Freud - Complete Works (713 page)

   ‘I now understand your
attitude to lay analysis quite clearly. You are determined that
there must be lay analysts. And since you cannot dispute their
inadequacy for their task, you are scraping together everything you
can to excuse them and make their existence easier. But I cannot in
the least see why there should be lay analysts, who, after all, can
only be therapists of the second class. I am ready, so far as I am
concerned, to make an exception in the case of the few laymen who
have already been trained as analysts; but no fresh ones should be
created and the training institutes should be put under an
obligation to take no more laymen into training.’

   I am at one with you, if it can
be shown that all the interests involved will be served by this
restriction. You will agree that these interests are of three
sorts: that of the patients, that of the doctors and - last not
least - that of science, which indeed comprises the interests of
all future patients. Shall we examine these three points
together?

   For the patient, then, it is a
matter of indifference whether the analyst is a doctor or not,
provided only that the danger of his condition being misunderstood
is excluded by the necessary medical report before the treatment
begins and on some possible occasions during the course of it. For
him it is incomparably more important that the analyst should
possess personal qualities that make him trustworthy, and that he
should have acquired the knowledge and understanding as well as the
experience which alone can make it possible for him to fulfil his
task. It might be thought that it would damage an analyst’s
authority if the patient knows that he is not a doctor and cannot
in some situations do without a doctor’s support. We have, of
course, never omitted to inform patients of their analyst’s
qualification, and we have been able to convince ourselves that
professional prejudices find no echo in them and that they are
ready to accept a cure from whatever direction it is offered them -
which, incidentally, the medical profession discovered long ago to
its deep mortification. Nor are the lay analysts who practise
analysis to-day any chance collection of riff-raff, but people of
academic education, doctors of philosophy, educationalists,
together with a few women of great experience in life and
outstanding personality. The analysis, to which all the candidates
in an analytic training institute have to submit, is at the same
time the best means of forming an opinion of their personal
aptitude for carrying out their exacting occupation.

The Question Of Lay Analysis

4386

   Now as to the interest of the
doctors. I cannot think that it would gain by the incorporation of
psycho-analysis into medicine. The medical curriculum already lasts
for five years and the final examinations extend well into a sixth
year. Every few years fresh demands are made on the student,
without the fulfilment of which his equipment for the future would
have to be declared insufficient. Access to the medical profession
is very difficult and its practice neither very satisfying nor very
remunerative. If one supports what is certainly a fully justified
demand that doctors should also be familiar with the mental side of
illness, and if on that account one extends medical education to
include some preparation for analysis, that implies a further
increase in the curriculum and a corresponding prolongation of the
period of study. I do not know whether the doctors will be pleased
by this consequence of their claim upon analysis. But it can
scarcely be escaped. And this at a period in which the conditions
of material existence have so greatly deteriorated for the classes
from which doctors are recruited, a period in which the younger
generation sees itself compelled to make itself self-supporting as
early in life as possible.

   But perhaps you will choose not
to burden medical studies with the preparation for analytic
practice but think it more expedient for future analysts to take up
their necessary training only after the end of their medical
studies. You may say the loss of time involved in this is of no
practical account, since after all a young man of less than thirty
will never enjoy his patients’ confidence, which is a
sine
qua non
of giving mental assistance. It might no doubt be said
in reply that a newly-fledged physician for physical illnesses
cannot count upon being treated by his patients with very great
respect either, and that a young analyst might very well fill in
his time by working in a psycho-analytic out-patient clinic under
the supervision of experienced practitioners.

The Question Of Lay Analysis

4387

   But what seems to me more
important is that with this proposal of yours you are giving
support to a waste of energy for which, in these difficult times, I
can really find no economic justification. Analytic training, it is
true, cuts across the field of medical education, but neither
includes the other. If - which may sound fantastic to-day - one had
to found a college of psycho-analysis, much would have to be taught
in it which is also taught by the medical faculty: alongside of
depth-psychology, which would always remain the principal subject,
there would be an introduction to biology, as much as possible of
the science of sexual life, and familiarity with the symptomatology
of psychiatry. On the other hand, analytic instruction would
include branches of knowledge which are remote from medicine and
which the doctor does not come across in his practice: the history
of civilization, mythology, the psychology of religion and the
science of literature. Unless he is well at home in these subjects,
an analyst can make nothing of a large amount of his material. By
way of compensation, the great mass of what is taught in medical
schools is of no use to him for his purposes. A knowledge of the
anatomy of the tarsal bones, of the constitution of the
carbohydrates, of the course of the cranial nerves, a grasp of all
that medicine has brought to light on bacillary exciting causes of
disease and the means of combating them, on serum reactions and on
neoplasms - all of this knowledge, which is undoubtedly of the
highest value in itself, is nevertheless of no consequence to him;
it does not concern him; it neither helps him directly to
understand a neurosis and to cure it nor does it contribute to a
sharpening of those intellectual capacities on which his occupation
makes the greatest demands. It cannot be objected that the case is
much the same when a doctor takes up some other special branch of
medicine - dentistry, for instance: in that case, too, he may not
need some of what he has to pass examinations in, and he will have
to learn much in addition, for which his schooling has not prepared
him. But the two cases cannot be put on a par. In dentistry the
great principles of pathology - the theories of inflammation,
suppuration, necrosis, and of the metabolism of the bodily organs -
still retain their importance. But the experience of an analyst
lies in another world, with other phenomena and other laws. However
much philosophy may ignore the gulf between the physical and the
mental, it still exists for our immediate experience and still more
for our practical endeavours.

