Freud - Complete Works (581 page)

Introductory Lectures On Psycho-Analysis

3500

   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.

Introductory Lectures On Psycho-Analysis

3501

   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.

3502

FROM THE HISTORY OF AN INFANTILE NEUROSIS

(1918 [1914])

3503

Intentionally left blank

3504

FROM THE HISTORY OF AN INFANTILE NEUROSIS ¹

I

INTRODUCTORY REMARKS

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.

From The History Of An Infantile Neurosis

3505

   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.

From The History Of An Infantile Neurosis

3506

   Another characteristic which
makes the present analysis noteworthy is connected with the
severity of the illness and the duration of the treatment. Analyses
which lead to a favourable conclusion in a short time are of value
in ministering to the therapeutist’s self-esteem and
substantiate the medical importance of psycho-analysis; but they
remain for the most part insignificant as regards the advancement
of scientific knowledge. Nothing new is learnt from them. In fact
they only succeed so quickly because everything that was necessary
for their accomplishment was already known. Something new can only
be gained from analyses that present special difficulties, and to
the overcoming of these a great deal of time has to be devoted.
Only in such cases do we succeed in descending into the deepest and
most primitive strata of mental development and in gaining from
there solutions for the problems of the later formations. And we
feel afterwards that, strictly speaking, only an analysis which has
penetrated so far deserves the name. Naturally a single case does
not give us all the information that we should like to have. Or, to
put it more correctly, it might teach us everything, if we were
only in a position to make everything out, and if we were not
compelled by the inexperience of our own perception to content
ourselves with a little.

   As regards these fertile
difficulties the case I am about to discuss left nothing to be
desired. The first years of the treatment produced scarcely any
change. Owing to a fortunate concatenation, all the external
circumstances nevertheless combined to make it possible to proceed
with the therapeutic experiment. I can easily believe that in less
favourable circumstances the treatment would have been given up
after a short time. Of the physician’s point of view I can
only declare that in a case of this kind he must behave as
‘timelessly’ as the unconscious itself, if he wishes to
learn anything or to achieve anything. And in the end he will
succeed in doing so, if he has the strength to renounce any
short-sighted therapeutic ambition. It is not to be expected that
the amount of patience, adaptability, insight, and confidence
demanded of the patient and his relatives will be forthcoming in
many other cases. But the analyst has a right to feel that the
results which he has attained from such lengthy work in one case
will help substantially to reduce the length of the treatment in a
subsequent case of equal severity, and that by submitting on a
single occasion

From The History Of An Infantile Neurosis

3507

   The patient with whom I am here
concerned remained for a long time unassailably entrenched behind
an attitude of ‘obliging apathy’. He listened,
understood, and remained unapproachable. His unimpeachable
intelligence was, as it were, cut off from the instinctual forces
which governed his behaviour in the few relations of life that
remained to him. It required a long education to induce him to take
an independent share in the work; and when as a result of this
exertion he began for the first time to feel relief, he immediately
gave up working in order to avoid any further changes, and in order
to remain comfortably in the situation which had been thus
established. His shrinking from a self-sufficient existence was so
great as to outweigh all the vexations of his illness. Only one way
was to be found of overcoming it. I was obliged to wait until his
attachment to myself had become strong enough to counter-balance
this shrinking, and then played off this one factor against the
other. I determined - but not until trustworthy signs had led me to
judge that the right moment had come that the treatment must be
brought to an end at a particular fixed date, no matter how far it
had advanced. I was resolved to keep to the date; and eventually
the patient came to see that I was in earnest. Under the inexorable
pressure of this fixed limit his resistance and his fixation to the
illness gave may, and now in a disproportionately short time the
analysis produced all the material which made it possible to clear
up his inhibitions and remove his symptoms. All the information,
too, which enabled me to understand his infantile neurosis is
derived from this last period of the work, during which resistance
temporarily disappeared and the patient gave an impression of
lucidity which is usually attainable only in hypnosis.

   Thus the course of this treatment
illustrates a maxim whose truth has long been appreciated in the
technique of analysis. The length of the road over which an
analysis must travel with the patient, and the quantity of material
which must be mastered on the way, are of no importance in
comparison with the resistance which is met with in the course of
the work, and are only of importance at all in so far as they are
necessarily proportional to the resistance. The situation is the
same as when to-day an enemy army needs weeks and months to make
its way across a stretch of country which in times of peace was
traversed by an express train in a few hours and which only a short
time before had been passed over by the defending army in a few
days.

   A third peculiarity of the
analysis which is to be described in these pages has only increased
my difficulty in deciding to make a report upon it. On the whole
its results have coincided in the most satisfactory manner with our
previous knowledge, or have been easily embodied into it. Many
details, however, seemed to me myself to be so extraordinary and
incredible that I felt some hesitation in asking other people to
believe them. I requested the patient to make the strictest
criticism of his recollections, but he found nothing improbable in
his statements and adhered closely to them. Readers may at all
events rest assured that I myself am only reporting what I came
upon as an independent experience, uninfluenced by my expectation.
So that there was nothing left for me but to remember the wise
saying that there are more things in heaven and earth than are
dreamed of in our philosophy. Anyone who could succeed in
eliminating his pre-existing convictions even more thoroughly could
no doubt discover even more such things.

From The History Of An Infantile Neurosis

3508

II

GENERAL SURVEY OF THE PATIENT’S ENVIRONMENT

AND
OF THE HISTORY OF THE CASE

I am unable to give either a purely historical
or a purely thematic account of my patient’s story; I can
write a history neither of the treatment nor of the illness, but I
shall find myself obliged to combine the two methods of
presentation. It is well known that no means has been found of in
any way introducing into the reproduction of an analysis the sense
of conviction which results from the analysis itself. Exhaustive
verbatim reports of the proceedings during the hours of analysis
would certainly be of no help at all; and in any case the technique
of the treatment makes it impossible to draw them up. So analyses
such as this are not published in order to produce conviction in
the minds of those whose attitude has hitherto been recusant and
sceptical. The intention is only to bring forward some new facts
for investigators who have already been convinced by their own
clinical experiences.