Freud - Complete Works (714 page)

   Moreover, to return to our
question of the analytic treatment of adult neurotics, even there
we have not yet exhausted every line of approach. Our civilization
imposes an almost intolerable pressure on us and it calls for a
corrective. Is it too fantastic to expect that psycho-analysis in
spite of its difficulties may be destined to the task of preparing
mankind for such a corrective? Perhaps once more an American may
hit on the idea of spending a little money to get the ‘social
workers’ of his country trained analytically and to turn them
into a band of helpers for combating the neuroses of
civilization.

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   ‘Aha! a new kind of
Salvation Army!’

   Why not? Our imagination always
follows patterns. The stream of eager learners who will then flow
to Europe will be obliged to pass Vienna by, for here the
development of analysis may have succumbed to a premature trauma of
prohibition. You smile? I am not saying this as a bribe for your
support. Not in the least. I know you do not believe me; nor can I
guarantee that it will happen. But one thing I do know. It is by no
means so important what decision you give on the question of lay
analysis. It may have a local effect. But the things that really
matter - the possibilities in psycho-analysis for
internal
development - can never be affected by regulations and
prohibitions.

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POSTSCRIPT

(1927)

The immediate occasion of my writing the small
volume which was the starting-point of the present discussion was a
charge of quackery brought against a non-medical member of our
Society, Dr. Theodor Reik, in the Vienna Courts. It is generally
known, I think, that after all the preliminary proceedings had been
completed and a number of expert opinions had been received, the
charge was dropped. I do not believe that this was a result of my
book. No doubt the prosecution’s case was too weak, and the
person who brought the charge as an aggrieved party proved an
untrustworthy witness. So that the quashing of the proceedings
against Dr. Reik is probably not to be regarded as a considered
judgement of the Vienna Courts on the general question of lay
analysis. When I drew the figure of the ‘Impartial
Person’ who was my interlocutor in my tract, I had before my
mind one of our high officials. This was a man with a friendly
attitude and a mind of unusual integrity, to whom I had myself
talked about Reik’s case and for whom I had, at his request,
written a confidential opinion on the subject. I knew I had not
succeeded in converting him to my views, and that was why I made my
dialogue with the Impartial Person end without agreement too.

   Nor did I expect that I should
succeed in bringing about unanimity in the attitude of analysts
themselves towards the problem of lay analysis. Anyone who compares
the views expressed by the Hungarian Society in this discussion
with those of the New York group will perhaps conclude that my book
has produced no effect whatever and that everyone persists in his
former opinion. But I do not believe this either. I think that many
of my colleagues have modified their extreme
parti pris
and
that the majority have accepted my view that the problem of lay
analysis ought not to be decided along the lines of traditional
usage but that it arises from a novel situation and therefore
demands a fresh judgement.

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   Again, the turn which I gave to
the whole discussion seems to have met with approval. My main
thesis was that the important question is not whether an analyst
possesses a medical diploma but whether he has had the special
training necessary for the practice of analysis. This served as the
starting-point for a discussion, which was eagerly embarked upon,
as to what is the training most suitable for an analyst. My own
view was and still remains that it is not the training prescribed
by the University for future doctors. What is known as medical
education appears to me to be an arduous and circuitous way of
approaching the profession of analysis. No doubt it offers an
analyst much that is indispensable to him. But it burdens him with
too much else of which he can never make use, and there is a danger
of its diverting his interest and his whole mode of thought from
the understanding of psychical phenomena. A scheme of training for
analysts has still to be created. It must include elements from the
mental sciences, from psychology, the history of civilization and
sociology, as well as from anatomy, biology and the study of
evolution. There is so much to be taught in all this that it is
justifiable to omit from the curriculum anything which has no
direct bearing on the practice of analysis and only serves
indirectly (like any other study) as a training for the intellect
and for the powers of observation. It is easy to meet this
suggestion by objecting that analytic colleges of this kind do not
exist and that I am merely setting up an ideal. An ideal, no doubt.
But an ideal which can and must be realized. And in our training
institutes, in spite of all their youthful insufficiencies, that
realization has already begun.

