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On the occasion of the opening of the Hebrew University 12 страница




 


THE QUESTION OF LAY ANALYSISConversations with an Impartial Person (1926)

 

The title of this small work is not immediately intelligible. I will therefore explain it. ‘Layman’ = ‘Non-doctor’; and the question is whether non-doctors as well as doctors are to be allowed to practise analysis. This question has its limitations both in time and place. In time, because up to now no one has been concerned as to who practises analysis. Indeed, people have been much too little concerned about it - the one thing they were agreed on was a wish that no one should practise it. Various reasons were given for this, but they were based on the same underlying distaste. Thus the demand that only doctors should analyse corresponds to a new and apparently more friendly attitude to analysis - if, that is, it can escape the suspicion of being after all only a slightly modified derivative of the earlier attitude. It is conceded that in some circumstances an analytic treatment shall be undertaken; but, if so, only doctors are to undertake it. The reason for this restriction then becomes a matter for enquiry.

 

The question is limited in place because it does not arise in all countries with equal significance. In Germany and America it would be no more than an academic discussion; for in those countries every patient can have himself treated how and by whom he chooses, and anyone who chooses can, as a ‘quack’, handle any patients, provided only that he undertakes the responsibility for his actions. The law does not intervene until it is called in to expiate some injury done to the patient. But in Austria, in which and for which I am writing, there is a preventive law, which forbids non-doctors from undertaking the treatment of patients, without waiting for its outcome.¹ So here the question whether laymen (= non-doctors) may treat patients by psycho-analysis has a practical sense. As soon as it is raised, however, it appears to be settled by the wording of the law. Neurotics are patients, laymen are non-doctors, psycho-analysis is a procedure for curing or improving nervous disorders, and all such treatments are reserved to doctors. It follows that laymen are not permitted to practise analysis on neurotics, and are punishable if they nevertheless do so. The position being so simple, one hardly ventures to take up the question of lay analysis. All the same, there are some complications, which the law does not trouble about, but which nevertheless call for consideration. It may perhaps turn out that in this instance the patients are not like other patients, that the laymen are not really laymen, and that the doctors have not exactly the qualities which one has a right to expect of doctors and on which their claims should be based. If this can be proved, there will be justifiable grounds for demanding that the law shall not be applied without modification to the instance before us.

 

¹ The same holds good in France.8

 

I

 

Whether this happens will depend on people who are not obliged to be familiar with the peculiarities of an analytic treatment. It is our task to give information on the subject to these impartial persons, whom we shall assume to be, at the moment, still in ignorance. It is to be regretted that we cannot let them be present as an audience at a treatment of this kind. But the ‘analytic situation’ allows of the presence of no third person. Moreover the different sessions are of very unequal value. An unauthorized listener who hit upon a chance one of them would as a rule form no useful impression; he would be in danger of not understanding what was passing between the analyst and the patient, or he would be bored. For good or ill, therefore, he must be content with our information, which we shall try to make as trustworthy as possible.

 

A patient, then, may be suffering from fluctuations in his moods which he cannot control, or from a sense of despondency by which his energy feels paralysed because he thinks he is incapable of doing anything properly, or from a nervous embarrassment among strangers. He may perceive, without understanding the reason for it, that he has difficulties in carrying out his professional work, or indeed any comparatively important decision or any undertaking. He may one day have suffered from a distressing attack - unknown in its origin - of feelings of anxiety, and since then have been unable, without a struggle, to walk along the street alone, or to travel by train; he may perhaps have had to give up both entirely. Or, a very remarkable thing, his thoughts may go their own way and refuse to be directed by his will. They pursue problems that are quite indifferent to him, but from which he cannot get free. Quite ludicrous tasks, too, are imposed on him, such as counting up the windows on the fronts of houses. And when he has performed simple actions such as posting a letter or turning off a gas-jet, he finds himself a moment later doubting whether he has really done so. This may be no more than an annoyance and a nuisance. But his state becomes intolerable if he suddenly finds he is unable to fend off the idea that he has pushed a child under the wheels of a car or has thrown a stranger off the bridge into the water, or if he has to ask himself whether he is not the murderer whom the police are looking for in connection with a crime that was discovered that day. It is obvious nonsense, as he himself knows; he has never done any harm to anyone; but if he were really the murderer who is being looked for, his feeling - his sense of guilt - could not be stronger.

