Freud - Complete Works (709 page)

   ‘Well, I no longer have any
desire to undertake an analytic treatment even in my imagination.
Who can say what other surprises I might meet with?’

   You are quite right to give up
the notion. You see how much more training and practice would be
needed. When you have found the right interpretation, another task
lies ahead. You must wait for the right moment at which you can
communicate your interpretation to the patient with some prospect
of success.

   ‘How can one always tell
the right moment?’

   That is a question of tact, which
can become more refined with experience. You will be making a bad
mistake if, in an effort, perhaps, at shortening the analysis, you
throw your interpretations at the patient’s head as soon as
you have found them. In that way you will draw expressions of
resistance, rejection and indignation from him; but you will not
enable his ego to master his repressed material. The formula is: to
wait till he has come so near to the repressed material that he has
only a few more steps to take under the lead of the interpretation
you propose.

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   ‘I believe I should never
learn to do that. And if I carry out these precautions in making my
interpretation, what next?’

   It will then be your fate to make
a discovery for which you were not prepared.

   ‘And what may that
be?’

   That you have been deceived in
your patient; that you cannot count in the slightest on his
collaboration and compliance; that he is ready to place every
possible difficulty in the way of your common work - in a word,
that he has no wish whatever to be cured.

   ‘Well! that is the craziest
thing you have told me yet. And I do not believe it either. The
patient who is suffering so much, who complains so movingly about
his troubles, who is making so great a sacrifice for the treatment
- you say he has no wish to be cured! But of course you do not mean
what you say.’

   Calm yourself! I
do
mean
it. What I said was the truth - not the whole truth, no doubt, but
a very noteworthy part of it. The patient wants to be cured - but
he also wants not to be. His ego has lost its unity, and for that
reason his will has no unity either. If that were not so, he would
be no neurotic.

   ‘"Were I sagacious, I
should not be Tell!"’

   The derivatives of what is
repressed have broken into his ego and established themselves
there; and the ego has as little control over trends from that
source as it has over what is actually repressed, and as a rule it
knows nothing about them. These patients, indeed, are of a peculiar
nature and raise difficulties with which we are not accustomed to
reckon. All our social institutions are framed for people with a
united and normal ego, which one can classify as good or bad, which
either fulfils its function or is altogether eliminated by an
overpowering influence. Hence the juridical alternative:
responsible or irresponsible. None of these distinctions apply to
neurotics. It must be admitted that there is difficulty in adapting
social demands to their psychological condition. This was
experienced on a large scale during the last war. Were the
neurotics who evaded service malingerers or not? They were both. If
they were treated as malingerers and if their illness was made
highly uncomfortable, they recovered; if after being ostensibly
restored they were sent back into service, they promptly took
flight once more into illness. Nothing could be done with them. And
the same is true of neurotics in civil life. They complain of their
illness but exploit it with all their strength; and if someone
tries to take it away from them they defend it like the proverbial
lioness with her young. Yet there would be no sense in reproaching
them for this contradiction.

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   ‘But would not the best
plan be not to give these difficult people any treatment at all,
but to leave them to themselves! I cannot think it is worth while
to expend such great efforts over each of them as you lead me to
suppose that you make.’

   I cannot approve of your
suggestion. It is undoubtedly a more proper line to accept the
complications of life rather than struggle against them. It may be
true that not every neurotic whom we treat is worth the expenditure
of an analysis; but there are some very valuable individuals among
them as well. We must set ourselves the goal of bringing it about
that as few human beings as possible enter civilized life with such
a defective mental equipment. And for that purpose we must collect
much experience and learn to understand many things. Every analysis
can be instructive and bring us a yield of new understanding quite
apart from the personal value of the individual patient.

   ‘But if a volitional
impulse has been formed in the patient’s ego which wishes to
retain the illness, it too must have its reasons and motives and be
able in some way to justify itself. But it is impossible to see why
anyone should want to be ill or what he can get out of
it.’

   Oh, that is not so hard to
understand. Think of the war neurotics, who do not have to serve,
precisely because they are ill. In civil life illness can be used
as a screen to gloss over incompetence in one’s profession or
in competition with other people; while in the family it can serve
as a means for sacrificing the other members and extorting proofs
of their love or for imposing one’s will upon them. All of
this lies fairly near the surface; we sum it up in the term
‘gain from illness’. It is curious, however, that the
patient - that is, his ego - nevertheless knows nothing of the
whole concatenation of these motives and the actions which they
involve. One combats the influence of these trends by compelling
the ego to take cognizance of them. But there are other motives,
that lie still deeper, for holding on to being ill, which are not
so easily dealt with. But these cannot be understood without a
fresh journey into psychological theory.

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4365

   ‘Please go on. A little
more theory will make no odds now.’

