Freud - Complete Works (703 page)

Inhibitions, Symptoms And Anxiety

4324

   We know of yet another emotional reaction
to the loss of an object, and that is mourning. But
we have no longer any difficulty in accounting for it. Mourning occurs under
the influence of reality-testing; for the latter function demands categorically
from the bereaved person that he should separate himself from the object, since
it no longer exists. Mourning is entrusted with the task of carrying out this retreat
from the object in all those situations in which it was the recipient of a high
degree of cathexis. That this separation should be painful fits in with what we
have just said, in view of the high and unsatisfiable cathexis of longing which
is concentrated on the object by the bereaved person during the reproduction of
the situations in which he must undo the ties that bind him to it.

4325

THE QUESTION OF LAY ANALYSIS

Conversations with an Impartial Person

(1926)

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4327

THE QUESTION OF LAY ANALYSIS

CONVERSATIONS WITH AN IMPARTIAL PERSON

INTRODUCTION

The title of this small work is not
immediately intelligible. I will therefore explain it.
‘Layman’ = ‘Non-doctor’; and the question
is whether non-doctors as well as doctors are to be allowed to
practise analysis. This question has its limitations both in time
and place. In
time
, because up to now no one has been
concerned as to
who
practises analysis. Indeed, people have
been much too little concerned about it - the one thing they were
agreed on was a wish that
no one
should practise it. Various
reasons were given for this, but they were based on the same
underlying distaste. Thus the demand that only doctors should
analyse corresponds to a new and apparently more friendly attitude
to analysis - if, that is, it can escape the suspicion of being
after all only a slightly modified derivative of the earlier
attitude. It is conceded that in some circumstances an analytic
treatment shall be undertaken; but, if so, only doctors are to
undertake it. The reason for this restriction then becomes a matter
for enquiry.

   The question is limited in
place
because it does not arise in all countries with equal
significance. In Germany and America it would be no more than an
academic discussion; for in those countries every patient can have
himself treated how and by whom he chooses, and anyone who chooses
can, as a ‘quack’, handle any patients, provided only
that he undertakes the responsibility for his actions. The law does
not intervene until it is called in to expiate some injury done to
the patient. But in Austria, in which and for which I am writing,
there is a preventive law, which forbids non-doctors from
undertaking the treatment of patients, without waiting for its
outcome.¹ So here the question whether laymen (= non-doctors)
may treat patients by psycho-analysis has a practical sense. As
soon as it is raised, however, it appears to be settled by the
wording of the law. Neurotics are patients, laymen are non-doctors,
psycho-analysis is a procedure for curing or improving nervous
disorders, and all such treatments are reserved to doctors. It
follows that laymen are not permitted to practise analysis on
neurotics, and are punishable if they nevertheless do so. The
position being so simple, one hardly ventures to take up the
question of lay analysis. All the same, there are some
complications, which the law does not trouble about, but which
nevertheless call for consideration. It may perhaps turn out that
in this instance the patients are not like other patients, that the
laymen are not really laymen, and that the doctors have not exactly
the qualities which one has a right to expect of doctors and on
which their claims should be based. If this can be proved, there
will be justifiable grounds for demanding that the law shall not be
applied without modification to the instance before us.

  
¹
The same holds good in France.

The Question Of Lay Analysis

4328

I

   Whether this happens will depend
on people who are not obliged to be familiar with the peculiarities
of an analytic treatment. It is our task to give information on the
subject to these impartial persons, whom we shall assume to be, at
the moment, still in ignorance. It is to be regretted that we
cannot let them be present as an audience at a treatment of this
kind. But the ‘analytic situation’ allows of the
presence of no third person. Moreover the different sessions are of
very unequal value. An unauthorized listener who hit upon a chance
one of them would as a rule form no useful impression; he would be
in danger of not understanding what was passing between the analyst
and the patient, or he would be bored. For good or ill, therefore,
he must be content with our information, which we shall try to make
as trustworthy as possible.