The Question Of Lay Analysis

4388

   It is unjust and inexpedient to
try to compel a person who wants to set someone else free from the
torment of a phobia or an obsession to take the roundabout road of
the medical curriculum. Nor will such an endeavour have any
success, unless it results in suppressing analysis entirely.
Imagine a landscape in which two paths lead to a hilltop with a
view - one short and straight, the other long, winding and
circuitous. You try to stop up the short path by a prohibitory
notice, perhaps because it passes by some flower-beds that you want
to protect. The only chance you have of your prohibition being
respected is if the short path is steep and difficult while the
longer one leads gently up. If, however, that is not so, and the
roundabout path is on the contrary the harder, you may imagine the
use of your prohibition and the fate of your flower-beds! I fear
you will succeed in compelling the laymen to study medicine just as
little as I shall be able to induce doctors to learn analysis. For
you know human nature as well as I do.

   ‘If you are right, that
analytic treatment cannot be carried out without special training,
but that the medical curriculum cannot bear the further burden of a
preparation for it, and that medical knowledge is to a great extent
unnecessary for an analyst, how shall we achieve the ideal
physician who shall be equal to all the tasks of his
calling?’

   I cannot foresee the way out of
these difficulties, nor is it my business to point it out. I see
only two things, first that analysis is an embarrassment to you and
that the best thing would be for it not to exist - though
neurotics, no doubt, are an embarrassment too; and secondly, that
the interests of everyone concerned would for the time being be met
if the doctors could make up their minds to tolerate a class of
therapists which would relieve them of the tedium of treating the
enormously common psychogenic neuroses while remaining in constant
touch with them to the benefit of the patients.

The Question Of Lay Analysis

4389

   ‘Is that your last word on
the subject? or have you something more to say?’

   Yes indeed. I wanted to bring up
a third interest - the interest of science. What I have to say
about that will concern you little; but, by comparison, it is of
all the more importance to me.

   For we do not consider it at all
desirable for psycho-analysis to be swallowed up by medicine and to
find its last resting-place in a text-book of psychiatry under the
heading ‘Methods of Treatment’, alongside of procedures
such as hypnotic suggestion, autosuggestion, and persuasion, which,
born from our ignorance, have to thank the laziness and cowardice
of mankind for their short-lived effects. It deserves a better fate
and, it may be hoped, will meet with one. As a
‘depth-psychology’, a theory of the mental unconscious,
it can become indispensable to all the sciences which are concerned
with the evolution of human civilization and its major institutions
such as art, religion and the social order. It has already, in my
opinion, afforded these sciences considerable help in solving their
problems. But these are only small contributions compared with what
might be achieved if historians of civilization, psychologists of
religion, philologists and so on would agree themselves to handle
the new instrument of research which is at their service. The use
of analysis for the treatment of the neuroses is only one of its
applications; the future will perhaps show that it is not the most
important one. In any case it would be wrong to sacrifice all the
other applications to this single one, just because it touches on
the circle of medical interests.

   For here a further prospect
stretches ahead, which cannot be encroached upon with impunity. If
the representatives of the various mental sciences are to study
psycho-analysis so as to be able to apply its methods and angles of
approach to their own material, it will not be enough for them to
stop short at the findings which are laid down in analytic
literature. They must learn to understand analysis in the only way
that is possible - by themselves undergoing an analysis. The
neurotics who need analysis would thus be joined by a second class
of persons, who accept analysis from intellectual motives, but who
will no doubt also welcome the increase in their capacities which
they will incidentally achieve. To carry out these analyses a
number of analysts will be needed, for whom any medical knowledge
will have particularly little importance. But these ‘teaching
analysts’ - let us call them - will require to have had a
particularly careful education. If this is not to be stunted, they
must be given an opportunity of collecting experience from
instructive and informative cases; and since healthy people who
also lack the motive of curiosity do not present themselves for
analysis, it is once more only upon neurotics that it will be
possible for the teaching analysts - under careful supervision - to
be educated for their subsequent non-medical activity. All this,
however, requires a certain amount of freedom of movement, and is
not compatible with petty restrictions.

The Question Of Lay Analysis

4390

   Perhaps you do not believe in
these purely theoretical interests of psycho-analysis or cannot
allow them to affect the practical question of lay analysis. Then
let me advise you that psycho-analysis has yet another sphere of
application, which is outside the scope of the quackery law and to
which the doctors will scarcely lay claim. Its application, I mean,
to the bringing-up of children. If a child begins to show signs of
an undesirable development, if it grows moody, refractory and
inattentive, the paediatrician and even the school doctor can do
nothing for it, even if the child produces clear neurotic symptoms,
such as nervousness, loss of appetite, vomiting or insomnia. A
treatment that combines analytic influence with educational
measures, carried out by people who are not ashamed to concern
themselves with the affairs in a child’s world, and who
understand how to find their way into a child’s mental life,
can bring about two things at once: the removal of the neurotic
symptoms and the reversal of the change in character which had
begun. Our recognition of the importance of these inconspicuous
neuroses of children as laying down the disposition for serious
illnesses in later life points to these child analyses as an
excellent method of prophylaxis. Analysis undeniably still has its
enemies. I do not know whether they have means at their command for
stopping the activities of these educational analysts or analytic
educationalists. I do not think it very likely; but one can never
feel too secure.