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The acceptance of suggestions on individual points is no doubt discouraged by the fact that during the treatment we are struggling unceasingly against resistances which are able to transform themselves into negative (hostile) transferences. Nor must we fail to point out that a large number of the individual findings of analysis, which might otherwise be suspected to being products of suggestion, are confirmed from another and irreproachable source. Our guarantors in this case are the sufferers from dementia praecox and paranoia, who are of course far above any suspicion of being influenced by suggestion. The translations of symbols and the phantasies, which these patients produce for us and which in them have forced their way through into consciousness, coincide faithfully with the results of our investigations into the unconscious of transference neurotics and thus confirm the objective correctness of our interpretations, on which doubt is so often thrown. You will not, I think, be going astray if you trust analysis on these points.

4 I will now complete my picture of the mechanism of cure by clothing it in the formulas of the libido theory. A neurotic is incapable of enjoyment and of efficiency - the former because his libido is not directed on to any real object and the latter because he is obliged to employ a great deal of this available energy on keeping his libido under repression and on warding off its assaults. He would become healthy if the conflict between his ego and his libido came to an end and if his ego had his libido again at its disposal. The therapeutic task consists, therefore, in freeing the libido from its present attachments, which are withdrawn from the ego, and in making it once more serviceable to the ego. Where, then, is the neurotic’s libido situated? It is easily found: it is attached to the symptoms, which yield it the only substitutive satisfaction possible at the time. We must therefore make ourselves masters of the symptoms and resolve them - which is precisely the same thing that the patient requires of us. In order to resolve the symptoms, we must go back as far as their origin, we must renew the conflict from which they arose, and, with the help of motive forces which were not at the patient’s disposal in the past, we must guide it to a different outcome. This revision of the process of repression can be accomplished only in part in connection with the memory traces of the processes which led to repression. The decisive part of the work is achieved by creating in the patient’s relation to the doctor - in the ‘transference’ - new editions of the old conflicts; in these the patient would like to behave in the same way as he did in the past, while we, by summoning up every available mental force, compel him to come to a fresh decision. Thus the transference becomes the battlefield on which all the mutually struggling forces should meet one another.

All the libido, as well as everything opposing it, is made to converge solely on the relation with the doctor. In this process the symptoms are inevitably divested of libido. In place of his patient’s true illness there appears the artificially constructed transference illness, in place of the various unreal objects of the libido there appears a single, and once more imaginary, object in the person of the doctor. But, by the help of he doctor’s suggestion, the new struggle around this object is lifted to the highest psychical level: it takes place as a normal mental conflict. Since a fresh repression is avoided, the alienation between ego and libido is brought to an end and the subject’s mental unity is restored. When the libido is released once more from its temporary object in the person of the doctor, it cannot return to its earlier objects, but is at the disposal of the ego. The forces against which we have been struggling during our work of therapy are, on the one hand, the ego’s antipathy to certain trends of the libido - an antipathy expressed in a tendency to repression - and, on the other hand, the tenacity or adhesiveness of the libido, which dislikes leaving objects that it has once cathected.

Thus our therapeutic work falls into two phases. In the first, all the libido is forced from the symptoms into the transference and concentrated there; in the second, the struggle is waged around this new object and the libido is liberated from it. The change which is decisive for a favourable outcome is the elimination of repression in this renewed conflict so that the libido cannot withdraw once more from the ego by flight into the unconscious. This is made possible by the alteration of the ego which is accomplished under the influence of the doctor’s suggestion. By means of the work of interpretation, which transforms what is unconscious into what is conscious, the ego is enlarged at the cost of this unconscious; by means of instruction, it is made conciliatory towards the libido and inclined to grant it some satisfaction, and its repugnance to the claims of the libido is diminished by the possibility of disposing of a portion of it by sublimation. The more closely events in the treatment coincide with this ideal description, the greater will be the success of the psycho-analytic therapy. It finds its limits in the lack of mobility of the libido, which may refuse to leave its objects, and the rigidity of narcissism, which will not allow transference on to objects to increase beyond certain bounds. Further light may perhaps be thrown on the dynamics of the process of cure if I say that we get hold of the whole of the libido which has been withdrawn from the dominance of the ego by attracting a portion of it on to ourselves by means of the transference.