   A patient, then, may be suffering
from fluctuations in his moods which he cannot control, or from a
sense of despondency by which his energy feels paralysed because he
thinks he is incapable of doing anything properly, or from a
nervous embarrassment among strangers. He may perceive, without
understanding the reason for it, that he has difficulties in
carrying out his professional work, or indeed any comparatively
important decision or any undertaking. He may one day have suffered
from a distressing attack - unknown in its origin - of feelings of
anxiety, and since then have been unable, without a struggle, to
walk along the street alone, or to travel by train; he may perhaps
have had to give up both entirely. Or, a very remarkable thing, his
thoughts may go their own way and refuse to be directed by his
will. They pursue problems that are quite indifferent to him, but
from which he cannot get free. Quite ludicrous tasks, too, are
imposed on him, such as counting up the windows on the fronts of
houses. And when he has performed simple actions such as posting a
letter or turning off a gas-jet, he finds himself a moment later
doubting whether he has really done so. This may be no more than an
annoyance and a nuisance. But his state becomes intolerable if he
suddenly finds he is unable to fend off the idea that he has pushed
a child under the wheels of a car or has thrown a stranger off the
bridge into the water, or if he has to ask himself whether he is
not the murderer whom the police are looking for in connection with
a crime that was discovered that day. It is obvious nonsense, as he
himself knows; he has never done any harm to anyone; but if he were
really the murderer who is being looked for, his feeling - his
sense of guilt - could not be stronger.

The Question Of Lay Analysis

4329

   Or again our patient - and this
time let us make her a woman - may suffer in another way and in a
different field. She is a pianist, but her fingers are overcome by
cramp and refuse to serve her. Or when she thinks of going to a
party she promptly becomes aware of a call of nature the
satisfaction of which would be incompatible with a social
gathering. She has therefore given up going to parties, dances,
theatres or concerts. She is overcome by violent headaches or other
painful sensations at times when they are most inconvenient. She
may even be unable to keep down any meal she eats which can become
dangerous in the long run. And, finally, it is a lamentable fact
that she cannot tolerate any agitations, which after all are
inevitable in life. On such occasions she falls in a faint, often
accompanied by muscular spasms that recall sinister pathological
states.

   Other patients, again, suffer
from disturbances in a particular field in which emotional life
converges with demands of a bodily sort. If they are men, they find
they are incapable of giving physical expression to their tenderest
feelings towards the opposite sex, while towards less loved objects
they may perhaps have every reaction at their command. Or their
sensual feelings attach them to people whom they despise and from
whom they would like to get free; or those same feelings impose
requirements on them whose fulfilment they themselves find
repulsive. If they are women, they feel prevented by anxiety or
disgust or by unknown obstructions from meeting the demands of
sexual life; or, if they have surrendered to love, they find
themselves cheated of the enjoyment which nature has provided as a
reward for such compliance.

   All these people recognize that
they are ill and go to doctors, by whom people expect nervous
disorders like these to be removed. The doctors, too, lay down the
categories into which these complaints are divided. They diagnose
them, each according to his own standpoint, under different names:
neurasthenia, psychasthenia, phobias, obsessional neurosis,
hysteria. They examine the organs which produce the symptoms, the
heart, the stomach, the bowels, the genitals, and find them
healthy. They recommend interruptions in the patient’s
accustomed mode of life, holidays, strengthening exercises, tonics,
and by these means bring about temporary improvements - or no
result at all. Eventually the patients hear that there are people
who are concerned quite specially with the treatment of such
complaints and start an analysis with them.

The Question Of Lay Analysis

4330

   During this disquisition on the
symptoms of neurotics, the Impartial Person, whom I imagine as
being present, has been showing signs of impatience. At this point,
however, he becomes attentive and interested. ‘So now’,
he says, ‘we shall learn what the analyst does with the
patient whom the doctor has not been able to help.’

   Nothing takes place between them
except that they talk to each other. The analyst makes use of no
instruments not even for examining the patient - nor does he
prescribe any medicines. If it is at all possible, he even leaves
the patient in his environment and in his usual mode of life during
the treatment. This is not a necessary condition, of course, and
may not always be practicable. The analyst agrees upon a fixed
regular hour with the patient, gets him to talk, listens to him,
talks to him in his turn and gets him to listen.

