Letter to Georg fuchs 15 страница

We have heard how the weak and immature ego of the first period of childhood is permanently damaged by the stresses put upon it in its efforts to fend off the dangers that are peculiar to that period of life. Children are protected against the dangers that threaten them from the external world by the solicitude of their parents; they pay for this security by a fear of loss of love which would deliver them over helpless to the dangers of the external world. This factor exerts a decisive influence on the outcome of the conflict when a boy finds himself in the situation of the Oedipus complex, in which the threat to his narcissism by the danger of castration, reinforced from primaeval sources, takes possession of him. Driven by the combined operation of these two influences, the contemporary real danger and the remembered one with its phylogenetic basis, the child embarks on his attempts at defence - repressions - which are effective for the moment but nevertheless turn out to be psychologically inadequate when the later re-animation of sexual life brings a reinforcement to the instinctual demands which have been repudiated in the past. If this is so, it would have to be said from a biological standpoint that the ego comes to grief over the task of mastering the excitations of the early sexual period, at a time when its immaturity makes it incompetent to do so. It is in this lagging of ego development behind libidinal development that we see the essential precondition of neurosis; and we cannot escape the conclusion that neuroses could be avoided if the childish ego were spared this task - if, that is to say, the child’s sexual life were allowed free play, as happens among many primitive peoples. It may be that the aetiology of neurotic illnesses is more complicated than we have here described it; if so, we have at least brought out one essential part of the aetiological complex. Nor should we forget the phylogenetic influences, which are represented in some way in the id in forms that we are not yet able to grasp, and which must certainly act upon the ego more powerfully in that early period than later. On the other hand, the realization dawns on us that such an early attempt at damming up the sexual instinct, so decided a partisanship by the young ego in favour of the external as opposed to the internal world, brought about by the prohibition of infantile sexuality, cannot be without its effect on the individual’s later readiness for culture. The instinctual demands forced away from direct satisfaction are compelled to enter on new paths leading to substitutive satisfaction, and in the course of these détours they may become desexualized and their connection with their original instinctual aims may become looser. And at this point we may anticipate the thesis that many of the highly valued assets of our civilization were acquired at the cost of sexuality and by the restriction of sexual motive forces.

We have repeatedly had to insist on the fact that the ego owes its origin as well as the most important of its acquired characteristics to its relation to the real external world. We are thus prepared to assume that the ego’s pathological states, in which it most approximates once again to the id, are founded on a cessation or slackening of that relation to the external world. This tallies very well with what we learn from clinical experience - namely, that the precipitating cause of the outbreak of a psychosis is either that reality has become intolerably painful or that the instincts have become extraordinarily intensified - both of which, in view of the rival claims made on the ego by the id and the external world, must lead to the same result. The problem of psychoses would be simple and perspicuous if the ego’s detachment from reality could be carried through completely. But that seems to happen only rarely or perhaps never. Even in a state so far removed from the reality of the external world as one of hallucinatory confusion, one learns from patients after their recovery that at the time in some corner of their mind (as they put it) there was a normal person hidden, who, like a detached spectator, watched the hubbub of illness go past him. I do not know if we may assume that this is so in general, but I can report the same of other psychoses with a less tempestuous course. I call to mind a case of chronic paranoia in which after each attack of jealousy a dream conveyed to the analyst a correct picture of the precipitating cause, free from any delusion. An interesting contrast was thus brought to light: while we are accustomed to discover from the dreams of neurotics jealousies which are alien to their waking lives, in this psychotic case the delusion which dominated the patient in the day-time was corrected by his dream. We may probably take it as being generally true that what occurs in all these cases is a psychical split. Two psychical attitudes have been formed instead of a single one - one, the normal one, which takes account of reality, and another which under the influence of the instincts detaches the ego from reality. The two exist alongside of each other. The issue depends on their relative strength. If the second is or becomes the stronger, the necessary precondition for a psychosis is present. If the relation is reversed, then there is an apparent cure of the delusional disorder. Actually it has only retreated into the unconscious - just as numerous observations lead us to believe that the delusion existed ready-made for a long time before its manifest irruption.

