Freud - Complete Works (603 page)

   The pleasure in breaking and in
broken things would be satisfied, too, if the child simply threw
the breakable object on the ground. The hurling them out of the
window into the street would still remain unexplained. This
‘out!’ seems to be an essential part of the magic
action and to arise directly from its hidden meaning. The new baby
must be got rid of - through the window, perhaps because he came in
through the window. The whole action would thus be equivalent to
the verbal response, already familiar to us, of a child who was
told that the stork had brought a little brother. ‘The stork
can take him away again!’ was his verdict.

A Childhood Recollection From Dichtung Und Wahrheit

3623

   All the same, we are not blind to
the objections - apart from any internal uncertainties - against
basing the interpretation of a childhood act on a single parallel.
For this reason I had for years kept back my theory about the
little scene in
Dichtung und Wahrheit
. Then one day I had a
patient who began his analysis with the following remarks, which I
set down word for word: ‘I am the eldest of a family of eight
or nine children.¹ One of my earliest recollections is of my
father sitting on the bed in his night-shirt, and telling me
laughingly that I had a new brother. I was then three and
three-quarters years old; that is the difference in age between me
and my next younger brother. I know, too, that a short time after
(or was it a year before?)²I threw a lot of things, brushes -
or was it only one brush? - shoes and other things, out of the
window into the street. I have a still earlier recollection. When I
was two years old, I spent a night with my parents in a hotel
bedroom at Linz on the way to the Salzkammergut. I was so restless
in the night and made such a noise that my father had to beat me.
’

   After hearing this statement I
threw all doubts to the winds. When in analysis two things are
brought out one immediately after the other, as though in one
breath, we have to interpret this proximity as a connection of
thought. It was, therefore, as if the patient had said,
‘
Because
I found that I had got a new brother, I
shortly afterwards threw these things into the street.’ The
act of flinging the brushes, shoes and so on, out of the window
must be recognized as a reaction to the birth of the brother. Nor
is it a matter for regret that in this instance the objects thrown
out were not crockery but other things, probably, anything the
child could reach at the moment. - The hurling out (through the
window into the street) thus proves to be the essential thing in
the act, while the pleasure in the smashing and the noise, and the
class of object on which ‘execution is done’, are
variable and unessential points.

   Naturally, the principle of there
being a connection of thought must be applied as well to the
patient’s third childish recollection, which is the earliest,
though it was put at the end of the short series. This can easily
be done. Evidently the two-year-old child was so restless because
he could not bear his parents being in bed together. On the journey
it was no doubt impossible to avoid the child being a witness of
this. The feelings which were aroused at that time in the jealous
little boy left him with an embitterment against women which
persisted and permanently interfered with the development of his
capacity for love.

  
¹
A momentary error of a striking character.
It was probably induced by the influence of the intention, which
was already showing itself, to get rid of a brother. (Cf. Ferenczi,
1912, ‘On Transitory Symptoms during
Analysis’.)

  
²
This doubt, attaching to the essential
point of the communication for purposes of resistance, was shortly
afterwards withdrawn by the patient of his own accord.

A Childhood Recollection From Dichtung Und Wahrheit

3624

   After making these two
observations I expressed the opinion at a meeting of the Vienna
Psycho-Analytical Society that occurrences of the same kind might
be not infrequent among young children; in response, Frau Dr. von
Hug-Hellmuth placed two further observations at my disposal, which
I append here.

I

   ‘At the age of about three
and a half, little Erich quite suddenly acquired the habit of
throwing everything he did not like out of the window. He also did
it, however, with things that were not in his way and did not
concern him. On his father’s birthday - he was three years
and four and a half months old - he snatched a heavy rolling-pin
from the kitchen, dragged it into the living-room and threw it out
of the window of the third-floor flat into the street. Some days
later he sent after it the kitchen-pestle, and then a pair of heavy
mountaineering boots of his father’s, which he had first to
take out of the cupboard.¹

   ‘At that time his mother
had a miscarriage, in the seventh or eighth month of pregnancy, and
after that the child was "sweet and quiet and so good that he
seemed quite changed". In the fifth or sixth month he
repeatedly said to his mother, "Mummy, I’II jump on your
tummy" - or, "I’II push your tummy in." And
shortly before the miscarriage, in October, he said, "If I
must have a brother, at least I don’t want him till after
Christmas."’

II

   ‘A young lady of nineteen
told me spontaneously that her earliest recollection was as
follows: "I see myself, frightfully naughty, sitting under the
table in the dining-room, ready to creep out. My cup of coffee is
standing on the table - I can still see the pattern on the china
quite plainly - and Granny comes into the room just as I am going
to throw it out of the window.

   ‘"For the fact was
that no one had been bothering about me, and in the meantime a skin
had formed on the coffee, which was always perfectly dreadful to me
and still is.

