PARAPRAXES 30 страница

But what about the cases in which the persecutor is not of the same sex as the patient and which appear, therefore, to contradict our explanation of their being a defence against homosexual libido? A little time ago I had an opportunity of examining such a case and was able to derive a confirmation from the apparent contradiction. A girl, who believed she was being persecuted by a man with whom she had had affectionate assignations on two occasions, had in fact first had a delusion that was directed against a woman who could be looked on as a substitute for her mother. It was only after her second assignation that she took the step of detaching the delusion from the woman and transferring it to the man. To begin with, therefore, the precondition of the persecutor being of the same sex as the patient was fulfilled in this case too. In making a complaint to a lawyer and to a doctor, the patient made no mention of this preliminary stage of her delusion and thus gave rise to an appearance of there being a contradiction of our explanation of paranoia.

Homosexual object-choice originally lies closer to narcissism than does the heterosexual kind. When it is a question, therefore, of repelling an undesirably strong homosexual impulse, the path back to narcissism is made particularly easy. Hitherto I have had very little opportunity of talking to you about the foundations of erotic life so far as we have discovered them, and it is too late now to catch up on the omission. This much, however, I can emphasize to you. Object-choice, the step forward in the development of the libido which is made after the narcissistic stage, can take place according to two different types: either according to the narcissistic type, where the subject’s own ego is replaced by another one that is as similar as possible, or according to the attachment type, where people who have become precious through satisfying the other vital needs are chosen as objects by the libido as well. A strong libidinal fixation to the narcissistic type of object-choice is to be included in the predisposition to manifest homosexuality.

You will recall that at our first meeting of the present academic year I described a case to you of a woman suffering from delusions of jealousy. Now that we are so near its end you would no doubt like to hear how delusions are explained by psycho-analysis. But I have less to tell you about that than you expect. The fact that a delusion cannot be shaken by logical arguments or real experiences is explained in the same way as in the case of an obsession - by its relation to the unconscious, which is represented and held down by the delusion or by the obsession. The difference between the two is based on the difference between the topography and dynamics of the two illnesses.

As with paranoia, so also with melancholia (of which, incidentally, many different clinical forms have been described) we have found a point at which it has become possible to obtain some insight into the internal structure of the disease. We have discovered that the self-reproaches, with which these melancholic patients torment themselves in the most merciless fashion, in fact apply to another person, the sexual object which they have lost or which has become valueless to them through its own fault. From this we can conclude that the melancholic has, it is true, withdrawn his libido from the object, but that, by a process which we must call ‘narcissistic identification’, the object has been set up in the ego itself, has been as it were, projected on to the ego. (Here I can only give you a pictorial description and not an ordered account on topographical and dynamic lines.) The subject’s own ego is then treated like the object that has been abandoned, and it is subjected to all the acts of aggression and expressions of vengefulness which have been aimed at the object. A melancholic’s propensity to suicide is also made more intelligible if we consider that the patient’s embitterment strikes with a single blow at his own ego and at the loved and hated object. In melancholia, as well as in other narcissistic disorders, a particular trait in the patient’s emotional life emerges with peculiar emphasis - what, since Bleuler, we have been accustomed to describe as ‘ambivalence’. By this we mean the direction towards the same person of contrary - affectionate and hostile - feelings. Unluckily I have been unable in the course of these lectures to tell you more about this emotional ambivalence.

In addition to narcissistic identification, there is a hysterical kind, which has been familiar to us very much longer. I wish it were possible to illustrate for you the differences between the two forms by a few clear specifications. There is something I can tell you about the periodic and cyclical forms of melancholia which I am sure you will be glad to hear. For in favourable circumstances - I have experienced this twice - it is possible by analytic treatment in the lucid intervals to prevent the return of the condition in the same or the opposite emotional mood. We learn from such cases that in melancholia and mania we are concerned once more with a special method of dealing with a conflict whose underlying determinants agree precisely with those of the other neuroses. You can imagine how much more there is for psycho-analysis to learn in this field of knowledge.