 

Or again our patient - and this time let us make her a woman - may suffer in another way and in a different field. She is a pianist, but her fingers are overcome by cramp and refuse to serve her. Or when she thinks of going to a party she promptly becomes aware of a call of nature the satisfaction of which would be incompatible with a social gathering. She has therefore given up going to parties, dances, theatres or concerts. She is overcome by violent headaches or other painful sensations at times when they are most inconvenient. She may even be unable to keep down any meal she eats which can become dangerous in the long run. And, finally, it is a lamentable fact that she cannot tolerate any agitations, which after all are inevitable in life. On such occasions she falls in a faint, often accompanied by muscular spasms that recall sinister pathological states.

 

Other patients, again, suffer from disturbances in a particular field in which emotional life converges with demands of a bodily sort. If they are men, they find they are incapable of giving physical expression to their tenderest feelings towards the opposite sex, while towards less loved objects they may perhaps have every reaction at their command. Or their sensual feelings attach them to people whom they despise and from whom they would like to get free; or those same feelings impose requirements on them whose fulfilment they themselves find repulsive. If they are women, they feel prevented by anxiety or disgust or by unknown obstructions from meeting the demands of sexual life; or, if they have surrendered to love, they find themselves cheated of the enjoyment which nature has provided as a reward for such compliance.

 

All these people recognize that they are ill and go to doctors, by whom people expect nervous disorders like these to be removed. The doctors, too, lay down the categories into which these complaints are divided. They diagnose them, each according to his own standpoint, under different names: neurasthenia, psychasthenia, phobias, obsessional neurosis, hysteria. They examine the organs which produce the symptoms, the heart, the stomach, the bowels, the genitals, and find them healthy. They recommend interruptions in the patient’s accustomed mode of life, holidays, strengthening exercises, tonics, and by these means bring about temporary improvements - or no result at all. Eventually the patients hear that there are people who are concerned quite specially with the treatment of such complaints and start an analysis with them.

 

During this disquisition on the symptoms of neurotics, the Impartial Person, whom I imagine as being present, has been showing signs of impatience. At this point, however, he becomes attentive and interested. ‘So now’, he says, ‘we shall learn what the analyst does with the patient whom the doctor has not been able to help.’

Nothing takes place between them except that they talk to each other. The analyst makes use of no instruments not even for examining the patient - nor does he prescribe any medicines. If it is at all possible, he even leaves the patient in his environment and in his usual mode of life during the treatment. This is not a necessary condition, of course, and may not always be practicable. The analyst agrees upon a fixed regular hour with the patient, gets him to talk, listens to him, talks to him in his turn and gets him to listen.

 

The Impartial Person’s features now show signs of unmistakable relief and relaxation, but they also clearly betray some contempt. It is as though he were thinking: ‘Nothing more than that? Words, words, words, as Prince Hamlet says.’ And no doubt he is thinking too of Mephistopheles’ mocking speech on how comfortably one can get along with words - lines that no German will ever forget.

‘So it is a kind of magic,’ he comments: ‘you talk, and blow away his ailments.’

 

Quite true. It would be magic if it worked rather quicker. An essential attribute of a magician is speed - one might say suddenness - of success. But analytic treatments take months and even years: magic that is so slow loses its miraculous character. And incidentally do not let us despise the word. After all it is a powerful instrument; it is the means by which we convey our feelings to one another, our method of influencing other people. Words can do unspeakable good and cause terrible wounds. No doubt ‘in the beginning was the deed’ and the word came later; in some circumstances it meant an advance in civilization when deeds were softened into words. But originally the word was magic - a magical act; and it has retained much of its ancient power.

 

The Impartial Person proceeds: ‘Let us suppose that the patient is no better prepared to understand analytic treatment than I am; then how are you going to make him believe in the magic of the word or of the speech that is to free him from his sufferings?’

Some preparation must of course be given to him; and there is a simple way of doing it. We call on him to be completely straightforward with his analyst, to keep nothing back intentionally that comes into his head, and then to put aside every reservation that might prevent his reporting certain thoughts or memories. Everyone is aware that there are some things in himself that he would be very unwilling to tell other people or that he considers it altogether out of the question to tell. These are his ‘intimacies’. He has a notion too - and this represents a great advance in psychological self-knowledge - that there are other things that one would not care to admit to oneself: things that one likes to conceal from oneself and which for that reason one breaks off short and drives out of one’s thoughts if, in spite of everything, they turn up. Perhaps he may himself notice that a very remarkable psychological problem begins to appear in this situation - of a thought of his own being kept secret from his own self. It looks as though his own self were no longer the unity which he had always considered it to be, as though there were something else as well in him that could confront that self. He may become obscurely aware of a contrast between a self and a mental life in the wider sense. If now he accepts the demand made by analysis that he shall say everything, he will easily become accessible to an expectation that to have relations and exchanges of thought with someone under such unusual conditions might also lead to peculiar results.