   It will not have escaped my
readers that in what I have said I have assumed as axiomatic
something that is still violently disputed in the discussion. I
have assumed, that is to say, that psycho-analysis is not a
specialized branch of medicine. I cannot see how it is possible to
dispute this. Psycho-analysis is a part of psychology; not of
medical psychology in the old sense, not of the psychology of
morbid processes, but simply of psychology. It is certainly not the
whole of psychology, but its sub-structure and perhaps even its
entire foundation. The possibility of its application to medical
purposes must not lead us astray. Electricity and radiology also
have their medical application, but the science to which they both
belong is none the less physics. Nor can their situation be
affected by historical arguments. The whole theory of electricity
had its origin in an observation of a nerve-muscle preparation; yet
no one would dream to-day of regarding it as a part of physiology.
It is argued that psycho-analysis was after all discovered by a
physician in the course of his efforts to assist his patients. But
that is clearly neither here nor there. Moreover, the historical
argument is double-edged. We might pursue the story and recall the
unfriendliness and indeed the animosity with which the medical
profession treated analysis from the very first. That would seem to
imply that it can have no claims over analysis to-day. And though I
do not accept that implication, I still feel some doubts as to
whether the present wooing of psycho-analysis by the doctors is
based, from the point of view of the libido theory, upon the first
or upon the second of Abraham’s sub-stages - whether they
wish to take possession of their object for the purpose of
destroying or of preserving it.

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   I should like to consider the
historical argument a moment longer. Since it is with me personally
that we are concerned, I can throw a little light, for anyone who
may be interested, on my own motives. After forty-one years of
medical activity, my self-knowledge tells me that I have never
really been a doctor in the proper sense. I became a doctor through
being compelled to deviate from my original purpose; and the
triumph of my life lies in my having, after a long and roundabout
journey, found my way back to my earliest path. I have no knowledge
of having had any craving in my early childhood to help suffering
humanity. My innate sadistic disposition was not a very strong one,
so that I had no need to develop this one of its derivatives. Nor
did I ever play the ‘doctor game’; my infantile
curiosity evidently chose other paths. In my youth I felt an
overpowering need to understand something of the riddles of the
world in which we live and perhaps even to contribute something to
their solution. The most hopeful means of achieving this end seemed
to be to enrol myself in the medical faculty; but even after that I
experimented - unsuccessfully - with zoology and chemistry, till at
last, under the influence of Brücke, who carried more weight
with me than any one else in my whole life, I settled down to
physiology, though in those days it was too narrowly restricted to
histology. By that time I had already passed all my medical
examinations; but I took no interest in anything to do with
medicine till the teacher whom I so deeply respected warned me that
in view of my impoverished material circumstances I could not
possibly take up a theoretical career. Thus I passed from the
histology of the nervous system to neuropathology and then,
prompted by fresh influences, I began to be concerned with the
neuroses. I scarcely think, however, that my lack of a genuine
medical temperament has done much damage to my patients. For it is
not greatly to the advantage of patients if their doctor’s
therapeutic interest has too marked an emotional emphasis. They are
best helped if he carries out his task coolly and keeping as
closely as possible to the rules.

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   No doubt what I have just said
throws little light on the problem of lay analysis; it was only
intended to exhibit my personal credentials as being myself a
supporter of the inherent value of psycho-analysis and of its
independence of its application to medicine. But it will be
objected at this point that whether psycho-analysis, regarded as a
science, is a subdivision of medicine or of psychology is a purely
academic question and of no practical interest. The real point at
issue, it will be said, is a different one, namely the application
of analysis to the treatment of patients; in so far as it claims to
do this it must be content, the argument will run, to be accepted
as a specialized branch of medicine, like radiology, for instance,
and to submit to the rules laid down for all therapeutic methods. I
recognize that that is so; I admit it. I only want to feel assured
that the therapy will not destroy the science. Unluckily analogies
never carry one more than a certain distance; a point is soon
reached at which the subjects of the comparison take divergent
paths. The case of analysis differs from that of radiology. A
physicist does not require to have a patient in order to study the
laws that govern X-rays. But the only subject-matter of
psycho-analysis is the mental processes of human beings and it is
only in human beings that it can be studied. For reasons which can
easily be understood, neurotic human beings offer far more
instructive and accessible material than normal ones, and to
withhold that material from anyone who wishes to study and apply
analysis is to dock him of a good half of his training
possibilities. I have, of course, no intention of asking that the
interests of neurotic patients should be sacrificed to those of
instruction and scientific research. The aim of my small volume on
the question of lay analysis was precisely to show that, if certain
precautions are observed, the two interests can quite easily be
brought into harmony and that the interests of medicine, as rightly
understood, will not be the last to profit by such a solution.

