Freud - Complete Works (710 page)

The Question Of Lay Analysis

4368

   ‘That does sound hopeless!
What can be done about it? The analysis would have to be given up.
But if, as you say, the same thing happens in every case, it would
be impossible to carry through any analyses at all.’

   We will begin by using the
situation in order to learn something from it. What we learn may
then perhaps help us to master it. Is it not an extremely
noteworthy fact that we succeed in transforming every neurosis,
whatever its content, into a condition of pathological love?

   Our conviction that a portion of
erotic life that has been abnormally employed lies at the basis of
neuroses must be unshakeably strengthened by this experience. With
this discovery we are once more on a firm footing and can venture
to make this love itself the object of analysis. And we can make
another observation. Analytic love is not manifested in every case
as clearly and blatantly as I have tried to depict it. Why not? We
can soon see. In proportion as the purely sensual and the hostile
sides of his love try to show themselves, the patient’s
opposition to them is aroused. He struggles against them and tries
to repress them before our very eyes. And now we understand what is
happening. The patient is
repeating
in the form of falling
in love with the analyst mental experiences which he has already
been through once before; he has
transferred
on to the
analyst mental attitudes that were lying ready in him and were
intimately connected with his neurosis. He is also repeating before
our eyes his old defensive actions; he would like best to repeat in
his relation to the analyst
all
the history of that
forgotten period of his life. So what he is showing us is the
kernel of his intimate life history:
he is reproducing it
tangibly, as though it were actually happening, instead of
remembering it
. In this way the riddle of the transference-love
is solved and the analysis can proceed on its way - with the
help
of the new situation which had seemed such a menace to
it.

The Question Of Lay Analysis

4369

   ‘That is very cunning. And
is the patient so easy to convince that he is not in love but only
obliged to stage a revival of an old piece!’

   Everything now depends on that.
And the whole skill in handling the ‘transference’ is
devoted to bringing it about. As you see, the requirements of
analytic technique reach their maximum at this point. Here the
gravest mistakes can be made or the greatest successes be
registered. It would be folly to attempt to evade the difficulties
by suppressing or neglecting the transference; whatever else had
been done in the treatment, it would not deserve the name of an
analysis. To send the patient away as soon as the inconveniences of
his transference neurosis make their appearance would be no more
sensible, and would moreover be cowardly. It would be as though one
had conjured up spirits and run away from them as soon as they
appeared. Sometimes, it is true, nothing else is possible. There
are cases in which one cannot master the unleashed transference and
the analysis has to be broken of; but one must at least have
struggled with the evil spirits to the best of one’s
strength. To yield to the demands of the transference, to fulfil
the patient’s wishes for affectionate and sensual
satisfaction, is not only justly forbidden by moral considerations
but is also completely ineffective as a technical method for
attaining the purpose of the analysis. A neurotic cannot be cured
by being enabled to reproduce uncorrected an unconscious stereotype
plate that is ready to hand in him. If one engages in compromises
with him by offering him partial satisfactions in exchange for his
further collaboration in the analysis, one must beware of falling
into the ridiculous situation of the cleric who was supposed to
convert a sick insurance agent. The sick man remained unconverted
but the cleric took his leave insured. The only possible way out of
the transference situation is to trace it back to the
patient’s past, as he really experienced it or as he pictured
it through the wish-fulfilling activity of his imagination. And
this demands from the analyst much skill, patience, calm and
self-abnegation.

   ‘And where do you suppose
the neurotic experienced the prototype of his
transference-love?’

   In his childhood: as a rule in
his relation with one of his parents. You will remember what
importance we had to attribute to these earliest emotional ties. So
here the circle closes.

The Question Of Lay Analysis

4370

   ‘Have you finished at last?
I am feeling just a little bewildered with all I have heard from
you. Only tell me one thing more: how and where can one learn what
is necessary for practising analysis?’

   There are at the moment two
Institutes at which instruction in psycho-analysis is given. The
first has been founded in Berlin by Dr. Max Eitingon, who is a
member of the Society there. The second is maintained by the Vienna
Psycho-Analytical Society at its own expense and at considerable
sacrifice. The part played by the authorities is at present limited
to the many difficulties which they put in the way of the young
undertaking. A third training Institute is at this moment being
opened in London by the Society there, under the direction of Dr.
Ernest Jones. At these Institutes the candidates themselves are
taken into analysis, receive theoretical instruction by lectures on
all the subjects that are important for them, and enjoy the
supervision of older and more experienced analysts when they are
allowed to make their first trials with comparatively slight cases.
A period of some two years is calculated for this training. Even
after this period, of course, the candidate is only a beginner and
not yet a master. What is still needed must be acquired by practice
and by an exchange of ideas in the psycho-analytical societies in
which young and old members meet together. Preparation for analytic
activity is by no means so easy and simple. The work is hard, the
responsibility great. But anyone who has passed through such a
course of instruction, who has been analysed himself, who has
mastered what can be taught to-day of the psychology of the
unconscious, who is at home in the science of sexual life, who has
learnt the delicate technique of psycho-analysis, the art of
interpretation, of fighting resistances and of handling the
transference - anyone who has accomplished all this
is no longer
a layman in the field of psycho-analysis
. He is capable of
undertaking the treatment of neurotic disorders, and will be able
in time to achieve in that field whatever can be required from this
form of therapy.