The view which postulates that in all psychoses there is a splitting of the ego could not call for so much notice if it did not turn out to apply to other states more like the neuroses and, finally, to the neuroses themselves. I first became convinced of this in cases fetishism. This abnormality, which may be counted as one of the perversions, is, as is well known, based on the patient (who is almost always male) not recognizing the fact that females have no penis - a fact which is extremely undesirable to him since it is a proof of the possibility of his being castrated himself. He therefore disavows his own sense-perception which showed him that the female genitals lack a penis and holds fast to the contrary conviction. The disavowed perception does not, however, remain entirely without influence for, in spite of everything, he has not the courage to assert that he actually saw a penis. He takes hold of something else instead - a part of the body or some other object - and assigns it the role of the penis which he cannot do without. It is usually something that he in fact saw at the moment at which he saw the female genitals, or it is something that can suitably serve as a symbolic substitute for the penis. Now it would be incorrect to describe this process when a fetish is constructed as a splitting of the ego; it is a compromise formed with the help of displacement, such as we have been familiar with in dreams. But our observations show us still more. The creation of the fetish was due to an intention to destroy the evidence for the possibility of castration, so that fear of castration could be avoided. If females, like other living creatures, possess a penis, there is no need to tremble for the continued possession of one’s own penis. Now we come across fetishists who have developed the same fear of castration as non-fetishists and react in the same way to it. Their behaviour is therefore simultaneously expressing two contrary premisses. On the one hand they are disavowing the fact of their perception - the fact that they saw no penis in the female genitals; and on the other hand they are recognizing the fact that females have no penis and are drawing the correct conclusions from it. The two attitudes persist side by side throughout their lives without influencing each other. Here is what may rightly be called a splitting of the ego. This circumstance also enables us to understand how it is that fetishism is so often only partially developed. It does not govern the choice of object exclusively but leaves room for a greater or lesser amount of normal sexual behaviour; sometimes, indeed, it retires into playing a modest part or is limited to a mere hint. In festishists, therefore, the detachment of the ego from the reality of the external world has never succeeded completely.

It must not be thought that fetishism presents an exceptional case as regards a splitting of the ego; it is merely a particularly favourable subject for studying the question. Let us return to our thesis that the childish ego, under the domination of the real world, gets rid of undesirable instinctual demands by what are called repressions. We will now supplement this by further asserting that, during the same period of life, the ego often enough finds itself in the position of fending off some demand from the external world which it feels distressing and that this is effected by means of a disavowal of the perceptions which bring to knowledge this demand from reality. Disavowals of this kind occur very often and not only with fetishists; and whenever we are in a position to study them they turn out to be half-measures, incomplete attempts at detachment from reality. The disavowal is always supplemented by an acknowledgement; two contrary and independent attitudes always arise and result in the situation of there being a splitting of the ego. Once more the issue depends on which of the two can seize hold of the greater intensity.

The facts of this splitting of the ego, which we have just described, are neither so new nor so strange as they may at first appear. It is indeed a universal characteristic of neuroses that there are present in the subject’s mental life, as regards some particular behaviour, two different attitudes, contrary to each other and independent of each other. In the case of neuroses, however, one of these attitudes belongs to the ego and the contrary one, which is repressed, belongs to the id. The difference between this case and the other is essentially a topographical or structural one, and it is not always easy to decide in an individual instance with which of the two possibilities one is dealing. They have, however, the following important characteristic in common. Whatever the ego does in its efforts of defence, whether it seeks to disavow a portion of the real external world or whether it seeks to reject an instinctual demand from the internal world, its success is never complete and unqualified. The outcome always lies in two contrary attitudes, of which the defeated, weaker one, no less than the other, leads to psychical complications. In conclusion, it is only necessary to point out how little of all these processes becomes known to us through our conscious perception.

0 CHAPTER IXTHE INTERNAL WORLD

We have no way of conveying knowledge of a complicated set of simultaneous events except by describing them successively; and thus it happens that all our accounts are at fault to begin with owing to one-sided simplification and must wait till they can be supplemented, built on to, and so set right.