It will not be out of place to give a warning that we can draw no direct conclusion from the distribution of the libido during and resulting from the treatment as to how it was distributed during the illness. Suppose we succeeded in bringing a case to a favourable conclusion by setting up and then resolving a strong father-transference to the doctor. It would not be correct to conclude that the patient had suffered previously from a similar unconscious attachment of his libido to his father. His father-transference was merely the battlefield on which we gained control of his libido; the patient’s libido as directed to it from other positions. A battlefield need not necessarily coincide with one of the enemy’s key fortresses. The defence of a hostile capital need not take place just in front of its gates. Not until after the transference has once more been resolved can we reconstruct in our thoughts the distribution of the libido which had prevailed during the illness.

6 From the standpoint of the libido theory, too, we may say a last word on dreams. A neurotic’s dreams help us, like his parapraxes and his free associations to them, to discover the sense of his symptoms and to reveal the way in which his libido is allocated. They show us, in the form of a wish-fulfilment, what wishful impulses have been subjected to repression and to what objects the libido withdrawn from the ego has become attached. For this reason the interpretation of dreams plays a large part in a psycho-analytic treatment, and in some cases it is over long periods the most important instrument of our work. We already know that the state of sleep in itself leads to a certain relaxation of the repressions. A repressed impulse, owing to this reduction in the pressure weighing down upon it, becomes able to express itself far more clearly in a dream than it can be allowed to be expressed by a symptom during the day. The study of dreams therefore becomes the most convenient means of access to a knowledge of the repressed unconscious, of which the libido withdrawn from the ego forms a part.

But the dreams of neurotics do not differ in any important respect from those of normal people; it is possible, indeed, that they cannot be distinguished from them at all. It would be absurd to give an account of the dreams of neurotics which could not also apply to the dreams of normal people. We must therefore say that the difference between neurosis and health holds only during the day; it is not prolonged into dream-life. We are obliged to carry over to healthy people a number of hypotheses which arise in connection with neurotics as a result of the link between the latter’s dreams and their symptoms. We cannot deny that healthy people as well possess in their mental life what alone makes possible the formation both of dreams and of symptoms, and we must conclude that they too have carried out repressions, that they expend a certain amount of energy in order to maintain them, that their unconscious system conceals repressed impulses which are still cathected with energy, and that a portion of their libido is withdrawn from their ego’s disposal. Thus a healthy person, too, is virtually a neurotic; but dreams appear to be the only symptoms which he is capable of forming. It is true that if one subjects his waking life to a closer examination one discovers something that contradicts this appearance - namely that this ostensibly healthy life is interspersed with a great number of trivial and in practice unimportant symptoms.

The distinction between nervous health and neurosis is thus reduced to a practical question and is decided by the outcome - by whether the subject is left with a sufficient amount of capacity for enjoyment and of efficiency. It probably goes back to the relative sizes of the quota of energy that remains free and of that which is bound by repression, and is of a quantitative not of a qualitative nature. I need not tell you that this discovery is the theoretical justification for our conviction that neuroses are in principle curable in spite of their being based on constitutional disposition.

The identity of the dreams of healthy and neurotic people enables us to infer thus much in regard to defining the characteristics of health. But in regard to dreams themselves we can make a further inference: we must not detach them from their connection with neurotic symptoms, we must not suppose that their essential nature is exhausted by the formula that describes them as a translation of thoughts into an archaic form of expression, but we must suppose that they exhibit to us allocations of the libido and object-cathexes that are really present.

7 We shall soon have reached the end. You are perhaps disappointed that on the topic of the psycho-analytic method of therapy I have only spoken to you about theory and not about the conditions which determine whether a treatment is to be undertaken or about the results it produces. I shall discuss neither: the former because it is not my intention to give you practical instructions on how to carry out a psycho-analysis, and the latter because several reasons deter me from it. At the beginning of our talks, I emphasized the fact that under favourable conditions we achieve successes which are second to none of the finest in the field of internal medicine; and I can now add something further - namely that they could not have been achieved by any other procedure. If I were to say more than this I should be suspected of trying to drown the loudly raised voices of depreciation by self-advertisement. The threat has repeatedly been made against psycho-analysts by our medical ‘colleagues’ - even at public congresses - that a collection of the failures and damaging results of analysis would be published which would open the suffering public’s eyes to the worthlessness of this method of treatment. But, apart from the malicious, denunciatory character of such a measure, it would not even be calculated to make it possible to form a correct judgement of the therapeutic effectiveness of analysis. Analytic therapy, as you know, is in its youth; it has taken a long time to establish its technique, and that could only be done in the course of working and under the influence of increasing experience. In consequence of the difficulties in giving instruction, the doctor who is a beginner in psycho-analysis is thrown back to a greater extent than other specialists on his own capacity for further development, and the results of his first years will never make it possible to judge the efficacy of analytic therapy.