   ‘"On that day my
brother, who is two and a half years younger than I am, was born,
and so no one had had any time to spare for me.

   ‘"They always tell me
that I was insupportable on that day: at dinner I threw my
father’s favourite glass on the floor, I dirtied my frock
several times, and was in the worst temper from morning to night.
In my rage I tore a bath-doll to pieces."’

  
¹
‘He always chose heavy
objects.’

A Childhood Recollection From Dichtung Und Wahrheit

3625

   These two cases scarcely call for
a commentary. They establish without further analytic effort that
the bitterness children feel about the expected or actual
appearance of a rival finds expression in throwing objects out of
the window and in other acts of naughtiness and destructiveness. In
the first case the ‘heavy objects’ probably symbolized
the mother herself, against whom the child’s anger was
directed so long as the new baby had not yet appeared. The
three-and-a-half-year-old boy knew about his mother’s
pregnancy and had no doubt that she had got the baby in her body.
‘Little Hans’¹ and his special dread of heavily
loaded carts may be recalled here.² In the second case the
very youthful age of the child, two and a half years, is
noteworthy.

   If we now return to
Goethe’s childhood memory and put in the place it occupies in
Dichtung und Wahrheit
what we believe we have obtained
through observations of other children, a perfectly valid train of
thought emerges which we should not otherwise have discovered. It
would run thus: ‘I was a child of fortune: destiny preserved
my life, although I came into the world as though dead. Even more,
destiny removed my brother, so that I did not have to share my
mother’s love with him.’ The train of thought then goes
on to someone else who died in those early days - the grandmother
who lived like a quiet friendly spirit in another part of the
house.

   I have, however, already remarked
elsewhere that if a man has been his mother’s undisputed
darling he retains throughout life the triumphant feeling, the
confidence in success, which not seldom brings actual success along
with it. And Goethe might well have given some such heading to his
autobiography as: ‘My strength has its roots in my relation
to my mother.’

  
¹
Cf. ‘Analysis of a Phobia in a
Five-Year-Old Boy’, (1909
b
)

  
²
Further confirmation of this
pregnancy-symbolism was given me some time ago by a lady of over
fifty. She had often been told that as a little child, when she
could hardly talk, she used to drag her father to the window in
great agitation whenever a heavy furniture-van was passing along
the street. In view of other recollections of the houses they had
lived in, it became possible to establish that she was then younger
than two and three quarter years. At about that time the brother
next to her was born, and in consequence of this addition to the
family a move was made. At about the same time, she often had an
alarming feeling before going to sleep of something uncannily
large, that came up to her, and ‘her hands got so
thick’.

3626

LINES OF ADVANCE IN PSYCHO-ANALYTIC THERAPY

(1919)

3627

Intentionally left blank

3628

LINES OF ADVANCE IN PSYCHO-ANALYTIC THERAPY

GENTLEMEN
, - As you know, we have
never prided ourselves on the completeness and finality of our
knowledge and capacity. We are just as ready now as we were earlier
to admit the imperfections of our understanding, to learn new
things and to alter our methods in any way that can improve
them.

   Now that we are met together once
more after the long and difficult years of separation that we have
lived through, I feel drawn to review the position of our
therapeutic procedure - to which, indeed, we owe our place in human
society - and to take a survey of the new directions in which it
may develop.

   We have formulated our task as
physicians thus: to bring to the patient’s knowledge the
unconscious, repressed impulses existing in him, and, for that
purpose, to uncover the resistances that oppose this extension of
his knowledge about himself. Does the uncovering of these
resistances guarantee that they will also be overcome? Certainly
not always; but our hope is to achieve this by exploiting the
patient’s transference to the person of the physician, so as
to induce him to adopt our conviction of the inexpediency of the
repressive process established in childhood and of the
impossibility of conducting life on the pleasure principle. I have
set out elsewhere the dynamic conditions prevailing in the fresh
conflict through which we lead the patient and which we substitute
in him for his previous conflict - that of his illness. I have
nothing at the moment to alter in that account.

Lines Of Advance In Psycho-Analytic Therapy

3629

   The work by which we bring the
repressed mental material into the patient’s consciousness
has been called by us psycho-analysis. Why ‘analysis’ -
which means breaking up or separating out, and suggests an analogy
with the work carried out by chemists on substances which they find
in nature and bring into their laboratories? Because in an
important respect there really is an analogy between the two. The
patient’s symptoms and pathological manifestations, like all
his mental activities, are of a highly composite kind; the elements
of this compound are at bottom motives, instinctual impulses. But
the patient knows nothing of these elementary motives or not nearly
enough. We teach him to understand the way in which these highly
complicated mental formations are compounded; we trace the symptoms
back to the instinctual impulses which motivate them; we point out
to the patient these instinctual motives, which are present in his
symptoms and of which he has hitherto been unaware, - just as a
chemist isolates the fundamental substance, the chemical
‘element’, out of the salt in which it had been
combined with other elements and in which it was unrecognizable. In
the same way, as regards those of the patient’s mental
manifestations that were not considered pathological, we show him
that he was only to a certain extent conscious of their motivation
- that other instinctual impulses of which he had remained in
ignorance had co-operated in producing them.