 

‘I understand,’ says our Impartial Person. ‘You assume that every neurotic has something oppressing him, some secret. And by getting him to tell you about it you relieve his oppression and do him good. That, of course, is the principle of Confession, which the Catholic Church has used from time immemorial in order to make secure its dominance over people’s minds.’

We must reply: ‘Yes and no!’ Confession no doubt plays a part in analysis - as an introduction to it, we might say. But it is very far from constituting the essence of analysis or from explaining its effects. In Confession the sinner tells what he knows; in analysis the neurotic has to tell more. Nor have we heard that Confession has ever developed enough power to get rid of actual pathological symptoms.

 

‘Then, after all, I do not understand,’ comes the rejoinder. ‘What can you possibly mean by "telling more than he knows"? But I can well believe that as an analyst you gain a stronger influence over your patients than a Father Confessor over his penitents, since your contacts with him are so much longer, more intensive and also more individual, and since you use this increased influence to divert him from his sick thoughts, to talk him out of his fears, and so on. It would certainly be strange if it were possible by such means to control purely physical phenomena as well, such as vomiting, diarrhoea, convulsions; but I know that influence like that is in fact quite possible if a person is put into a state of hypnosis. By the trouble you take with the patient you probably succeed in bringing about a hypnotic relation of that sort with him - a suggestive attachment to yourself - even though you may not intend to; and in that case the miraculous results of your treatment are the effect of hypnotic suggestion. But, so far as I know, hypnotic treatment works much faster than your analysis, which, as you tell me, lasts for months and years.’

 

Our Impartial Person cannot be either so ignorant or so perplexed as we thought to begin with. There are unmistakable signs that he is trying to understand psycho-analysis with the help of his previous knowledge, that he is trying to link it up with something he already knows. The difficult task now lies ahead of us of making it clear to him that he will not succeed in this: that analysis is a procedure sui generis, something novel and special, which can only be understood with the help of new insights - or hypotheses, if that sounds better. But he is still waiting for our answer to his last remarks.

 

What you say about the special personal influence of the analyst certainly deserves great attention. An influence of the kind exists and plays a large part in analysis - but not the same part as in hypnotism. It ought to be possible to convince you that the situations in the two cases are quite different. It may be enough to point out that we do not use this personal influence, the factor of ‘suggestion’, to suppress the symptoms of the illness, as happens with hypnotic suggestion. Further, it would be a mistake to believe that this factor is the vehicle and promoter of the treatment throughout its length. At its beginning, no doubt. But later on it opposes our analytic intentions and forces us to adopt the most far-reaching counter-measures. And I should like to show by an example how far diverting a patient’s thoughts and talking him out of things are from the technique of analysis. If a patient of ours is suffering from a sense of guilt, as though he had committed a serious crime, we do not recommend him to disregard his qualms of conscience and do not emphasize his undoubted innocence; he himself has often tried to do so without success. What we do is to remind him that such a strong and persistent feeling must after all be based on something real, which it may perhaps be possible to discover.

 

‘It would surprise me’, comments the Impartial Person, ‘if you were able to soothe your patients by agreeing with their sense of guilt in that way. But what are your analytic intentions? and what

do you do with your patients?’4

 

II

 

If I am to say anything intelligible to you, I shall no doubt have to tell you something of a psychological theory which is not known or not appreciated outside analytic circles. It will be easy to deduce from this theory what we want from our patients and how we obtain it. I shall expound it to you dogmatically, as though it were a complete theoretical structure. But do not suppose that it came into being as such a structure, like a philosophical system. We have developed it very slowly, we have wrestled over every small detail of it, we have unceasingly modified it, keeping a continuous contact with observation, till it has finally taken a shape in which it seems to suffice for our purposes. Only a few years ago I should have had to clothe this theory in other terms. Nor, of course, can I guarantee to you that the form in which it is expressed to-day will remain the final one. Science, as you know, is not a revelation; long after its beginnings it still lacks the attributes of definiteness, immutability and infallibility for which human thought so deeply longs. But such as it is, it is all that we can have. If you will further bear in mind that our science is very young, scarcely as old as the century, and that it is concerned with what is perhaps the most difficult material that can be the subject of human research, you will easily be able to adopt the correct attitude towards my exposition. But interrupt me whenever you feel inclined, if you cannot follow me or if you want further explanations.