The picture of an ego which mediates between the id and the external world, which takes over the instinctual demands of the former in order to lead them to satisfaction, which derives perceptions from the latter and uses them as memories, which, intent on its self-preservation, puts itself in defence against excessively strong claims from both sides and which, at the same time, is guided in all its decisions by the injunctions of a modified pleasure principle - this picture in fact applies to the ego only up to the end of the first period of childhood, till about the age of five. At about that time an important change has taken place. A portion of the external world has, at least partially, been abandoned as an object and has instead, by identification, been taken into the ego and thus become an integral part of the internal world. This new psychical agency continues to carry on the functions which have hitherto been performed by the people in the external world: it observes the ego, gives it orders, judges it and threatens it with punishments, exactly like the parents whose place it has taken. We call this agency the super-ego and are aware of it in its judicial functions as our conscience. It is a remarkable thing that the super-ego often displays a severity for which no model has been provided by the real parents, and moreover that it calls the ego to account not only for its deeds but equally for its thoughts and unexecuted intentions, of which the super-ego seems to have knowledge. This reminds us that the hero of the Oedipus legend too felt guilty for his deeds and submitted himself to self-punishment, although the coercive power of the oracle should have acquitted him of guilt in our judgement and his own. The super-ego is in fact the heir to the Oedipus complex and is only established after that complex has been disposed of. For that reason its excessive severity does not follow a real model but corresponds to the strength of the defence used against the temptation of the Oedipus complex. Some suspicion of this state of things lies, no doubt, at the bottom of the assertion made by philosophers and believers that the moral sense is not instilled into men by education or acquired by them in their social life but is implanted in them from a higher source.

So long as the ego works in full harmony with the super-ego it is not easy to distinguish between their manifestations; but tensions and estrangements between them make themselves very plainly visible. The torments caused by the reproaches of conscience correspond precisely to a child’s fear of loss of love, a fear the place of which has been taken by the moral agency. On the other hand, if the ego has successfully resisted a temptation to do something which would be objectionable to the super-ego, it feels raised in its self-esteem and strengthened in its pride, as though it had made some precious acquisition. In this way the super-ego continues to play the part of an external world for the ego, although it has become a portion of the internal world. Throughout later life it represents the influence of a person’s childhood, of the care and education given him by his parents and of his dependence on them - a childhood which is prolonged so greatly in human beings by a family life in common. And in all this it is not only the personal qualities of these parents that is making itself felt, but also everything that had a determining effect on them themselves, the tastes and standards of the social class in which they lived and the innate dispositions and traditions of the race from which they sprang. Those who have a liking for generalizations and sharp distinctions may say that the external world, in which the individual finds himself exposed after being detached from his parents, represents the power of the present; that his id, with its inherited trends, represents the organic past; and that the super-ego, which comes to join them later, represents more than anything the cultural past, which a child has, as it were, to repeat as an after-experience during the few years of his early life. It is unlikely that such generalizations can be universally correct. Some portion of the cultural acquisitions have undoubtedly left a precipitate behind them in the id; much of what is contributed by the super-ego will awaken an echo in the id; not a few of the child’s new experiences will be intensified because they are repetitions of some primaeval phylogenetic experience.

‘Was du ererbt von deinen Vätern hast,

Erwirb es, um es zu besitzen.’¹

Thus the super-ego takes up a kind of intermediate position between the id and the external world; it unites in itself the influences of the present and the past. In the establishment of the super-ego we have before us, as it were, an example of the way in which the present is changed into the past....

* * * * *

¹ [‘What thou hast inherited from thy fathers, acquire it to make it thine’]2

ANALYSIS TERMINABLE AND INTERMINABLE (1937)

Experience has taught us that psycho-analytic therapy - the freeing of someone from his neurotic symptoms, inhibitions and abnormalities of character - is a time-consuming business. Hence, from the very first, attempts have been made to shorten the duration of analyses. Such endeavours required no justification; they could claim to be based on the strongest considerations of reason and expediency. But there was probably still at work in them as well some trace of the impatient contempt with which the medical science of an earlier day regarded the neuroses as being uncalled-for consequences of invisible injuries. If it had now become necessary to attend to them, they should at least be disposed of as quickly as possible.

A particularly energetic attempt in this direction was made by Otto Rank, following upon his book, The Trauma of Birth (1924). He supposed that the true source of neurosis was the act of birth, since this involves the possibility of a child’s ‘primal fixation’ to his mother not being surmounted but persisting as a ‘primal repression’. Rank hoped that if this primal trauma were dealt with by a subsequent analysis the whole neurosis would be got rid of. Thus this one small piece of analytic work would save the necessity for all the rest. And a few months should be enough to accomplish this. It cannot be disputed that Rank’s argument was bold and ingenious; but it did not stand the test of critical examination. Moreover, it was a child of its time, conceived under the stress of the contrast between the post-war misery of Europe and the ‘prosperity’ of America, and designed to adapt the tempo of analytic therapy to the haste of American life. We have not heard much about what the implementation of Rank’s plan has done for cases of sickness. Probably not more than if the fire-brigade, called to deal with a house that had been set on fire by an overturned oil-lamp, contented themselves with removing the lamp from the room in which the blaze had started. No doubt a considerable shortening of the brigade’s activities would be effected by this means. The theory and practice of Rank’s experiment are now things of the past - no less than American ‘prosperity’ itself.