Many attempts at treatment miscarried during the early period of analysis because they were undertaken in cases which were altogether unsuited to the procedure and which we should exclude to-day on the basis of our present view of the indications for treatment. But these indications, too, could only be arrived at by experiment. In those days we did not know a priori that paranoia and dementia praecox in strongly marked forms are inaccessible, and we had a right to make trial of the method on all kinds of disorders. But most of the failures of those early years were due not to the doctor’s fault or an unsuitable choice of patients but to unfavourable external conditions. Here we have only dealt with internal resistances, those of the patient, which are inevitable and can be overcome. The external resistances which arise from the patient’s circumstances, from his environment, are of small theoretical interest but of the greatest practical importance. Psycho-analytic treatment may be compared with a surgical operation and may similarly claim to be carried out under arrangements that will be the most favourable for its success. You know the precautionary measures adopted by a surgeon: a suitable room, good lighting, assistants, exclusion of the patient’s relatives, and so on. Ask yourselves now how many of these operations would turn out successfully if they had to take place in the presence of all the members of the patient’s family, who would stick their noses into the field of the operation and exclaim aloud at every incision. In psycho-analytic treatments the intervention of relatives is a positive danger and a danger one does not know how to meet. One is armed against the patient’s internal resistances which one knows are inevitable, but how can one ward off these external resistances? No kind of explanations make any impression on the patient’s relatives; they cannot be induced to keep at a distance from the whole business, and one cannot make common cause with them because of the risk of losing the confidence of the patient, who - quite rightly moreover - expects the person in whom he has put his trust to take his side. No one who has any experience of the rifts which so often divide a family will, if he is an analyst, be surprised to find that the patient’s closest relatives sometimes betray less interest in his recovering than in his remaining as he is. When, as so often, the neurosis is related to conflicts between members of a family, the healthy party will not hesitate long in choosing between his own interest and the sick party’s recovery. It is not to be wondered at, indeed, if a husband looks with disfavour on a treatment in which, as he may rightly suspect, the whole catalogue of his sins will be brought to light. Nor do we wonder at it; but we cannot in that case blame ourselves if our efforts remain unsuccessful and the treatment is broken off prematurely because the husband’s resistance is added to that of his sick wife. We had in fact undertaken something which in the prevailing circumstances was unrealizable.

Instead of reporting a number of cases, I will tell you the story of a single one, in which, from considerations of medical discretion, I was condemned to play a long-suffering part. I undertook the analytic treatment - it was many years ago - of a girl who had for some time been unable, owing to anxiety, to go out in the street or to stay at home by herself. The patient slowly brought out an admission that her imagination had been seized by chance observations of the affectionate relations between her mother and a well-to-do friend of the family. But she was so clumsy - or so subtle - that she gave her mother a hint of what was being talked about in the analytic sessions. She brought this about by changing her behaviour towards her mother, by insisting on being protected by no one but her mother from her anxiety at being alone and by barring the door to her in her anxiety if she tried to leave the house. Her mother had herself been very neurotic in the past, but had been cured years before in a hydropathic establishment. Or rather, she had there made the acquaintance of the man with whom she was able to enter into a relation that was in every way satisfying to her. The girl’s passionate demands took her aback, and she suddenly understood the meaning of her daughter’s anxiety: the girl had made herself ill in order to keep her mother prisoner and to rob her of the freedom of movement that her relations with her lover required. The mother quickly made up her mind and brought the obnoxious treatment to an end. The girl was taken to a sanatorium for nervous diseases and was demonstrated for many years as ‘a poor victim of psycho-analysis’. All this time, too, I was pursued by the calumny of responsibility for the unhappy end of the treatment. I kept silence, for I thought I was bound by the duty of medical discretion. Long afterwards I learnt from one of my colleagues, who visited the sanatorium and had seen the agoraphobic girl there, that the liaison between her mother and the well-to-do friend of the family was common knowledge in the city and that it was probably connived at by the husband and father. Thus it was to this ‘secret’ that the treatment had been sacrificed.