   Again, we have thrown light on
the sexual impulsions in man by separating them into their
component elements; and when we interpret a dream we proceed by
ignoring the dream as a whole and starting associations from its
single elements.

   This well-founded comparison of
medical psycho-analytic activity with a chemical procedure might
suggest a new direction for our therapy. We have
analysed
the patient - that is, separated his mental processes into their
elementary constituents and demonstrated these instinctual elements
in him singly and in isolation; what could be more natural than to
expect that we should also help him to make a new and a better
combination of them? You know that this demand has actually been
put forward. We have been told that after an analysis of a sick
mind a synthesis of it must follow. And, close upon this, concern
has been expressed that the patient might be given too much
analysis and too little synthesis; and there has then followed a
move to put all the weight on this synthesis as the main factor in
the psychotherapeutic effect, to see in it a kind of restoration of
something that had been destroyed - destroyed, as it were, by
vivisection.

Lines Of Advance In Psycho-Analytic Therapy

3630

   But I cannot think, Gentlemen,
that any new task is set us by this psycho-synthesis. If I allowed
myself to be frank and uncivil I should say it was nothing but an
empty phrase. I will limit myself to remarking that it is merely
pushing a comparison so far that it ceases to have any meaning, or,
if you prefer, that it is an unjustifiable exploitation of a name.
A name, however, is only a label applied to distinguish a thing
from other similar things, not a syllabus, a description of its
content or a definition. And the two objects compared need only
coincide at a single point and may be entirely different from each
other in everything else. What is psychical is something so unique
and peculiar to itself that no one comparison can reflect its
nature. The work of psycho-analysis suggests analogies with
chemical analysis, but it does so just as much with the
intervention of a surgeon or the manipulations of an orthopaedist
or the influence of an educator. The comparison with chemical
analysis has its limitation: for in mental life we have to deal
with trends that are under a compulsion towards unification and
combination. Whenever we succeed in analysing a symptom into its
elements, in freeing an instinctual impulse from one nexus, it does
not remain in isolation, but immediately enters into a new
one.¹

   In actual fact, indeed, the
neurotic patient presents us with a torn mind, divided by
resistances. As we analyse it and remove the resistances, it grows
together; the great unity which we call his ego fits into itself
all the instinctual impulses which before had been split off and
held apart from it. The psycho-synthesis is thus achieved during
analytic treatment without our intervention, automatically and
inevitably. We have created the conditions for it by breaking up
the symptoms into their elements and by removing the resistances.
It is not true that something in the patient has been divided into
its components and is now quietly waiting for us to put it somehow
together again.

   Developments in our therapy,
therefore, will no doubt proceed along other lines; first and
foremost, along the one which Ferenczi, in his paper
‘Technical Difficulties in an Analysis of Hysteria’
(1919), has lately termed ‘activity’ on the part of the
analyst.

  
¹
After all, something very similar occurs in
chemical analysis. Simultaneously with the isolation of the various
elements induced by the chemist, syntheses which are no part of his
intention come about, owing to the liberation of the elective
affinities of the substances concerned.

Lines Of Advance In Psycho-Analytic Therapy

3631

   Let us at once agree upon what we
mean by this activity. We have defined our therapeutic task as
consisting of two things: making conscious the repressed material
and uncovering the resistances. In that we are active enough, to be
sure. But are we to leave it to the patient to deal alone with the
resistances we have pointed out to him? Can we give him no other
help in this besides the stimulus he gets from the transference?
Does it not seem natural that we should help him in another way as
well, by putting him into the mental situation most favourable to
the solution of the conflict which is our aim? After all, what he
can achieve depends, too, on a combination of external
circumstances. Should we hesitate to alter this combination by
intervening in a suitable manner? I think activity of such a kind
on the part of the analysing physician is unobjectionable and
entirely justified.

   You will observe that this opens
up a new field of analytic technique the working over of which will
require close application and which will lead to quite definite
rules of procedure. I shall not attempt to-day to introduce you to
this new technique, which is still in the course of being evolved,
but will content myself with enunciating a fundamental principle
which will probably dominate our work in this field. It runs as
follows:
Analytic treatment should be carried through, as far as
is possible, under privation - in a state of abstinence
.

   How far it is possible to show
that I am right in this must be left to a more detailed discussion.
By abstinence, however, is not to be understood doing without any
and every satisfaction - that would of course not be practicable;
nor do we mean what it popularly connotes, refraining from sexual
intercourse; it means something else which has far more to do with
the dynamics of falling ill and recovering.