I myself had adopted another way of speeding up an analytic treatment even before the war. At that time I had taken on the case of a young Russian, a man spoilt by wealth, who had come to Vienna in a state of complete helplessness, accompanied by a private doctor and an attendant.¹ In the course of a few years it was possible to give him back a large amount of his independence, to awaken his interest in life and to adjust his relations to the people most important to him. But there progress came to a stop. We advanced no further in clearing up the neurosis of his childhood, on which his later illness was based, and it was obvious that the patient found his present position highly comfortable and had no wish to take any step forward which would bring him nearer to the end of his treatment. It was a case of the treatment inhibiting itself: it was in danger of failing as a result of its - partial - success. In this predicament I resorted to the heroic measure of fixing a time limit for the analysis. At the beginning of a year’s work I informed the patient that the coming year was to be the last one of his treatment, no matter what he achieved in the time still left to him. At first he did not believe me, but once he was convinced that I was in deadly earnest, the desired change set in. His resistances shrank up, and in these last months of his treatment he was able to reproduce all the memories and to discover all the connections which seemed necessary for understanding his early neurosis and mastering his present one. When he left me in the midsummer of 1914, with as little suspicion as the rest of us of what lay so shortly ahead, I believed that his cure was radical and permanent.

¹ See my paper published with the patient’s consent, ‘From the History of an Infantile Neurosis’ (1918b). It contains no detailed account of the young man’s adult illness, which is touched on only when its connection with his infantile neurosis absolutely requires it.6

In a footnote added to this patient’s case history in 1923, I have already reported that I was mistaken. When, towards the end of the war, he returned to Vienna, a refugee and destitute, I had to help him to master a part of the transference which had not been resolved. This was accomplished in a few months, and I was able to end my footnote with the statement that ‘since then the patient has felt normal and has behaved unexceptionably, in spite of the war having robbed him of his home, his possessions, and all his family relationships’. Fifteen years have passed since then without disproving the truth of this verdict; but certain reservations have become necessary. The patient has stayed on in Vienna and has kept a place in society, if a humble one. But several times during this period his good state of health has been interrupted by attacks of illness which could only be construed as offshoots of his perennial neurosis. Thanks to the skill of one of my pupils, Dr. Ruth Mack Brunswick, a short course of treatment has on each occasion brought these conditions to an end. I hope that Dr. Mack Brunswick herself will shortly report on the circumstances. Some of these attacks were still concerned with residual portions of the transference; and, where this was so, short-lived though they were, they showed a distinctly paranoid character. In other attacks, however, the pathogenic material consisted of pieces of the patient’s childhood history, which had not come to light while I was analysing him and which now came away - the comparison is unavoidable - like sutures after an operation, or small fragments of necrotic bone. I have found the history of this patient’s recovery scarcely less interesting than that of his illness.

I have subsequently employed this fixing of a time-limit in other cases as well, and I have also taken the experiences of other analysts into account. There can be only one verdict about the value of this blackmailing device: it is effective provided that one hits the right time for it. But it cannot guarantee to accomplish the task completely. On the contrary, we may be sure that, while part of the material will become accessible under the pressure of the threat, another part will be kept back and thus become buried, as it were, and lost to our therapeutic efforts. For once the analyst has fixed the time-limit he cannot extend it; otherwise the patient would lose all faith in him. The most obvious way out would be for the patient to continue his treatment with another analyst, although we know that such a change will involve a fresh loss of time and abandoning fruits of work already done. Nor can any general rule be laid down as to the right time for resorting to this forcible technical device; the decision must be left to the analyst’s tact. A miscalculation cannot be rectified. The saying that a lion only springs once must apply here.

7 II

The discussion of the technical problem of how to accelerate the slow progress of an analysis leads us to another, more deeply interesting question: is there such a thing as a natural end to an analysis - is there any possibility at all of bringing an analysis to such an end? To judge by the common talk of analysts it would seem to be so, for we often hear them say, when they are deploring or excusing the recognized imperfections of some fellow-mortal: ‘His analysis was not finished’ or ‘he was never analysed to the end.’