   The Impartial Person’s
features now show signs of unmistakable relief and relaxation, but
they also clearly betray some contempt. It is as though he were
thinking: ‘Nothing more than that? Words, words, words, as
Prince Hamlet says.’ And no doubt he is thinking too of
Mephistopheles’ mocking speech on how comfortably one can get
along with words - lines that no German will ever forget.

   ‘So it is a kind of
magic,’ he comments: ‘you talk, and blow away his
ailments.’

   Quite true. It
would
be
magic if it worked rather quicker. An essential attribute of a
magician is speed - one might say suddenness - of success. But
analytic treatments take months and even years: magic that is so
slow loses its miraculous character. And incidentally do not let us
despise the
word
. After all it is a powerful instrument; it
is the means by which we convey our feelings to one another, our
method of influencing other people. Words can do unspeakable good
and cause terrible wounds. No doubt ‘in the beginning was the
deed’ and the word came later; in some circumstances it meant
an advance in civilization when deeds were softened into words. But
originally the word was magic - a magical act; and it has retained
much of its ancient power.

The Question Of Lay Analysis

4331

   The Impartial Person proceeds:
‘Let us suppose that the patient is no better prepared to
understand analytic treatment than I am; then how are you going to
make him believe in the magic of the word or of the speech that is
to free him from his sufferings?’

   Some preparation must of course
be given to him; and there is a simple way of doing it. We call on
him to be completely straightforward with his analyst, to keep
nothing back intentionally that comes into his head, and then to
put aside
every
reservation that might prevent his reporting
certain thoughts or memories. Everyone is aware that there are some
things in himself that he would be very unwilling to tell other
people or that he considers it altogether out of the question to
tell. These are his ‘intimacies’. He has a notion too -
and this represents a great advance in psychological self-knowledge
- that there are other things that one would not care to admit
to oneself
: things that one likes to conceal from oneself
and which for that reason one breaks off short and drives out of
one’s thoughts if, in spite of everything, they turn up.
Perhaps he may himself notice that a very remarkable psychological
problem begins to appear in this situation - of a thought of his
own being kept secret from his own self. It looks as though his own
self were no longer the unity which he had always considered it to
be, as though there were something else as well in him that could
confront that self. He may become obscurely aware of a contrast
between a self and a mental life in the wider sense. If now he
accepts the demand made by analysis that he shall say everything,
he will easily become accessible to an expectation that to have
relations and exchanges of thought with someone under such unusual
conditions might also lead to peculiar results.

The Question Of Lay Analysis

4332

   ‘I understand,’ says
our Impartial Person. ‘You assume that every neurotic has
something oppressing him, some secret. And by getting him to tell
you about it you relieve his oppression and do him good. That, of
course, is the principle of Confession, which the Catholic Church
has used from time immemorial in order to make secure its dominance
over people’s minds.’

   We must reply: ‘Yes and
no!’ Confession no doubt plays a part in analysis - as an
introduction to it, we might say. But it is very far from
constituting the essence of analysis or from explaining its
effects. In Confession the sinner tells what he knows; in analysis
the neurotic has to tell more. Nor have we heard that Confession
has ever developed enough power to get rid of actual pathological
symptoms.

   ‘Then, after all, I do not
understand,’ comes the rejoinder. ‘What can you
possibly mean by "telling more than he knows"? But I can
well believe that as an analyst you gain a stronger influence over
your patients than a Father Confessor over his penitents, since
your contacts with him are so much longer, more intensive and also
more individual, and since you use this increased influence to
divert him from his sick thoughts, to talk him out of his fears,
and so on. It would certainly be strange if it were possible by
such means to control purely physical phenomena as well, such as
vomiting, diarrhoea, convulsions; but I know that influence like
that is in fact quite possible if a person is put into a state of
hypnosis. By the trouble you take with the patient you probably
succeed in bringing about a hypnotic relation of that sort with him
- a suggestive attachment to yourself - even though you may not
intend to; and in that case the miraculous results of your
treatment are the effect of hypnotic suggestion. But, so far as I
know, hypnotic treatment works much faster than your analysis,
which, as you tell me, lasts for months and years.’