 

‘I will interrupt you before you have even begun. You say that you intend to expound a new psychology to me; but I should have thought that psychology was no new science. There have been psychologies and psychologists enough; and I heard of great achievements in that field while I was at college.’ 5

 

I should not dream of disputing them. But if you look into the matter more closely you will have to class these great achievements as belonging rather to the physiology of the sense organs. The theory of mental life could not be developed, because it was inhibited by a single essential misunderstanding. What does it comprise to-day, as it is taught at college? Apart from those valuable discoveries in the physiology of the senses, a number of classifications and definitions of our mental processes which, thanks to linguistic usage, have become the common property of every educated person. That is clearly not enough to give a view of our mental life. Have you not noticed that every philosopher, every imaginative writer, every historian and every biographer makes up his own psychology for himself, brings forward his own particular hypotheses concerning the interconnections and aims of mental acts - all more or less plausible and all equally untrustworthy? There is an evident lack of any common foundation. And it is for that reason too that in the field of psychology there is, so to speak, no respect and no authority. In that field everyone can ‘run wild’ as he chooses. If you raise a question in physics or chemistry, anyone who knows he possesses no ‘technical knowledge’ will hold his tongue. But if you venture upon a psychological assertion, you must be prepared to meet judgements and contradictions from every quarter. In this field, apparently, there is no ‘technical knowledge’. Everyone has a mental life, so everyone regards himself as a psychologist. But that strikes me as an inadequate legal title. The story is told of how someone who applied for a post as a children’s nurse was asked if she knew how to look after babies. ‘Of course,’ she replied, ‘why, after all, I was a baby once myself.’

 

‘And you claim that you have discovered this "common foundation" of mental life, which has been overlooked by every psychologist, from observations on sick people?’

The source of our findings does not seem it me to deprive them of their value. Embryology, to take an example, would not deserve to be trusted if it could not give a plain explanation of the origin of innate malformations. I have told you of people whose thoughts go their own way, so that they are obliged to worry over problems to which they are perfectly indifferent. Do you think that academic psychology could ever make the smallest contribution towards explaining an abnormality such as that? And, after all, we all of us have the experience at night-time of our thoughts going their own way and creating things which we do not understand, which puzzle us, and which are suspiciously reminiscent of pathological products. Our dreams, I mean. The common people have always firmly believed that dreams have a sense and a value - that they mean something. Academic psychology has never been able to inform us what this meaning is. It could make nothing of dreams. If it attempted to produce explanations, they were non-psychological - such as tracing them to sensory stimuli, or to an unequal depth of sleep in different portions of the brain, and so on. But it is fair to say that a psychology which cannot explain dreams is also useless for an understanding of normal mental life, that it has no claim to be called a science.

 

‘You are becoming aggressive; so you have evidently got on to a sensitive spot. I have heard, it is true, that in analysis great value is attached to dreams, that they are interpreted, and that memories of real events are looked for behind them, and so on. But I have heard as well that the interpretation of dreams is left to the caprice of analysts, and that they themselves have never ceased disputing over the way of interpreting dreams and the justification for drawing conclusions from them. If that is so, you ought not to underline so heavily the advantage that analysis has won over academic psychology.’

 

There is really a great deal of truth in what you say. It is true that the interpretation of dreams has come to have unequalled importance both for the theory and the practice of analysis. If I seem to be aggressive, that is only a way of defending myself. And when I think of all the mischief some analysts have done with the interpretation of dreams I might lose heart and echo the pessimistic pronouncement of our great satirist Nestroy when he says that every step forward is only half as big as it looks at first. But have you ever found that men do anything but confuse and distort what they get hold of? By the help of a little foresight and self-discipline most of the dangers of dream-interpretation can be avoided with certainty. But you will agree that I shall never come to my exposition if we let ourselves be led aside like this.

 

‘Yes. If I understood rightly, you wanted to tell me about the fundamental postulate of the new psychology.’

That was not what I wanted to begin with. My purpose is to let you hear what pictures we have formed of the structure of the mental apparatus in the course of our analytic studies.7

 

‘What do you mean by the "mental apparatus"? and what, may I ask, is it constructed of?’