The Question Of Lay Analysis

4371

VI

   ‘You have expended a great
deal of effort on showing me what psycho-analysis is and what sort
of knowledge is needed in order to practise it with some prospect
of success. Very well. Listening to you can have done me no harm.
But I do not know what influence on my judgement you expect your
explanations to have. I see before me a case which has nothing
unusual about it. The neuroses are a particular kind of illness and
analysis is a particular method of treating them - a specialized
branch of medicine. It is the rule in other cases as well for a
doctor who has chosen a special branch of medicine not to be
satisfied with the education that is confirmed by his diploma:
particularly if he intends to set up in a fairly large town, such
as can alone offer a livelihood to specialists. Anyone who wants to
be a surgeon tries to work for a few years at a surgical clinic,
and similarly with oculists, laryngologists and so on - to say
nothing of psychiatrists, who are perhaps never able to get away
from a state institution or a sanatorium. And the same will happen
in the case of psycho-analysts: anyone who decides in favour of
this new specialized branch of medicine will, when his studies are
completed, take on the two years’ training you spoke of in a
training institute, if it really requires so much time. He will
realize afterwards, too, that it is to his advantage to keep up his
contact with his colleagues in a psycho-analytical society, and
everything will go along swimmingly. I cannot see where there is a
place in this for the question of lay analysis.’

   A doctor who does what you have
promised on his behalf will be welcome to all of us. Four-fifths of
those whom I recognize as my pupils are in any case doctors. But
allow me to point out to you how the relations of doctors to
analysis have really developed and how they will probably continue
to develop. Doctors have no historical claim to the sole possession
of analysis. On the contrary, until recently they have met it with
everything possible that could damage it, from the shallowest
ridicule to the gravest calumny. You will justly reply that that
belongs to the past and need not affect the future. I agree, but I
fear the future will be different from what you have foretold.

The Question Of Lay Analysis

4372

   Permit me to give the word
‘quack’ the meaning it ought to have instead of the
legal one. According to the law a quack is anyone who treats
patients without possessing a state diploma to prove he is a
doctor. I should prefer another definition: a quack is anyone who
undertakes a treatment without possessing the knowledge and
capacities necessary for it. Taking my stand on this definition, I
venture to assert that - not only in European countries - doctors
form a preponderating contingent of quacks in analysis. They very
frequently practise analytic treatment without having learnt it and
without understanding it.

   It is no use your objecting that
that is unconscientious and that you cannot believe doctors capable
of it; that after all a doctor knows that a medical diploma is not
a letter of marque and that a patient is not an outlaw; and that
one must always grant to a doctor that he is acting in good faith
even if he may perhaps be in error.

   The facts remain; we will hope
that they can be accounted for as you think. I will try to explain
to you how it becomes possible for a doctor to act in connection
with psycho-analysis in a manner which he would carefully avoid in
every other field.

   The first consideration is that
in his medical school a doctor receives a training which is more or
less the opposite of what he would need as a preparation for
psycho-analysis. His attention has been directed to objectively
ascertainable facts of anatomy, physics and chemistry, on the
correct appreciation and suitable influencing of which the success
of medical treatment depends. The problem of life is brought into
his field of vision so far as it has hitherto been explained to us
by the play of forces which can also be observed in inanimate
nature. His interest is not aroused in the mental side of vital
phenomena; medicine is not concerned with the study of the higher
intellectual functions, which lies in the sphere of another
faculty. Only psychiatry is supposed to deal with the disturbances
of mental functions; but we know in what manner and with what aims
it does so. It looks for the somatic determinants of mental
disorders and treats them like other causes of illness.

The Question Of Lay Analysis

4373

   Psychiatry is right to do so and
medical education is clearly excellent. If it is described as
one-sided, one must first discover the standpoint from which one is
making that characteristic into a reproach. In itself every science
is one-sided. It must be so, since it restricts itself to
particular subjects, points of view and methods. It is a piece of
nonsense in which I would take no part to play off one science
against another. After all, physics does not diminish the value of
chemistry; it cannot take its place but on the other hand cannot be
replaced by it. Psycho-analysis is certainly quite particularly
one-sided, as being the science of the mental unconscious. We must
not therefore dispute to the medical sciences their right to be
one-sided.

   We shall only find the standpoint
we are in search of if we turn from scientific medicine to
practical therapeutics. A sick person is a complicated organism. He
may remind us that even the mental phenomena which are so hard to
grasp should not be effaced from the picture of life. Neurotics,
indeed, are an undesired complication, an embarrassment as much to
therapeutics as to jurisprudencc and to military service. But they
exist and are a particular concern of medicine. Medical education,
however, does nothing, literally nothing, towards their
understanding and treatment. In view of the intimate connection
between the things that we distinguish as physical and mental, we
may look forward to a day when paths of knowledge and, let us hope,
of influence will be opened up, leading from organic biology and
chemistry to the field of neurotic phenomena. That day still seems
a distant one, and for the present these illnesses are inaccessible
to us from the direction of medicine.

   It would be tolerable if medical
education merely failed to give doctors any orientation in the
field of the neuroses. But it does more: it gives them a false and
detrimental attitude. Doctors whose interest has not been aroused
in the psychical factors of life are all too ready to form a low
estimate of them and to ridicule them as unscientific. For that
reason they are unable to take anything really seriously which has
to do with them and do not recognize the obligations which derive
from them. They therefore fall into the layman’s lack of
respect for psychological research and make their own task easy for
themselves. - No doubt neurotics have to be treated, since they are
sick people and come to the doctor; and one must always be ready to
experiment with something new. But why burden oneself with a
tedious preparation? We shall manage all right; who can tell if
what they teach in the analytic institutes is any good? - The less
such doctors understand about the matter, the more venturesome they
become. Only a man who really knows is modest, for he knows how
insufficient his knowledge is.