I told you too that we hoped that the analysis of the narcissistic disorders would give us an insight into the way in which our ego is put together and built up out of different agencies. We have already made a start with this at one point. From the analysis of delusions of observation we have drawn the conclusion that there actually exists in the ego an agency which unceasingly observes, criticizes and compares, and in that way sets itself over against the other part of the ego. We believe, therefore, that the patient is betraying a truth to us which is not yet sufficiently appreciated when he complains that he is spied upon and observed at every step he takes and that every one of his thoughts is reported and criticized. His only mistake is in regarding this uncomfortable power as something alien to him and placing it outside himself. He senses an agency holding sway in his ego which measures his actual ego and each of its activities by an ideal ego that he has created for himself in the course of his development. We believe, too, that this creation was made with the intention of re-establishing the self-satisfaction which was attached to primary infantile narcissism but which since then has suffered so many disturbances and mortifications. We know the self-observing agency as the ego-censor, the conscience; it is this that exercises the dream-censorship during the night, from which the repressions of inadmissible wishful impulses proceed. When in delusions of observation it becomes split up, it reveals to us its origin from the influences of parents, educators and social environment - from an identification with some of these model figures.

These are a few of the findings which have hitherto been reached from the application of psycho-analysis to the narcissistic disorders. No doubt there are not yet enough of them and they still lack the precision which can only be attained from established familiarity with a new field. We owe all of them to a use of the concept of ego-libido or narcissistic libido, by whose help we can extend to the narcissistic neuroses the views which have proved their value with the transference neuroses. Now, however, you will ask whether it is possible that we shall succeed in subsuming all the disturbances of the narcissistic illnesses and of the psychoses under the libido theory, whether we look upon the libidinal factor in mental life as universally guilty of the causation of illness, and need never attribute the responsibility for it to changes in the functioning of the self-preservative instinct. Well, Ladies and Gentlemen, this question seems to me to call for no urgent reply, and, above all, not to be ripe for judgement. We can confidently leave it over in expectation of the progress of our scientific work. I should not be surprised if it turned out that the power to produce pathogenic effects was in fact a prerogative of the libidinal instincts, so that the libido theory could celebrate its triumph all along the line from the simplest ‘actual’ neurosis to the most severe alienation of the personality. We after all know that it is a characteristic feature of the libido that it struggles against submitting to the reality of the universe - to Ananke. But I regard it as extremely probable that the ego-instincts are carried along secondarily by the pathogenic instigation of the libido and forced into functional disturbances. Nor can I think that it would be a disaster to the trend of our researches, if what lies before us is the discovery that in severe psychoses the ego-instincts themselves have gone astray as a primary fact. The future will give the answer - to you, at any rate.

4 Let me once more, however, return for a moment to anxiety, to throw light on a last obscurity that we left there. I have said that there is something that does not tally with the relation (so thoroughly recognized apart from this) between anxiety and libido: the fact, namely, that realistic anxiety in face of a danger seems to be a manifestation of the self-preservative instinct - which, after all, can scarcely be disputed. How would it be, though, if what was responsible for the affect of anxiety was not the egoistic ego-instincts but the ego-libido? After all, the state of anxiety is in every instance inexpedient, and its inexpedience becomes obvious if it reaches a fairly high pitch. In such cases it interferes with action, whether flight or defence, which alone is expedient and alone serves the cause of self-preservation. If, therefore, we attribute the affective portion of realistic anxiety to ego-libido and the accompanying action to the self-preservative instinct, we shall have got rid of the theoretical difficulty. After all, you do not seriously believe that one runs away because one feels anxiety? No. One feels anxiety and one runs away for a common motive, which is roused by the perception of danger. People who have been through a great mortal danger tell us that they were not at all afraid but merely acted - for instance, that they aimed their rifle at the wild beast - and that is unquestionably what was most expedient.

LECTURE XXVII TRANSFERENCE

LADIES AND GENTLEMEN, - Since we are now drawing towards the end of our discussions, there is a particular expectation which will be in your minds and which should not be disappointed. You no doubt suppose that I would not have led you through thick and thin of the subject-matter of psycho-analysis only to dismiss you at the end without saying a word about therapy, on which, after all, the possibility of practising psycho-analysis at all is based. The subject, moreover, is one that I cannot withhold from you, since what you learn in connection with it will enable you to make the acquaintance of a new fact in whose absence your understanding of the illnesses investigated by us will remain most markedly incomplete.

You do not, I know, expect me to initiate you into the technique by which analysis for therapeutic ends should be carried out. You only want to know in the most general way the method by which psycho-analytic therapy operates and what, roughly, it accomplishes. And you have an indisputable right to learn this. I shall not, however, tell it you but shall insist on your discovering it for yourselves.