It will soon be clear what the mental apparatus is; but I must beg you not to ask what material it is constructed of. That is not a subject of psychological interest. Psychology can be as indifferent to it as, for instance, optics can be to the question of whether the walls of a telescope are made of metal or cardboard. We shall leave entirely on one side the material line of approach, but not so the spatial one. For we picture the unknown apparatus which serves the activities of the mind as being really like an instrument constructed of several parts (which we speak of as ‘agencies’), each of which performs a particular function and which have a fixed spatial relation to one another: it being understood that by spatial relation - ‘in front of’ and ‘behind’, ‘superficial’ and ‘deep’- we merely mean in the first instance a representation of the regular succession of the functions. Have I made myself clear?

 

‘Scarcely. Perhaps I shall understand it later. But, in any case, here is a strange anatomy of the soul - a thing which, after all, no longer exists at all for the scientists.’

What do you expect? It is a hypothesis like so many others in the sciences: the very earliest ones have always been rather rough. ‘Open to revision’ we can say in such cases. It seems to me unnecessary for me to appeal here to the ‘as if’ which has become so popular. The value of a ‘fiction’ of this kind (as the philosopher Vaihinger would call it) depends on how much one can achieve with its help.

 

But to proceed. Putting ourselves on the footing of everyday knowledge, we recognize in human beings a mental organization which is interpolated between their sensory stimuli and the perception of their somatic needs on the one hand and their motor acts on the other, and which mediates between them for a particular purpose. We call this organization their ‘Ich’. Now there is nothing new in this. Each one of us makes this assumption without being a philosopher, and some people even in spite of being philosophers. But this does not, in our opinion, exhaust the description of the mental apparatus. Besides this ‘I’, we recognize another mental region, more extensive, more imposing and more obscure than the ‘I’, and this we call the ‘Es’. The relation between the two must be our immediate concern.

 

You will probably protest at our having chosen simple pronouns to describe our two agencies or provinces instead of giving them orotund Greek names. In psycho-analysis, however, we like to keep in contact with the popular mode of thinking and prefer to make its concepts scientifically serviceable rather than to reject them. There is no merit in this; we are obliged to take this line; for our theories must be understood by our patients, who are often very intelligent, but not always learned. The impersonal ‘it’ is immediately connected with certain forms of expression used by normal people. ‘It shot through me,’ people say; ‘there was something in me at that moment that was stronger than me.’ ‘C’était plus fort que moi.’

 

In psychology we can only describe things by the help of analogies. There is nothing peculiar in this; it is the case elsewhere as well. But we have constantly to keep changing these analogies, for none of them lasts us long enough. Accordingly, in trying to make the relation between the ego and the id clear, I must ask you to picture the ego as a kind of façade of the id, as a frontage, like an external, cortical, layer of it. We can hold on to this last analogy. We know that cortical layers owe their peculiar characteristics to the modifying influence of the external medium on which they abut. Thus we suppose that the ego is the layer of the mental apparatus (of the id) which has been modified by the influence of the external world (of reality). This will show you how in psycho-analysis we take spatial ways of looking at things seriously. For us the ego is really something superficial and the id something deeper - looked at from outside, of course. The ego lies between reality and the id, which is what is truly mental.

 

‘I will not ask any questions yet as to how all this can be known. But tell me first what you gain from this distinction between an ego and an id? What leads you to make it?’

Your question shows me the right way to proceed. For the important and valuable thing is to know that the ego and the id differ greatly from each other in several respects. The rules governing the course of mental acts are different in the ego and the id; the ego pursues different purposes and by other methods. A great deal could be said about this; but perhaps you will be content with a fresh analogy and an example. Think of the difference between ‘the front’ and ‘behind the lines’, as things were during the war. We were not surprised then that some things were different at the front from what they were behind the lines, and that many things were permitted behind the lines which had to be forbidden at the front. The determining influence was, of course, the proximity of the enemy; in the case of mental life it is the proximity of the external world. There was a time when ‘outside’, ‘strange’ and ‘hostile’ were identical concepts. And now we come to the example. In the id there are no conflicts; contradictions and antitheses persist side by side in it unconcernedly, and are often adjusted by the formation of compromises. In similar circumstances the ego feels a conflict which must be decided; and the decision lies in one urge being abandoned in favour of the other. The ego is an organization characterized by a very remarkable trend towards unification, towards synthesis. This characteristic is lacking in the id; it is, as we might say, ‘all to pieces’; its different urges pursue their own purposes independently and regardless of one another.

 

‘And if such an important mental region "behind the lines" exists, how can you explain its having been overlooked till the time of analysis?’0

 




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