Freud - Complete Works (711 page)

The Question Of Lay Analysis

4374

   The comparison which you brought
up to pacify me, between specialization in analysis and in other
branches of medicine, is thus not applicable. For surgery,
ophthalmology, and so on, the medical school itself offers an
opportunity for further education. The analytic training institutes
are few in number, young in years, and without authority. The
medical schools have not recognized them and take no notice of
them. The young doctor, who has had to take so much on trust from
his teachers that he has had little occasion for educating his
judgement, will gladly seize an occasion for playing the part of a
critic for once in a field in which there is as yet no recognized
authority.

   There are other things too that
favour his appearing as an analytic quack. If he tried to undertake
eye-operations without sufficient preparation, the failure of his
cataract extractions and iridectomies and the absence of patients
would soon bring his hazardous enterprise to an end. The practice
of analysis is comparatively safe for him. The public is spoilt by
the average successful outcome of eye-operations and expects cure
from the surgeon. But if a ‘nerve-specialist’ fails to
restore his patients no one is surprised. People have not been
spoilt by successes in the therapy of the neuroses; the
nerve-specialist has at least ‘taken a lot of trouble with
them’. Indeed, there is not much that can be done; nature
must help, or time. With women there is first menstruation, then
marriage, and later on the menopause. Finally death is a real help.
Moreover, what the medical analyst has done with his neurotic
patient is so inconspicuous that no reproach can attach to it. He
has made use of no instruments or medicines; he has merely
conversed with him and tried to talk him into or out of something.
Surely that can do no harm, especially if he avoids touching on
distressing or agitating subjects. The medical analyst, who has
avoided any strict teaching, will, no doubt, not have omitted an
attempt to improve analysis, to pull out its poison fangs and make
it pleasant for the patient. And it will be wise for him to stop
there; for if he really ventures to call up resistances and then
does not know how to meet them, he may in true earnest make himself
unpopular.

The Question Of Lay Analysis

4375

   Honesty compels me to admit that
the activity of an untrained analyst does less harm to his patients
than that of an unskilled surgeon. The possible damage is limited
to the patient having been led into useless expenditure and having
his chances of recovery removed or diminished. Furthermore, the
reputation of analytic therapy has been lowered. All this is most
undesirable, but it bears no comparison with the dangers that
threaten from the knife of a surgical quack. In my judgement,
severe or permanent aggravations of a pathological condition are
not to be feared even with an unskilled use of analysis. The
unwelcome reactions cease after a while. Compared with the traumas
of life which have provoked the illness, a little mishandling by
the doctor is of no account. It is simply that the unsuitable
attempt at a cure has done the patient no good.

   ‘I have listened to your
account of the medical quack in analysis without interrupting you,
though I formed an impression that you are dominated by a hostility
against the medical profession to the historical explanation of
which you yourself have pointed the way. But I will grant you one
thing: if analyses are to be carried out, it should be by people
who have been thoroughly trained for it. And do you not think that
with time the doctors who turn to analysis will do everything to
obtain that training?’

   I fear not. So long as the
attitude of the medical school to the analytic training institute
remains unaltered, doctors will find the temptation to make things
easier for themselves too great.

   ‘But you seem to be
consistently evading any direct pronouncement on the question of
lay analysis. What I guess now is that, because it is impossible to
keep a check on doctors who want to analyse, you are proposing, out
of revenge, as it were, to punish them by depriving them of their
monopoly in analysis and by throwing open this medical activity to
laymen as well.’

   I cannot say whether you have
guessed my motives correctly. Perhaps I shall be able later on to
put evidence before you of a less partial attitude. But I lay
stress on the demand that
no one should practise analysis who
has not acquired the right to do so by a particular training
.
Whether such a person is a doctor or not seems to me
immaterial.

The Question Of Lay Analysis

4376

   ‘Then what definite
proposals have you to make?’

   I have not got so far as that
yet; and I cannot tell whether I shall get there at all. I should
like to discuss another question with you, and first of all to
touch on one special point. It is said that the authorities, at the
instigation of the medical profession, want to forbid the practice
of analysis by laymen altogether. Such a prohibition would also
affect the non-medical members of the Psycho-Analytical Society,
who have enjoyed an excellent training and have perfected
themselves greatly by practice. If the prohibition were enacted, we
should find ourselves in a position in which a number of people are
prevented from carrying out an activity which one can safely feel
convinced they can perform very well, while the same activity is
opened to other people for whom there is no question of a similar
guarantee. That is not precisely the sort of result to which
legislation should lead. However, this special problem is neither
very important nor difficult to solve. Only a handful of people are
concerned, who cannot be seriously damaged. They will probably
emigrate to Germany where no legislation will prevent them from
finding recognition for their proficiency. If it is desired to
spare them this and to mitigate the law’s severity, that can
easily be done on the basis of some well-known precedents. Under
the Austrian Monarchy it repeatedly happened that permission was
given to notorious quacks,
ad personam
, to carry out medical
activities in certain fields, because people were convinced of
their real ability. Those concerned were for the most part peasant
healers, and their recommendation seems regularly to have been made
by one of the Archduchesses who were once so numerous; but it ought
to be possible for it also to be done in the case of town-dwellers
and on the basis of a different and merely expert guarantee. Such a
prohibition would have more important effects on the Vienna
analytic training institute, which would thenceforward be unable to
accept any candidates for training from non-medical circles. Thus
once again in our country a line of intellectual activity would be
suppressed which is allowed to develop freely elsewhere. I am the
last person to claim any competence in judging laws and
regulations. But this much I can see: that to lay emphasis on our
quackery law does not lead in the direction of the approach to
conditions in Germany which is so much aimed at to-day, and that
the application of that law to the case of psycho-analysis has
something of an anachronism about it, since at the time of its
enactment there was as yet no such thing as analysis and the
peculiar nature of neurotic illnesses was not yet recognized.

