Freud - Complete Works (604 page)

Lines Of Advance In Psycho-Analytic Therapy

3634

   Our honoured friend, J. J.
Putnam, in the land of America which is now so hostile to us, must
forgive us if we cannot accept his proposal either - namely that
psycho-analysis should place itself in the service of a particular
philosophical outlook on the world and should urge this upon the
patient for the purpose of ennobling his mind. In my opinion, this
is after all only to use violence, even though it is overlaid with
the most honourable motives.

   Lastly, another quite different
kind of activity is necessitated by the gradually growing
appreciation that the various forms of disease treated by us cannot
all be dealt with by the same technique. It would be premature to
discuss this in detail, but I can give two examples of the way in
which a new kind of activity comes into question. Our technique
grew up in the treatment of hysteria and is still directed
principally to the cure of that affection. But the phobias have
already made it necessary for us to go beyond our former limits.
One can hardly master a phobia if one waits till the patient lets
the analysis influence him to give it up. He will never in that
case bring into the analysis the material indispensable for a
convincing resolution of the phobia. One must proceed differently.
Take the example of agoraphobia; there are two classes of it, one
mild, the other severe. Patients belonging to the first class
suffer from anxiety when they go into the street by themselves, but
they have not yet given up going out alone on that account; the
others protect themselves from the anxiety by altogether ceasing to
go about alone. With these last one succeeds only when one can
induce them by the influence of the analysis to behave like phobic
patients of the first class - that is, to go into the street and to
struggle with their anxiety while they make the attempt. One
starts, therefore, by moderating the phobia so far; and it is only
when that has been achieved at the physician’s demand that
the associations and memories come into the patient’s mind
which enable the phobia to be resolved.

   In severe cases of obsessive acts
a passive waiting attitude seems even less indicated. Indeed in
general these cases incline to an ‘asymptotic’ process
of recovery, an interminable protraction of the treatment. Their
analysis is always in danger of bringing to light a great deal and
changing nothing. I think there is little doubt that here the
correct technique can only be to wait until the treatment itself
has become a compulsion, and then with this counter-compulsion
forcibly to suppress the compulsion of the disease. You will
understand, however, that these two instances I have given you are
only samples of the new developments towards which our therapy is
tending.

Lines Of Advance In Psycho-Analytic Therapy

3635

   And now in conclusion I will cast
a glance at a situation which belongs to the future - one that will
seem fantastic to many of you, but which I think, nevertheless,
deserves that we should be prepared for it in our minds. You know
that our therapeutic activities are not very far-reaching. There
are only a handful of us, and even by working very hard each one
can devote himself in a year to only a small number of patients.
Compared to the vast amount of neurotic misery which there is in
the world, and perhaps need not be, the quantity we can do away
with is almost negligible. Besides this, the necessities of our
existence limit our work to the well-to-do classes, who are
accustomed to choose their own physicians and whose choice is
diverted away from psycho-analysis by all kinds of prejudices. At
present we can do nothing for the wider social strata, who suffer
extremely seriously from neuroses.

   Now let us assume that by some
kind of organization we succeeded in increasing our numbers to an
extent sufficient for treating a considerable mass of the
population. On the other hand, it is possible to foresee that at
some time or other the conscience of society will awake and remind
it that the poor man should have just as much right to assistance
for his mind as he now has to the life-saving help offered by
surgery; and that the neuroses threaten public health no less than
tuberculosis, and can be left as little as the latter to the
impotent care of individual members of the community. When this
happens, institutions or out-patient clinics will be started, to
which analytically-trained physicians will be appointed, so that
men who would otherwise give way to drink, women who have nearly
succumbed under their burden of privations, children for whom there
is no choice but between running wild or neurosis, may be made
capable, by analysis, of resistance and of efficient work. Such
treatments will be free. It may be a long time before the State
comes to see these duties as urgent. Present conditions may delay
its arrival even longer. Probably these institutions will first be
started by private charity. Some time or other, however, it must
come to this.

   We shall then be faced by the
task of adapting our technique to the new conditions. I have no
doubt that the validity of our psychological assumptions will make
its impression on the uneducated too, but we shall need to look for
the simplest and most easily intelligible ways of expressing our
theoretical doctrines. We shall probably discover that the poor are
even less ready to part with their neuroses than the rich, because
the hard life that awaits them if they recover offers them no
attraction, and illness gives them one more claim to social help.
Often, perhaps, we may only be able to achieve anything by
combining mental assistance with some material support, in the
manner of the Emperor Joseph. It is very probable, too, that the
large-scale application of our therapy will compel us to alloy the
pure gold of analysis freely with the copper of direct suggestion;
and hypnotic influence, too, might find a place in it again, as it
has in the treatment of war neuroses. But, whatever form this
psychotherapy for the people may take, whatever the elements out of
which it is compounded, its most effective and most important
ingredients will assuredly remain those borrowed from strict and
untendentious psycho-analysis.

3636

ON THE TEACHING OF PSYCHO-ANALYSIS IN UNIVERSITIES

(1919)

3637

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3638

ON THE TEACHING OF PSYCHO-ANALYSIS IN UNIVERSITIES

The question of the advisability of teaching
psycho-analysis in Universities may be considered from two points
of view: that of psycho-analysis and that of the University.

