Recommendations to physicians practising psycho-analysis 7 страница

ON PSYCHO-ANALYSIS (1913 [1911])

In response to a friendly request by the Secretary of your Section of Neurology and Psychiatry, I venture to draw the attention of this Congress to the subject of psycho-analysis, which is being extensively studied at the present time in Europe and America.

Psycho-analysis is a remarkable combination, for it comprises not only a method of research into the neuroses but also a method of treatment based on the aetiology thus discovered. I may begin by saying that psycho-analysis is not a child of speculation, but the outcome of experience; and for that reason, like every new product of science, is unfinished. It is open to anyone to convince himself by his own investigations of the correctness of the theses embodied in it, and to help in the further development of the study.

Psycho-analysis started with researches into hysteria, but in the course of years it has extended far beyond that field of work. The Studies on Hysteria by Breuer and myself, published in 1895, were the beginnings of psycho-analysis. They followed in the track of Charcot’s work on ‘traumatic’ hysteria, Liébeault’s and Bernheim’s investigations of the phenomena of hypnosis, and Janet’s studies of unconscious mental processes. Psycho-analysis soon found itself in sharp opposition to Janet’s views, because (a) it declined to trace back hysteria directly to congenital hereditary degeneracy, (b) it offered, instead of a mere description, a dynamic explanation based on the interplay of psychical forces and (c) it ascribed the origin of psychical dissociation (whose importance had been recognized by Janet as well) not to a failure of mental synthesis resulting from a congenital disability, but to a special psychical process known as ‘repression’ (‘Verdrängung’).

It was conclusively proved that hysterical symptoms are residues (reminiscences) of profoundly moving experiences, which have been withdrawn from everyday consciousness, and that their form is determined (in a manner that excludes deliberate action) by details of the traumatic effects of the experiences. On this view, the therapeutic prospects lie in the possibility of getting rid of this ‘repression’, so as to allow part of the unconscious psychical material to become conscious and thus to deprive it of its pathogenic power. This view is a dynamic one, in so far as it regards psychical processes as displacements of psychical energy which can be gauged by the amount of their effect on the affective elements. This is most significant in hysteria, where the process of ‘conversion’ creates the symptoms by transforming a quantity of mental impulses into somatic innervations.

The first psycho-analytic examinations and attempts at treatment were made with the help of hypnotism. Afterwards this was abandoned and the work was carried out by the method of ‘free association’, with the patient remaining in his normal state. This modification had the advantage of enabling the procedure to be applied to a far larger number of cases of hysteria, as well as to other neuroses and also to healthy people. The development of a special technique of interpretation became necessary, however, in order to draw conclusions from the expressed ideas of the person under investigation. These interpretations established with complete certainty the fact that psychical dissociations are maintained entirely by ‘internal resistances’. The conclusion seems justified, therefore, that the dissociations have originated owing to internal conflict, which has led to the ‘repression’ of the underlying impulse. To overcome this conflict and in that way to cure the neurosis, the guiding hand of a doctor trained in psycho-analysis is required.

Furthermore, it has been shown to be true quite generally that in all neuroses the pathological symptoms are really the end-products of such conflicts, which have led to ‘repression’ and ‘splitting’ of the mind. The symptoms are generated by different mechanisms: (a) either as formations in substitution for the repressed forces, or (b) as compromises between the repressing and repressed forces, or (c) as reaction-formations and safeguards against the repressed forces.

Researches were further extended to the conditions which determine whether or not psychical conflicts will lead to ‘repression’ (that is, to dissociation dynamically caused), since it goes without saying that a psychical conflict, per se, may also have a normal outcome. The conclusion arrived at by psycho-analysis was that such conflicts were always between the sexual instincts (using the word ‘sexual’ in the widest sense) and the wishes and trends of the remainder of the ego. In neuroses it is the sexual instincts that succumb to ‘repression’ and so constitute the most important basis for the genesis of symptoms, which may accordingly be regarded as substitutes for sexual satisfactions.

Our work on the question of the disposition to neurotic affections has added the ‘infantile’ factor to the somatic and hereditary ones hitherto recognized. Psycho-analysis was obliged to trace back patients’ mental life to their early infancy, and the conclusion was reached that inhibitions of mental development (‘infantilisms’) present a disposition to neurosis. In particular, we have learnt from our investigations of sexual life that there really is such a thing as ‘infantile sexuality’, that the sexual instinct is made up of many components and passes through a complicated course of development, the final outcome of which, after many restrictions and transformations, is the ‘normal’ sexuality of adults. The puzzling perversions of the sexual instinct which occur in adults appear to be either inhibitions of development, fixations or lop-sided growths. Thus neuroses are the negative of perversions.

