in arithmetic; yet, in spite of all this,
something seems to creep in which has not been taken into account
in our sum. This unexpected novelty itself takes many shapes, and I
will begin by describing to you the commoner and more easily
understandable of the forms in which it appears.

   We notice, then, that the
patient, who ought to want nothing else but to find a way out of
his distressing conflict, develops a special interest in the person
of the doctor. Everything connected with the doctor seems to be
more important to him than his own affairs and to be diverting him
from his illness. For a time, accordingly, relations with him
become very agreeable; he is particularly obliging, tries wherever
possible to show his gratitude, reveals refinements and merits in
his nature which we should not, perhaps, have expected to find in
him. The doctor, too, thereupon forms a favourable opinion of the
patient and appreciates the good fortune which has enabled him to
give his assistance to such a particularly valuable personality. If
the doctor has an opportunity of talking to the patient’s
relatives, he learns to his satisfaction that the liking is a
mutual one. The patient never tires in his home of praising the
doctor and of extolling ever new qualities in him.
‘He’s enthusiastic about you,’ say his relatives,
‘he trusts you blindly; everything you say is like a
revelation to him.’ Here and there someone in this chorus has
sharper eyes and says: ‘It’s becoming a bore, the way
he talks of nothing else but you and has your name on his lips all
the time.’

Introductory Lectures On Psycho-Analysis

3482

   Let us hope that the doctor is
modest enough to attribute his patient’s high opinion of him
to the hopes he can rouse in him and to the widening of his
intellectual horizon by the surprising and liberating enlightenment
that the treatment brings with it. Under these conditions the
analysis makes fine progress too. The patient understands what is
interpreted to him and becomes engrossed in the tasks set him by
the treatment; the material of memories and associations floods in
I upon him in plenty, the certainty and appositeness of his
interpretations are a surprise to the doctor, and the latter can
only take note with satisfaction that here is a patient who readily
accepts all the psychological novelties which are apt to provoke
the most bitter contradiction among healthy people in the outside
world. Moreover the cordial relations that prevail during the work
of analysis are accompanied by an objective improvement, which is
recognized on all sides, in the patient’s illness.

   But such fine weather cannot last
for ever. One day it clouds over. Difficulties arise in the
treatment; the patient declares that nothing more occurs to him. He
gives the clearest impression of his interest being no longer in
the work and of his cheerfully disregarding the instructions given
him to say everything that comes into his head and not to give way
to any critical obstacle to doing so. He behaves as though he were
outside the treatment and as though he had not made this agreement
with the doctor. He is evidently occupied with something, but
intends to keep it to himself. This is a situation that is
dangerous for the treatment. We are unmistakably confronted by a
formidable resistance. But what has happened to account for it?

Introductory Lectures On Psycho-Analysis

3483

   If we are able once more to
clarify the position, we find that the cause of the disturbance is
that the patient has transferred on to the doctor intense feelings
of affection which are justified neither by the doctor’s
behaviour nor by the situation that has developed during the
treatment. The form in which this affection is expressed and what
its aims are depend of course on the personal relation between the
two people involved. If those concerned are a young girl and a
youngish man, we shall get the impression of a normal case of
falling in love; we shall find it understandable that a girl should
fall in love with a man with whom she can be much alone and talk of
intimate things and who has the advantage of having met her as a
helpful superior; and we shall probably overlook the fact that what
we should expect from a neurotic girl would rather be an impediment
in her capacity for love. The further the personal relations
between doctor and patient diverge from this supposed case, the
more we shall be surprised to find nevertheless the same emotional
relationship constantly recurring. It may still pass muster if a
woman who is unhappy in her marriage appears to be seized with a
serious passion for a doctor who is still unattached, if she is
ready to seek a divorce in order to be his or if, where there are
social obstacles, she even expresses no hesitation about entering
into a secret
liaison
with him. Such things come about even
outside psycho-analysis. But in these circumstances we are
astonished to hear declarations by married women and girls which
bear witness to a quite particular attitude to the therapeutic
problem: they had always known, they say, that they could only be
cured by love, and before the treatment began they had expected
that through this relation they would at last be granted what life
had hitherto withheld from them; it had only been in this hope that
they had taken so much trouble over the treatment and overcome all
the difficulties in communicating their thoughts - and we on our
part can add: and had so easily understood what is otherwise so
hard to believe. But an admission of this sort surprises us: it
throws all our calculations to the winds. Can it be that we have
left the most important item out of our account?