Think it over! You have learnt all that is essential about the determinants of falling ill as well as all the factors that come into effect after the patient has fallen ill. Where do these leave room for any therapeutic influence? In the first place there is hereditary disposition. We have not talked about it very often because it is emphatically stressed from other directions and we have nothing new to say about it. But do not suppose that we underestimate it; precisely as therapists we come to realize its power clearly enough. In any case we can do nothing to alter it; we too must take it as something given, which sets a limit to our efforts. Next there is the influence of early experiences in childhood, to which we are in the habit of giving prominence in analysis: they belong to the past and we cannot undo them. Then comes everything that we have summarized as ‘real frustration’ - the misfortunes of life from which arise deprivation of love, poverty, family quarrels, ill-judged choice of a partner in marriage, unfavourable social circumstances, and the strictness of the ethical standards to whose pressure the individual is subject. Here, to be sure, there would be handles enough for a very effective therapy, but it would have to be of the kind which Viennese folklore attributes to the Emperor Joseph - the benevolent interference of a powerful personage before whose will people bow and difficulties vanish. But who are we, that we should be able to adopt benevolence of this kind as an instrument of our therapy? Poor ourselves and socially powerless, and compelled to earn our livelihood from our medical activity, we are not even in a position to extend our efforts to people without means, as other doctors with other methods of treatment are after all able to do. Our therapy is too time-consuming and too laborious for that to be possible. Perhaps, however, you are clutching at one of the factors I have mentioned and believe that there you have found the point at which our influence can make its attack. If the ethical restrictions demanded by society play a part in the deprivation imposed on the patient, treatment can, after all, give him the courage, or perhaps a direct injunction, to disregard those barriers and achieve satisfaction and recovery while forgoing the fulfilment of an ideal that is exalted, but so often not adhered to, by society. The patient will thus become healthy by ‘living a full life’ sexually. This, it is true, casts a shadow on analytic treatment for not serving general morality. What it has given to the individual it will have taken from the community.

But, Ladies and Gentlemen, who has so seriously misinformed you? A recommendation to the patient to ‘live a full life’ sexually could not possibly play a part in analytic therapy - if only because we ourselves have declared that an obstinate conflict is taking place in him between a libidinal impulse and sexual repression, between a sensual and an ascetic trend. This conflict would not be solved by our helping one of these trends to victory over its opponent. We see, indeed, that in neurotics asceticism has the upper hand; and the consequence of this is precisely that the suppressed sexual tendency finds a way out in symptoms. If, on the contrary, we were to secure victory for sensuality, then the sexual repression that had been put on one side would necessarily be replaced by symptom. Neither of these two alternative decisions could end the internal conflict; in either case one party to it would remain unsatisfied. There are only a few cases in which the conflict is so unstable that a factor such as the doctor’s taking sides could decide it; and such cases do not in fact stand in need of analytic treatment. Anyone on whom the doctor could have so much influence would have found the same way out without the doctor. You must be aware that if an abstinent young man decides in favour of illicit sexual intercourse or if an unsatisfied wife seeks relief with another man, they have not as a rule waited for permission from a doctor or even from their analyst.

In this connection people usually overlook the one essential point - that the pathogenic conflict in neurotics is not to be confused with a normal struggle between mental impulses both of which are on the same psychological footing. In the former case the dissension is between two powers, one of which has made its way to the stage of what is preconscious or conscious while the other has been held back at the stage of the unconscious. For that reason the conflict cannot be brought to an issue; the disputants can no more come to grips than, in the familiar simile, a polar bear and a whale. A true decision can only be reached when they both meet on the same ground. To make this possible is, I think, the sole task of our therapy.

Moreover, I can assure you that you are misinformed if you suppose that advice and guidance in the affairs of life play an integral part in analytic influence. On the contrary, so for as possible we avoid the role of a mentor such as this and there is nothing we would rather bring about than the patient should make his decisions for himself. With this purpose, too, we require him to postpone for the term of his treatment any vital decisions on choice of a profession, business undertakings, marriage or divorce, and only to put them in practice when the treatment is finished. You must admit that all this is different from what you pictured. Only in the case of some very youthful or quite helpless or unstable individuals are we unable to put the desired limitation of our role into effect. With them we have to combine the functions of a doctor and an educator; but when this is so we are quite conscious of our responsibility and behave with the necessary caution.