The cultural development imposed on mankind is the factor which necessitates the restrictions and repressions of the sexual instinct, greater or lesser sacrifices being demanded according to the individual constitution. Development is hardly ever achieved smoothly, and disturbances may occur (whether on account of the individual constitution or of premature sexual incidents) leaving behind a disposition to future neuroses. Such dispositions may remain harmless if the adult’s life proceeds satisfactorily and quietly; but they become pathogenic if the conditions of mature life forbid satisfaction of the libido or make too high demands on its suppression.

Researches into the sexual activity of children have led to a further conception of the sexual instinct, based not on its purposes but on its sources. The sexual instinct possesses in a high degree the capacity for being diverted from direct sexual aims and for being directed towards higher aims which are no longer sexual (‘sublimation’). The instinct is thus enabled to make most important contributions to the social and artistic achievements of humanity.8

Recognition of the simultaneous presence of the three factors of ‘infantilism’, ‘sexuality’ and ‘repression’ constitutes the main characteristic of the psycho-analytic theory, and marks its distinction from other views of pathological mental life. At the same time, psycho-analysis has demonstrated that there is no fundamental difference, but only one of degree, between the mental life of normal people, of neurotics and of psychotics. A normal person has to pass through the same repressions and has to struggle with the same substitutive structures; the only difference is that he deals with these events with less trouble and better success. The psycho-analytic method of investigation can accordingly be applied equally to the explanation of normal psychical phenomena, and has made it possible to discover the close relationship between pathological psychical products and normal structures such as dreams, the small blunders of everyday life, and such valuable phenomena as jokes, myths and imaginative works. The explanation of these has been carried furthest in the case of dreams, and has resulted here in the following general formula: ‘A dream is a disguised fulfilment of a repressed wish.’ The interpretation of dreams has as its object the removal of the disguise to which the dreamer’s thoughts have been subjected. It is, moreover, a highly valuable aid to psycho-analytic technique, for it constitutes the most convenient method of obtaining insight into unconscious psychical life.

There is often a tendency in medical and especially in psychiatric circles to contradict the theories of psycho-analysis without any real study or practical application of them. This is due not only to the striking novelty of these theories and the contrast they present to the views hitherto held by psychiatrists, but also to the fact that the premisses and technique of psycho-analysis are much more nearly related to the field of psychology than to that of medicine. It cannot be disputed, however, that purely medical and non-psychological teachings have hitherto done very little towards an understanding of mental life. The progress of psycho-analysis is further retarded by the dread felt by the average observer of seeing himself in his own mirror. Men of science tend to meet emotional resistances with arguments, and thus satisfy themselves to their own satisfaction! Whoever wishes not to ignore a truth will do well to distrust his antipathies, and, if he wishes to submit the theory of psycho-analysis to a critical examination, let him first analyse himself.

9 I cannot think that in these few sentences I have succeeded in painting a clear picture of the principles and purposes of psycho-analysis. But I will add a list of the chief publications on the subject, a study of which will give further enlightenment to any whom I may have interested.

1. Breuer and Freud, Studies on Hysteria, 1895. Fr. Deuticke, Vienna.

A portion of the above has been translated into English in ‘Selected Papers on Hysteria and other Psycho-neuroses’, by Dr. A. A. Brill, New York, 1909.

2. Freud, Drei Abhandlungen zur Sexualtheorie, Vienna, 1905.

English translation by Dr. Brill, ‘Three Contributions to the Sexual Theory’, New York, 1910.

3. Freud, Zur Psychopathologie des Alltagslebens, S. Karger, Berlin. 3rd edition, 1910.

4. Freud, Die Traumdeutung, Vienna, 1900. 3rd ed., 1911.

5. Freud, ‘The Origin and Development of Psycho-analysis’,

Amer. Jour. of Psychology, April, 1910. Also in German:

Ueber Psychoanalyse. Five Lectures given at the Clark University, Worcester, Mass, 1909.

6. Freud, Der Witz und seine Beziehung zum Unbewussten, Vienna, 1905.

7. Freud, Collection of minor papers on the Doctrine of Neuroses,

3-1906. Vienna,1906.

8. Idem. A second collection. Vienna, 1909.

9. Hitschmann, Freud’s Neurosenlehre, Vienna, 1911.

10. C. G. Jung, Diagnostische Associationsstudien. Two volumes, 1906-1910.

11. C. G. Jung, Über die psychologie der Dementia Praecox, 1907.

12. Jahrbuch für psycho-analytische und psychopathologische Forschungen,

published by E. Bleuler and S. Freud, edited by Jung. Since 1909.

13. Schriften zur angewandten Seelenkunde. Fr. Deuticke, Vienna.

Since 1907. Eleven parts, by Freud, Jung, Abraham, Pfister, Rank, Jones, Riklin, Graf, Sadger.

14. Zentralblatt für Psychoanalyse.

Edited by A. Adler and W Stekel. J. Bergmann, Wiesbaden. Since Sept., 1910.

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