   When I described the relation
between the ego and the id to you, I suppressed an important part
of the theory of the mental apparatus. For we have been obliged to
assume that within the ego itself a particular agency has become
differentiated, which we name the super-ego. This super-ego
occupies a special position between the ego and the id. It belongs
to the ego and shares its high degree of psychological
organization; but it has a particularly intimate connection with
the id. It is in fact a precipitate of the first object-cathexes of
the id and is the heir to the Oedipus complex after its demise.
This super-ego can confront the ego and treat it like an object;
and it often treats it very harshly. It is as important for the ego
to remain on good terms with the super-ego as with the id.
Estrangements between the ego and the super-ego are of great
significance in mental life. You will already have guessed that the
super-ego is the vehicle of the phenomenon that we call conscience.
Mental health very much depends on the super-ego’s being
normally developed - that is, on its having become sufficiently
impersonal. And that is precisely what it is not in neurotics,
whose Oedipus complex has not passed through the correct process of
transformation. Their super-ego still confronts their ego as a
strict father confronts a child; and their morality operates in a
primitive fashion in that the ego gets itself punished by the
super-ego. Illness is employed as an instrument for this
‘self-punishment’, and neurotics have to behave as
though they were governed by a sense of guilt which, in order to be
satisfied, needs to be punished by illness.

   ‘That really sounds most
mysterious. The strangest thing about it is that apparently even
this mighty force of the patient’s conscience does not reach
his consciousness.’

The Question Of Lay Analysis

4366

   Yes, we are only beginning to
appreciate the significance of all these important circumstances.
That is why my description was bound to turn out so obscure. But
now I can proceed. We describe all the forces that oppose the work
of recovery as the patient’s ‘resistances’. The
gain from illness is one such resistance. The ‘unconscious
sense of guilt’ represents the super-ego’s resistance;
it is the most powerful factor, and the one most dreaded by us. We
meet with still other resistances during the treatment. If the ego
during the early period has set up a repression out of fear, then
the fear still persists and manifests itself as a resistance if the
ego approaches the repressed material. And finally, as you can
imagine, there are likely to be difficulties if an instinctual
process which has been going along a particular path for whole
decades is suddenly expected to take a new path that has just been
made open for it. That might be called the id’s resistance.
The struggle against all these resistances is our main work during
an analytic treatment; the task of making interpretations is
nothing compared to it. But as a result of this struggle and of the
overcoming of the resistances, the patient’s ego is so much
altered and strengthened that we can look forward calmly to his
future behaviour when the treatment is over. On the other hand, you
can understand now why we need such long treatments. The length of
the path of development and the wealth of the material are not the
decisive factors. It is more a question of whether the path is
clear. An army can be held up for weeks on a stretch of country
which in peace time an express train crosses in a couple of hours -
if the army has to overcome the enemy’s resistance there.
Such battles call for time in mental life too. I am unfortunately
obliged to tell you that every effort to hasten analytic treatment
appreciably has hitherto failed. The best way of shortening it
seems to be to carry it out according to the rules.

   ‘If I ever felt any desire
to poach on your preserves and try my hand at analysing someone
else, what you tell me about the resistances would have cured me of
it. But how about the special personal influence that you yourself
have after all admitted? Does not that come into action against the
resistances?’

   It is a good thing you have asked
me about that. This personal influence is our most powerful dynamic
weapon. It is the new element which we introduce into the situation
and by means of which we make it fluid. The intellectual content of
our explanations cannot do it, for the patient, who shares all the
prejudices of the world around him, need believe us as little as
our scientific critics do. The neurotic sets to work because he has
faith in the analyst, and he believes him because he acquires a
special emotional attitude towards the figure of the analyst.
Children, too, only believe people they are attached to. I have
already told you what use we make of this particularly large
‘suggestive’ influence. Not for suppressing the
symptoms - this distinguishes the analytic method from other
psychotherapeutic procedures - but as a motive force to induce the
patient to overcome his resistances.

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   ‘Well, and if that
succeeds, does not everything then go smoothly?’

   Yes, it ought to. But there turns
out to be an unexpected complication. It was perhaps the greatest
of the analyst’s surprises to find that the emotional
relation which the patient adopts towards him is of a quite
peculiar nature. The very first doctor who attempted an analysis -
it was not myself - came up against this phenomenon and did not
know what to make of it. For this emotional relation is, to put it
plainly, in the nature of falling in love. Strange, is it not?
Especially when you take into account that the analyst does nothing
to provoke it but on the contrary rather keeps at a distance from
the patient, speaking humanly, and surrounds himself with some
degree of reserve - when you learn besides that this odd
love-relationship disregards anything else that is really
propitious and every variation in personal attraction, age, sex or
class. This love is of a positively compulsive kind. Not that that
characteristic need be absent from spontaneous falling in love. As
you know, the contrary is often the case. But in the analytic
situation it makes its appearance with complete regularity without
there being any rational explanation for it. One would have thought
that the patient’s relation to the analyst called for no more
than a certain amount of respect, trust, gratitude and human
sympathy. Instead, there is this falling in love, which itself
gives the impression of being a pathological phenomenon.

   ‘I should have thought all
the same that it would be favourable for your analytic purposes. If
someone is in love, he is amenable, and he will do anything in the
world for the sake of the other person.’

   Yes. It
is
favourable to
start with. But when this falling in love has grown deeper, its
whole nature comes to light, much of which is incompatible with the
task of analysis. The patient’s love is not satisfied with
being obedient; it grows exacting, calls for affectionate and
sensual satisfactions, it demands exclusiveness, it develops
jealousy, and it shows more and more clearly its reverse side, its
readiness to become hostile and revengeful if it cannot obtain its
ends. At the same time, like all falling in love, it drives away
all other mental material; it extinguishes interest in the
treatment and in recovery - in short, there can be no doubt that it
has taken the place of the neurosis and that our work has had the
result of driving out one form of illness with another.