Lines Of Advance In Psycho-Analytic Therapy

3632

   You will remember that it was a
frustration
that made the patient ill, and that his symptoms
serve him as substitutive satisfactions. It is possible to observe
during the treatment that every improvement in his condition
reduces the rate at which he recovers and diminishes the
instinctual force impelling him towards recovery. But this
instinctual force is indispensible; reduction of it endangers our
aim - the patient’s restoration to health. What, then, is the
conclusion that forces itself inevitably upon us? Cruel though it
may sound, we must see to it that the patient’s suffering, to
a degree that is in some way or other effective, does not come to
an end prematurely. If, owing to the symptoms having been taken
apart and having lost their value, his suffering becomes mitigated,
we must reinstate it elsewhere in the form of some appreciable
privation; otherwise we run the danger of never achieving any
improvements except quite insignificant and transitory ones.

   As far as I can see, the danger
threatens from two directions in especial. On the one hand, when
the illness has been broken down by the analysis, the patient makes
the most assiduous efforts to create for himself in place of his
symptoms new substitutive satisfactions, which now lack the feature
of suffering. He makes use of the enormous capacity for
displacement possessed by the now partly liberated libido, in order
to cathect with libido and promote to the position of substitutive
satisfactions the most diverse kinds of activities, preferences and
habits, not excluding some that have been his already. He
continually finds new distractions of this kind, into which the
energy necessary to carrying on the treatment escapes, and he knows
how to keep them secret for a time. It is the analyst’s task
to detect these divergent paths and to require him every time to
abandon them, however harmless the activity which leads to
satisfaction may be in itself. The half-recovered patient may also
enter on less harmless paths - as when, for instance, if he is a
man, he seeks prematurely to attach himself to a woman. It may be
observed, incidentally, that unhappy marriage and physical
infirmity are the two things that most often supersede a neurosis.
They satisfy in particular the sense of guilt (need for punishment)
which makes many patients cling so fast to their neuroses. By a
foolish choice in marriage they punish themselves; they regard a
long organic illness as a punishment by fate and thereafter often
cease to keep up their neurosis.

Lines Of Advance In Psycho-Analytic Therapy

3633

   In all such situations activity
on the part of the physician must take the form of energetic
opposition to premature substitutive satisfactions. It is easier
for him, however, to prevent the
second
danger which
jeopardizes the propelling force of the analysis, though it is not
one to be under-estimated. The patient looks for his substitutive
satisfactions above all in the treatment itself, in his
transference-relationship with the physician; and he may even
strive to compensate himself by this means for all the other
privations laid upon him. Some concessions must of course be made
to him, greater or less, according to the nature of the case and
the patient’s individuality. But it is not good to let them
become too great. Any analyst who out of the fullness of his heart,
perhaps, and his readiness to help, extends to the patient all that
one human being may hope to receive from another, commits the same
economic error as that of which our non-analytic institutions for
nervous patients are guilty. Their one aim is to make everything as
pleasant as possible for the patient, so that he may feel well
there and be glad to take refuge there again from the trials of
life. In so doing they make no attempt to give him more strength
for facing life and more capacity for carrying out his actual tasks
in it. In analytic treatment all such spoiling must be avoided. As
far as his relations with the physician are concerned, the patient
must be left with unfulfilled wishes in abundance. It is expedient
to deny him precisely those satisfactions which he desires most
intensely and expresses most importunately.

   I do not think I have exhausted
the range of desirable activity on the part of the physician in
saying that a condition of privation is to be kept up during the
treatment. Activity in another direction during analytic treatment
has already, as you will remember, been a point at issue between us
and the Swiss school. We refused most emphatically to turn a
patient who puts himself into our hands in search of help into our
private property, to decide his fate for him, to force our own
ideals upon him, and with the pride of a Creator to form him in our
own image and see that it is good. I still adhere to this refusal,
and I think that this is the proper place for the medical
discretion which we have had to ignore in other connections. I have
learnt by experience, too, that such a far-reaching activity
towards patients is not in the least necessary for therapeutic
purposes. For I have been able to help people with whom I had
nothing in common - neither race, education, social position nor
outlook upon life in general - without affecting their
individuality. At the time of the controversy I have just spoken
of, I had the impression, to be sure, that the objections of our
spokesmen - I think it was Ernest Jones who took the chief part -
were too harsh and uncompromising. We cannot avoid taking some
patients for treatment who are so helpless and incapable of
ordinary life that for them one has to combine analytic with
educative influence; and even with the majority, occasions now and
then arise in which the physician is bound to take up the position
of teacher and mentor. But it must always be done with great
caution, and the patient should be educated to liberate and fulfil
his own nature, not to resemble ourselves.