In the years before the war, when arrivals from many foreign countries made me independent of the favour or disfavour of my own city, I followed a rule of not taking on patient for treatment unless he was sui juris, not dependent on anyone else in the essential relations of his life. This is not possible, however, for every psycho-analyst. Perhaps you may conclude from my warning against relatives that patients designed for psycho-analysis should be removed from their families and that this kind of treatment should accordingly be restricted to inmates of hospitals for nervous diseases. I could not,, however, follow you in that. It is much more advantageous for patients, (in so far as they are not in a phase of severe exhaustion) to remain during the treatment in the conditions in which they have to struggle with the tasks that face them. But the patients’ relatives ought not to cancel out this advantage by their conduct and should not offer any hostile opposition to the doctor’s efforts. But how do you propose to influence in that direction factors like these which are inaccessible to us? And you will guess, of course, how much the prospects of a treatment are determined by the patient’s social milieu and the cultural level of his family.

This presents a gloomy prospect for the effectiveness of psycho-analysis as a therapy - does it not? - even though we are able to explain the great majority of our failures by attributing them to interfering external factors. Friends of analysis have advised us to meet the threatened publication of our failures with statistics of our successes drawn up by ourselves. I did not agree to this. I pointed out that statistics are worthless if the items assembled in them are too heterogeneous; and the cases of neurotic illness which we had taken into treatment were in fact incomparable in a great variety of respects. Moreover, the period of time that could be covered was too short to make it possible to judge the durability of the cures. And it was altogether impossible to report on many of the cases: they concerned people who had kept both their illness and its treatment secret, and their recovery had equally to be kept secret. But the strongest reason for holding back lay in the realization that in matters of therapy people behave highly irrationally, so that one has no prospect of accomplishing anything with them by rational means. A therapeutic novelty is either received with delirious enthusiasm - as, for instance, when Koch introduced his first tuberculin against tuberculosis to the public - or it is treated with abysmal distrust - like Jenner’s vaccination, which was in fact a blessing and which even to-day has its irreconcilable opponents. There was obviously a prejudice against psycho-analysis. If one had cured a severe case, one might hear people say: ‘That proves nothing. He would have recovered on his own account by this time.’ And when a woman patient, who had already passed through four cycles of depression and mania, came to be treated by me during an interval after an attack of melancholia and three weeks later started on a phase of mania, all the members of her family and a high medical authority, too, who was called in for consultation - were convinced that the fresh attack could only be the result of my attempted analysis. Nothing can be done against prejudices. You can see it again to-day in the prejudices which each group of nations at war has developed against the other. The most sensible thing to do is to wait, and to leave such prejudices to the eroding effects of time. One day the same people begin to think about the same things in quite a different way from before; why they did not think so earlier remains a dark mystery.

It is possible that the prejudice against analytic treatment is already diminishing. The constant spread of analytic teachings, the increasing number of doctors practising analysis in a number of countries seems to vouch for this. When I was a young doctor, I found myself in a similar storm of indignation on the doctors’ part against treatment by hypnotic suggestion, which is now held up in contrast to analysis by people of ‘moderate’ views. Hypnotism, however, has not fulfilled its original promise as a therapeutic agent. We psycho-analysts may claim to be its legitimate heirs and we do not forget how much encouragement and theoretical clarification we owe to it. The damaging results attributed to psycho-analysis are restricted essentially to passing manifestations of increased conflict if an analysis is clumsily carried out or if it is broken off in the middle. You have heard an account of what we do with our patients and can form your own judgement as to whether our efforts are calculated to lead to any lasting damage. Abuse of analysis is possible in various directions; in particular, the transference is a dangerous instrument in the hands of an unconscientious doctor. But no medical instrument or procedure is guaranteed against abuse; if a knife does not cut, it cannot be used for healing either.

I have finished, Ladies and Gentlemen. It is more than a conventional form of words if I admit that I myself am profoundly aware of the many defects in the lectures I have given you. I regret above all that I have so often promised to return later to a topic I have lightly touched on and have then found no opportunity of redeeming my promise. I undertook to give you an account of a subject which is still incomplete and in process of development, and my condensed summary has itself turned out to be an incomplete one. At some points I have set out the material on which to draw a conclusion and have then myself not drawn it. But I could not pretend to make you into experts; I have only tried to stimulate and enlighten you.