We must first of all decide what is meant by the ambiguous phrase ‘the end of an analysis’. From a practical standpoint it is easy to answer. An analysis is ended when the analyst and the patient cease to meet each other for the analytic session. This happens when two conditions have been approximately fulfilled: first, that the patient shall no longer be suffering from his symptoms and shall have overcome his anxieties and his inhibitions; and secondly, that the analyst shall judge that so much repressed material has been made conscious, so much that was unintelligible has been explained, and so much internal resistance conquered, that there is no need to fear a repetition of the pathological processes concerned. If one is prevented by external difficulties from reaching this goal, it is better to speak of an incomplete analysis rather than of an unfinished one.

The other meaning of the ‘end’ of an analysis is much more ambitious. In this sense of it, what we are asking is whether the analyst has had such a far-reaching influence on the patient that no further change could be expected to take place in him if his analysis were continued. It is as though it were possible by means of analysis to attain to a level of absolute psychical normality - a level, moreover, which we could feel confident would be able to remain stable, as though, perhaps, we had succeeded in resolving every one of the patient’s repressions and in filling in all the gaps in his memory. We may first consult our experience to enquire whether such things do in fact happen, and then turn to our theory to discover whether there is any possibility of their happening.

Every analyst will have treated a few cases which have had this gratifying outcome. He has succeeded in clearing up the patient’s neurotic disturbance, and it has not returned and has not been replaced by any other such disturbance. Nor are we without some insight into the determinants of these successes. The patient’s ego had not been noticeably altered and the aetiology of his disturbance had been essentially traumatic. The aetiology of every neurotic disturbance is, after all, a mixed one. It is a question either of the instincts being excessively strong - that is to say, recalcitrant to taming by the ego - or of the effects of early (i.e. premature) traumas which the immature ego was unable to master. As a rule there is a combination of both factors, the constitutional and the accidental. The stronger the constitutional factor, the more readily will a trauma lead to a fixation and leave behind a developmental disturbance; the stronger the trauma, the more certainly will its injurious effects become manifest even when the instinctual situation is normal. There is no doubt that an aetiology of the traumatic sort offers by far the more favourable field for analysis. Only when a case is a predominantly traumatic one will analysis succeed in doing what it is so superlatively able to do; only then will it, thanks to having strengthened the patient’s ego, succeed in replacing by a correct solution the inadequate decision made in his early life. Only in such cases can one speak of an analysis having been definitively ended. In them, analysis has done all that it should and does not need to be continued. It is true that, if the patient who has been restored in this way never produces another disorder calling for analysis, we do not know how much his immunity may not be due to a kind fate which has spared him ordeals that are too severe.

A constitutional strength of instinct and an unfavourable alteration of the ego acquired in its defensive struggle in the sense of its being dislocated and restricted - these are the factors which are prejudicial to the effectiveness of analysis and which may make its duration interminable. One is tempted to make the first factor - strength of instinct - responsible as well for the emergence of the second - the alteration of the ego; but it seems that the latter too has an aetiology of its own. And, indeed, it must be admitted that our knowledge of these matters is as yet insufficient. They are only now becoming the subject of analytic study. In this field the interest of analysts seems to me to be quite wrongly directed. Instead of an enquiry into how a cure by analysis comes about (a matter which I think has been sufficiently elucidated) the question should be asked of what are the obstacles that stand in the way of such a cure.

This brings me to two problems which arise directly out of analytic practice, as I hope to show by the following examples. A certain man, who had himself practised analysis with great success, came to the conclusion that his relations both to men and women - to the men who were his competitors and to the woman whom he loved - were nevertheless not free from neurotic impediments; and he therefore made himself the subject of an analysis by someone else whom he regarded as superior to himself. This critical illumination of his own self had a completely successful result. He married the woman he loved and turned into a friend and teacher of his supposed rivals. Many years passed in this way, during which his relations with his former analyst also remained unclouded. But then, for no assignable external reason, trouble arose. The man who had been analysed became antagonistic to the analyst and reproached him for having failed to give him a complete analysis. The analyst, he said, ought to have known and to have taken into account the fact that a transference-relation can never be purely positive; he should have given his attention to the possibilities of a negative transference. The analyst defended himself by saying that, at the time of the analysis, there was no sign of a negative transference. But even if he had failed to observe some very faint signs of it - which was not altogether ruled out, considering the limited horizon of analysis in those early days - it was still doubtful, he thought, whether he would have had the power to activate a topic (or, as we say, a ‘complex’) by merely pointing it out, so long as it was not currently active in the patient himself at the time. To activate it would certainly have required some unfriendly piece of behaviour in reality on the analyst’s part. Furthermore, he added, not every good relation between an analyst and his subject during and after analysis was to be regarded as a transference; there were also friendly relations which were based on reality and which proved to be viable.

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