But you must not conclude from my eagerness in defending myself against the charge that neurotics are encouraged in analytic treatment to live a full life - you must not conclude from this that we influence them in favour of conventional virtue. That is at least as far from being the case. It is true that we are not reformers but merely observers; nevertheless, we cannot help observing with a critical eye and we have found it impossible to side with conventional sexual morality or to form a very high opinion of the manner in which society attempts the practical regulation of the problems of sexual life. We can present society with a blunt calculation that what is described as its morality calls for a bigger sacrifice than it is worth and that its proceedings are not based on honesty and do not display wisdom. We do not keep such criticisms from our patients’ ears, we accustom them to giving unprejudiced consideration to sexual matters no less than to any others; and if, having grown independent after the completion of their treatment, they decide on their own judgement in favour of some midway position between living a full life and absolute asceticism, we feel our conscience clear whatever their choice. We tell ourselves that anyone who has succeeded in educating himself to truth about himself is permanently defended against the danger of immorality, even though his standard of morality may differ in some respect from that which is customary in society. Moreover, we must guard against over-estimating the importance of the part played by the question of abstinence in influencing neuroses. Only in a minority of cases can the pathogenic situation of frustration and the subsequent damming-up of libido be brought to an end by the sort of sexual intercourse that can be procured without much trouble.

Thus you cannot explain the therapeutic effect of psycho-analysis by its permitting a full sexual life. Look around, then, for something else. I fancy that, while I was rejecting this suggestion of yours, one remark of mine put you on the right track. What we make use of must no doubt be the replacing of what is unconscious by what is conscious, the translation of what is unconscious into what is conscious. Yes, that is it. By carrying what is unconscious on into what is conscious, we lift the repressions, we remove the preconditions for the formation of symptoms, we transform the pathogenic conflict to a normal one for which it must be possible somehow to find a solution. All that we bring about in a patient is this single psychical change: the length to which it is carried is the measure of the help we provide. Where no repressions (or analogous psychical processes) can be undone, our therapy nothing to expect.

We can express the aim of our efforts in a variety of formulas: making conscious what is unconscious, lifting repressions, filling gaps in the memory - all these amount to the same thing. But perhaps you will be dissatisfied by this admission. You had formed a different picture of the return to health of a neurotic patient - that, after submitting to the tedious hours of a psycho-analysis, he would become another man; but the total result, so it seems, is that he has rather less that is unconscious and rather more that is conscious in him than he had before. The fact is that you are probably under-estimating the importance of an internal change of this kind. The neurotic who is cured has really become another man, though a bottom, of course, he has remained the same; that is to say, he has become what he might have become at best under the most favourable conditions. But that is a very great deal. If you now hear all that has to be done and what efforts it needs to bring about this apparently trivial change in a man’s mental life, you will no doubt begin to realize the importance of this difference in psychical levels.

I will digress for a moment to ask if you know what is meant by a causal therapy. That is how we describe procedure which does not take the symptoms of an illness as its point of attack but sets about removing its causes. Well, then, is our psycho-analytic method a causal therapy or not? The reply is not a simple one, but it may perhaps give us an opportunity of realizing the worthlessness of a question framed in this way. In so far as analytic therapy does not make it its first task to remove the symptoms, it is behaving like a causal therapy. In another respect, you may say, it is not. For we long ago traced the causal chain back through the repressions to the instinctual dispositions, their relative intensities in the constitution and the deviations in the course of their development. Supposing, now, that it was possible, by some chemical means, perhaps, to interfere in this mechanism, to increase or diminish the quantity of libido present at a given time or to strengthen one instinct at the cost of another - this then would be a causal therapy in the true sense of the word, for which our analysis would have carried out the indispensable preliminary work of reconnaissance. At present, as you know, there is no question of any such method of influencing libidinal processes; with our psychical therapy we attack at a different point in the combination - not exactly at what we know are the roots of the phenomena, but nevertheless far enough away from the symptoms, at a point which has been made accessible to us by some very remarkable circumstances.

What, then, must we do in order to replace what is unconscious in our patients by what is conscious? There was a time when we thought this was a very simple matter: all that was necessary was for us to discover this unconscious material and communicate it to the patient. But we know already that this was a short-sighted error. Our knowledge about the unconscious material is not equivalent to his knowledge; if we communicate our knowledge to him, he does not receive it instead of his unconscious material but beside it; and that makes very little change in it. We must rather picture this unconscious material topographically, we must look for it in his memory at the place where it became unconscious owing to a repression. The repression must be got rid of - after which the substitution of the conscious material for the unconscious can proceed smoothly. How, then, do we lift a repression of this kind? Here our task enters a second phase. First, the search for the repression and then the removal of the resistance which maintains the repression.