   (1) The inclusion of
psycho-analysis in the University curriculum would no doubt be
regarded with satisfaction by every psycho-analyst. At the same
time it is clear that the psycho-analyst can dispense entirely with
the University without any loss to himself. For what he needs in
the matter of theory can be obtained from the literature of the
subject and, going more deeply, at the scientific meetings of the
psycho-analytic societies as well as by personal contact with their
more experienced members. As regards practical experience, apart
from what he gains from his own personal analysis, he can acquire
it by carrying out treatments, provided that he can get supervision
and guidance from recognized psycho-analysts.

   The fact that an organization of
this kind exists is actually due to the exclusion of
psycho-analysis from Universities. And it is therefore evident that
these arrangements will continue to perform an effective function
so long as this exclusion persists.

   (2) So far as the Universities
are concerned, the question depends on their deciding whether they
are willing to attribute any value at all to psycho-analysis in the
training of physicians and scientists. If so, the further problem
remains of how it is to be incorporated into the regular
educational framework.

   The importance of psycho-analysis
for the whole of medical and academic training is based on the
following facts:

   (
a
) This training has been
quite rightly criticized during the last few decades for the
one-sided way in which it directs the student into the fields of
anatomy, physics and chemistry, while failing, on the other hand,
to make plain to him the significance of mental factors in the
different vital functions as well as in illnesses and their
treatment. This short-coming in medical education makes itself felt
later as a flagrant blind spot in the physician. This will not only
show itself in his lack of interest in the most absorbing problems
of human life, whether healthy or diseased, but will also render
him unskilful in his treatment of patients, so that even quacks and
‘healers’ will have a greater effect on them than he
does.

On The Teaching Of Psycho-Analysis In Universities

3639

   This obvious deficiency led some
time ago to the inclusion in the University curriculum of courses
of lectures on medical psychology. But so long as these lectures
were based on academic psychology or on experimental psychology
(which deals only with questions of detail), they were unable to
meet the requirements of the student’s training; nor could
they bring him any nearer to the problems of life in general or to
those of his profession. For these reasons the place occupied by
this kind of medical psychology in the curriculum proved
insecure.

   A course of lectures on
psycho-analysis, on the other hand, would certainly answer these
requirements. Before coming to psycho-analysis proper, an
introductory course would be needed, which would deal in detail
with the relations between mental and physical life - the basis of
all kinds of psychotherapy -, would describe the various kinds of
suggestive procedures, and would finally show how psycho-analysis
constitutes the outcome and culmination of all the earlier methods
of mental treatment. Psycho-analysis, in fact, more than any other
system, is fitted for teaching psychology to the medical
student.

   (
b
) Another of the
functions of psycho-analysis should be to afford a preparation for
the study of psychiatry. This, in its present shape, is exclusively
descriptive in character; it merely teaches the student to
recognize a series of pathological entities, enabling him to
distinguish which are incurable and which are dangerous to the
community. Its sole connection with the other branches of medical
science lies in organic aetiology - that is, in its anatomical
findings; but it offers not the slightest understanding of the
facts observed. Such an understanding can be furnished only by a
depth-psychology.

   In America, according to the best
of my information, it has already been recognized that
psycho-analysts (the first attempt at a depth-psychology) has made
successful inroads into this unexplored region of psychiatry. Many
medical schools in that country, accordingly, have already
organized courses of psycho-analysis as an introduction to
psychiatry.

   The teaching of psycho-analysis
would have to proceed in two stages: an elementary course, designed
for all medical students, and a course of specialized lectures for
psychiatrists.

On The Teaching Of Psycho-Analysis In Universities

3640

   (
c
) In the investigation
of mental processes and intellectual functions, psycho-analysis
pursues a specific method of its own. The application of this
method is by no means confined to the field of psychological
disorders, but extends also to the solution of problems in art,
philosophy and religion. In this direction it has already yielded
several new points of view and thrown valuable light on such
subjects as the history of literature, on mythology, on the history
of civilizations and on the philosophy of religion. Thus the
general psycho-analytic course should be thrown open to the
students of these branches of learning as well. The fertilizing
effects of psycho-analytic thought on these other disciplines would
certainly contribute greatly towards forging a closer link, in the
sense of a
universitas literarum
, between medical science
and the branches of learning which lie within the sphere of
philosophy and the arts.

   To sum up, it may be asserted
that a University stands only to gain by the inclusion in its
curriculum of the teaching of psycho-analysis. That teaching, it is
true, can only be given in a dogmatic and critical manner, by means
of theoretical lectures; for these lectures will allow only a very
restricted opportunity for carrying out experiments or for
practical demonstrations. For the purposes of research, it should
be sufficient for teachers of psycho-analysis to have access to an
out-patient department for the supply of the necessary material in
the form of ‘neurotic’ patients. For psycho-analytic
psychiatry, a mental in-patient department would also have to be
available.

   Consideration, lastly, must be
given to the objection that, along these lines, the medical student
will never learn psycho-analysis proper. This is indeed true, if we
have in mind the actual practice of psycho-analysis. But for the
purposes we have in view it will be enough if he learns something
about
psycho-analysis and something
from
it. After
all, University training does not equip the medical student to be a
skilled surgeon; and no one who chooses surgery as a profession can
avoid further training in the form of several years of work in a
surgical department of a hospital.