The Question Of Lay Analysis

4377

   I come now to a question the
discussion of which seems to me more important. Is the practice of
psycho-analysis a matter which should in general be subject to
official interference, or would it be more expedient to leave it to
follow its natural development? I shall certainly not come to any
decision on this point here and now, but I shall take the liberty
of putting the problem before you for your consideration. In our
country from of old a positive
furor prohibendi
has been the
rule, a tendency to keep people under tutelage, to interfere and to
forbid, which, as we all know, has not borne particularly good
fruit. In our new republican Austria, it seems, things have not yet
changed very much. I fancy you will have an important word to say
in deciding the case of psycho-analysis which we are now
considering; I do not know whether you have the wish or the
influence with which to oppose these bureaucratic tendencies. At
all events, I shall not spare you my unauthoritative thoughts on
the subject. In my opinion a superabundance of regulations and
prohibitions injures the authority of the law. It can be observed
that where only a few prohibitions exist they are carefully
observed, but where one is accompanied by prohibitions at every
step, one feels definitely tempted to disregard them. Moreover, it
does not mean one is quite an anarchist if one is prepared to
realize that laws and regulations cannot from their origin claim to
possess the attribute of being sacred and untransgressable, that
they are often inadequately framed and offend our sense of justice,
or will do so after a time, and that, in view of the sluggishness
of the authorities, there is often no other means of correcting
such inexpedient laws than by boldly violating them. Furthermore,
if one desires to maintain respect for laws and regulations it is
advisable not to enact any where a watch cannot easily be kept on
whether they are obeyed or transgressed. Much of what I have quoted
above on the practice of analysis by doctors could be repeated here
in regard to genuine analysis by laymen which the law is seeking to
suppress. The course of an analysis is most inconspicuous, it
employs neither medicines nor instruments and consists only in
talking and an exchange of information; it will not be easy to
prove that a layman is practising ‘analysis’, if he
asserts that he is merely giving encouragement and explanations and
trying to establish a healthy human influence on people who are in
search of mental assistance. It would surely not be possible to
forbid that merely because doctors sometimes do the same thing. In
English-speaking countries the practices of Christian Science have
become very widespread: a kind of dialectical denial of the evils
in life, based on an appeal to the doctrines of the Christian
religion. I do not hesitate to assert that that procedure
represents a regrettable aberration of the human spirit; but who in
America or England would dream of forbidding it and making it
punishable? Are the authorities so certain of the right path to
salvation that they venture to prevent each man from trying
‘to be saved after his own fashion’. And granted that
many people if they are left to themselves run into danger and come
to grief, would not the authorities do better carefully to mark the
limits of the regions which are to be regarded as not to be
trespassed upon, and for the rest, so far as possible, to allow
human beings to be educated by experience and mutual influence?
Psycho-analysis is something so new in the world, the mass of
mankind is so little instructed about it, the attitude of official
science to it is still so vacillating, that it seems to me
over-hasty to intervene in its development with legislative
regulations. Let us allow patients themselves to discover that it
is damaging to them to look for mental assistance to people who
have not learnt how to give it. If we explain this to them and warn
them against it, we shall have spared ourselves the need to forbid
it. On the main roads of Italy the pylons that carry high-tension
cables bear the brief and impressive inscription: ‘
Chi
tocca, muore
.’ This is perfectly calculated to regulate
the behaviour of passers-by to any wires that may be hanging down.
The corresponding German notices exhibit an unnecessary and
offensive verbosity: ‘
Das Berühren der
Leitungsdrähte ist, weil lebensgefährlich, stregstens
verboten
.’ Why the prohibition? Anyone who holds his life
dear will make the prohibition for himself; and anyone who wants to
kill himself in that way will not ask for permission.

The Question Of Lay Analysis

4378

   ‘But there are instances
that can be quoted as legal precedents against allowing lay
analysis; I mean the prohibition against laymen practising
hypnotism and the recently enacted prohibition against holding
spiritualist seances or founding spiritualist societies.’

   I cannot say that I am an admirer
of these measures. The second one is a quite undisguised
encroachment of police supervision to the detriment of intellectual
freedom. I am beyond suspicion of having much belief in what are
known as ‘occult phenomena’ or of feeling any desire
that they should be recognized. But prohibitions like these will
not stifle people’s interest in that supposedly mysterious
world. They may on the contrary have done much harm and have closed
the door to an impartial curiosity which might have arrived at a
judgement that would have set us free from these harassing
possibilities. But once again this only applies to Austria. In
other countries ‘para-psychical’ researches are not met
by any legal obstacles. The case of hypnotism is somewhat different
from that of analysis. Hypnotism is the evoking of an abnormal
mental state and is used by laymen to-day only for the purpose of
public shows. If hypnotic therapy had maintained its very promising
beginnings, a position would have been arrived at similar to that
of analysis. And incidentally the history of hypnotism provides a
precedent for that of analysis in another direction. When I was a
young lecturer in neuropathology, the doctors inveighed
passionately against hypnotism, declared that it was a swindle, a
deception of the Devil’s and a highly dangerous procedure.
To-day they have monopolized this same hypnotism and they make use
of it unhesitatingly as a method of examination; for some nerve
specialists it is still their chief therapeutic instrument.