How do we remove the resistance? In the same way: by discovering it and showing it to the patient. Indeed, the resistance too is derived from a repression - from the same one that we are endeavouring to resolve, or from one that took place earlier. It was set up by the anticathexis which arose in order to repress the objectionable impulse. Thus we now do the same thing that we tried to do to begin with: interpret, discover and communicate; but now we are doing it at the right place. The anticathexis or the resistance does not form part of the unconscious but of the ego, which is our collaborator, and is so even if it is not conscious. As we know, the word ‘unconscious’ is being used here in two senses: on the one hand as a phenomenon and on the other as a system. This sounds very difficult and obscure; but is it not only repeating what we have already said in earlier passages? We have long been prepared for it. We expect that this resistance will be given up and the anticathexis withdrawn when our interpretation has made it possible for the ego to recognize it. What are the motive forces that we work with in such a case? First with the patient’s desire for recovery, which has induced him to take part with us in our joint work, and secondly with the help of his intelligence, to which we give support by our interpretation. There is no doubt that it is easier for the patient’s intelligence to recognize the resistance and to find the translation corresponding to what is repressed if we have previously given him the appropriate anticipatory ideas. If I say to you: ‘Look up at the sky! There’s a balloon there!’ you will discover it much more easily than if I simply tell you to look up and see if you can see anything. In the same way, a student who is looking through a microscope for the first time is instructed by his teacher as to what he will see; otherwise he does not see it at all, though it is there and visible.

0 And now for the fact! In a whole number of nervous diseases - in hysteria, anxiety states, obsessional neurosis - our expectation is fulfilled. By searching for the repression in this way, by uncovering the resistances, by pointing out what is repressed, we really succeed in accomplishing our task - that is, in overcoming the resistances, lifting the repression and transforming the unconscious material into conscious. In doing so we gain the clearest impression of the way in which a violent struggle takes place in the patient’s mind about the overcoming of each resistance - a normal mental struggle, on the same psychological ground, between the motives which seek to maintain the anticathexis and those which are prepared to give it up. The former are the old motives which in the past put the repression into effect; among the latter are the newly arrived ones which, we may hope, will decide the conflict in our favour. We have succeeded in reviving the old conflict which led to repression and in bringing up for revision the process that was then decided. The new material that we produce includes, first the reminder that the earlier decision led to illness and the promise that a different path will lead to recovery, and, second, the enormous change in all the circumstances that has take place since the time of the original rejection. Then the ego was feeble, infantile, and may perhaps have had grounds for banning the demands of the libido as a danger. To-day it has grown strong and experienced, and moreover has a helper at and in the shape of the doctor. Thus we may expect to lead the revived conflict to a better outcome than that which ended in repression, and, as I have said, in hysteria and in the anxiety and obsessional neuroses success proves us in general to be correct,

There are, however, other forms of illness in which, in spite of the conditions being the same, our therapeutic procedure is never successful. In them, too, it had been a question of an original conflict between the ego and the libido which led to repression - though this may call for a different topographical description; in them, too, it is possible to trace the points in the patient’s life at which the repressions occurred; we make use of the same procedure, are ready to make the same promises and give the same help by the offer of anticipatory ideas; and once again the lapse of time between the repressions and the present day favours a different outcome to the conflict. And yet we do not succeed in lifting a single resistance or getting rid of a single repression. These patients, paranoics, melancholics, sufferers from dementia praecox, remain on the whole unaffected and proof against psycho-analytic therapy. What can be the reason for this? Not any lack of intelligence. A certain amount of intellectual capacity is naturally required in our patients; but there is certainly no lack of it in, for instance, the extremely shrewd combinatory paranoics. Nor do any of the other motives seem to be absent. Thus the melancholics have a very high degree of consciousness, absent in paranoics, that they are ill and that that is why they suffer so much; but this does not make them more accessible. We are faced here by a fact which we do not understand and which therefore leads us to doubt whether we have really understood all the determinants of our possible success with the other neuroses.

If we continue to concern ourselves only with our hysterics and obsessional neurotics, we are soon met by a second fact for which we were not in the least prepared. For after a while we cannot help noticing that these patients behave in a quite peculiar manner to us. We believed, to be sure, that we had reckoned with all the motives concerned in the treatment, that we had completely rationalized the situation between us and the patients so that it could be looked over at a lance like a sum in arithmetic; yet, in spite of all this, something seems to creep in which has not been taken into account in our sum. This unexpected novelty itself takes many shapes, and I will begin by describing to you the commoner and more easily understandable of the forms in which it appears.

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