FROM THE HISTORY OF AN INFANTILE NEUROSIS WOLF MAN (1918 [1914])

The case upon which I propose to report in the following pages (once again only in a fragmentary manner) is characterized by a number of peculiarities which require to be emphasized before I proceed to a description of the facts themselves. It is concerned with a young man whose health had broken down in his eighteenth year after a gonorrhoeal infection, and who was entirely incapacitated and completely dependent upon other people when he began his psycho-analytic treatment several years later. He had lived an approximately normal life during the ten years of his boyhood that preceded the date of his illness, and got through his studies at his secondary school without much trouble. But his earlier years were dominated by a severe neurotic disturbance, which began immediately before his fourth birthday as an anxiety-hysteria (in the shape of an animal phobia), then changed into an obsessional neurosis with a religious content, and lasted with its offshoots as far as into his tenth year.

¹ This case history was written down shortly after the termination of the treatment, in the winter of 1914-15. At that time I was still freshly under the impression of the twisted re-interpretations which C. G. Jung and Alfred Adler were endeavouring to give to the findings of psycho-analysis. This paper is therefore connected with my essay ‘On the History of the Psycho-Analytic Movement’ which was published in the Jahrbuch der Psychoanalyse in 1914. It supplements the polemic contained in that essay, which is in its essence of a personal character, by an objective estimation of the analytic material. It was originally intended for the next volume of the Jahrbuch, the appearance of which was, however, postponed indefinitely owing to the obstacles raised by the Great War. I therefore decided to add it to the present collection of papers which was being issued by a new publisher. Meanwhile I had been obliged to deal in my Introductory Lectures on Psycho-Analysis (which I delivered in 1916 and 1917) with many points which should have been raised for the first time in this paper. No alterations of any importance have been made in the text of the first draft; additions are indicated by means of square brackets.

Only this infantile neurosis will be the subject of my communication. In spite of the patient’s direct request, I have abstained from writing a complete history of his illness, of his treatment, and of his recovery, because I recognized that such a task was technically impracticable and socially impermissible. This at the same time removes the possibility of demonstrating the connection between his illness in childhood and his later and permanent one. As regards the latter I can only say that on account of it the patient spent a long time in German sanatoria, and was at that period classified in the most authoritative quarters as a case of ‘manic-depressive insanity’. This diagnosis was certainly applicable to the patient’s father, whose life with its wealth of activity and interests, was disturbed by repeated attacks of severe depression. But in the son I was never able, during an observation which lasted several years, to detect any changes of mood which were disproportionate to the manifest psychological situation either in their intensity or in the circumstances of their appearance. I have formed the opinion that this case, like many others which clinical psychiatry has labelled with the most multifarious and shifting diagnoses, is to be regarded as a condition following on an obsessional neurosis which has come to an end spontaneously, but has left a defect behind it after recovery.

My description will therefore deal with an infantile neurosis which was analysed not while it actually existed, but only fifteen years after its termination. This state of things has its advantages as well as its disadvantages in comparison with the alternative. An analysis which is conducted upon a neurotic child itself must, as a matter of course, appear to be more trustworthy, but it cannot be very rich in material; too many words and thoughts have to be lent to the child, and even so the deepest strata may turn out to be impenetrable to consciousness. An analysis of a childhood disorder through the medium of recollection in an intellectually mature adult is free from these limitations; but it necessitates our taking into account the distortion and refurbishing to which a person’s own past is subjected when it is looked back upon from a later period. The first alternative perhaps gives the more convincing results; the second is by far the more instructive.

In any case it may be maintained that analysis of children’s neuroses can claim to possess a specially high theoretical interest They afford us, roughly speaking, as much help towards a proper understanding of the neuroses of adults as do children’s dreams in respect to the dreams of adults. Not, indeed, that they are more perspicuous or poorer in elements; in fact, the difficulty of feeling one’s way into the mental life of a child makes them set the physician a particularly difficult task. But nevertheless, so many of the later deposits are wanting in them that the essence of the neurosis springs to the eyes with unmistakable distinctness. In the present phase of the battle which is raging round psycho-analysis the resistance to its findings has, as we know, taken on a new form. People were content formerly to dispute the reality of the facts which are asserted by analysis; and for this purpose the best technique seemed to be to avoid examining them. That procedure appears to be slowly exhausting itself; and people are now adopting another plan of recognizing the facts, but of eliminating, by means of twisted interpretations, the consequences that follow from them, so that the critics can still ward off the objectionable novelties as efficiently as ever. The study of children’s neuroses exposes the complete inadequacy of these shallow or high-handed attempts at re-interpretation. It shows the predominant part that is played in the formation of neuroses by those libidinal motive forces which are so eagerly disavowed, and reveals the absence of any aspirations towards remote cultural aims, of which the child still knows nothing, and which cannot therefore be of any significance for him.

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