   I myself brought forward all the
necessary precautions and I can safely say that the discussion
added nothing on this point. But I should like to remark that the
emphasis was often placed in a manner which did not do justice to
the facts. What was said about the difficulties of differential
diagnosis and the uncertainty in many cases in deciding about
somatic symptoms - situations, that is, in which medical knowledge
and medical intervention are necessary - this is all of it
perfectly true. Nevertheless, the number of cases in which doubts
of this kind never arise at all and in which a doctor is
not
required is surely incomparably greater. These cases may be quite
uninteresting scientifically, but they play an important enough
part in life to justify the activity of lay analysts, who are
perfectly competent to deal with them. Some time ago I analysed a
colleague who gave evidence of a particularly strong dislike of the
idea of anyone being allowed to engage in a medical activity who
was not himself a medical man. I was in a position to say to him:
‘We have now been working for more than three months. At what
point in our analysis have I had occasion to make use of my medical
knowledge?’ He admitted that I had had no such occasion.

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   Again, I attach no great
importance to the argument that a lay analyst, because he must be
prepared to consult a doctor, will have no authority in the eyes of
his patients and will be treated with no more respect than such
people as bone-setters or masseurs. Once again, the analogy is an
imperfect one - quite apart from the fact that what governs
patients in their recognition of authority is usually their
emotional transference and that the possession of a medical diploma
does not impress them nearly so much as doctors believe. A
professional lay analyst will have no difficulty in winning as much
respect as is due to a secular pastoral worker. Indeed, the words,
‘secular pastoral worker’, might well serve as a
general formula for describing the function which the analyst,
whether he is a doctor or a layman, has to perform in his relation
to the public. Our friends among the protestant clergy, and more
recently among the catholic clergy as well, are often able to
relieve their parishioners of the inhibitions of their daily life
by confirming their faith - after having first offered them a
little analytic information about the nature of their conflicts.
Our opponents, the Adlerian ‘individual psychologists’,
endeavour to produce a similar result in people who have become
unstable and inefficient by arousing their interest in the social
community after having first thrown some light upon a single corner
of their mental life and shown them the part played in their
illness by their egoistic and distrustful impulses. Both of these
procedures, which derive their power from being based on analysis,
have their place in psychotherapy. We who are analysts set before
us as our aim the most complete and profoundest possible analysis
of whoever may be our patient. We do not seek to bring him relief
by receiving him into the catholic, protestant or socialist
community. We seek rather to enrich him from his own internal
sources, by putting at the disposal of his ego those energies
which, owing to repression, are inaccessibly confined in his
unconscious, as well as those which his ego is obliged to squander
in the fruitless task of maintaining these repressions. Such
activity as this is pastoral work in the best sense of the words.
Have we set ourselves too high an aim? Are the majority of our
patients worth the pains that this work requires of us? Would it
not be more economical to prop up their weaknesses from without
rather than to rebuild them from within? I cannot say; but there is
something else that I
do
know. In psycho-analysis there has
existed from the very first an inseparable bond between cure and
research. Knowledge brought therapeutic success. It was impossible
to treat a patient without learning something new; it was
impossible to gain fresh insight without perceiving its beneficent
results. Our analytic procedure is the only one in which this
precious conjunction is assured. It is only by carrying on our
analytic pastoral work that we can deepen our dawning comprehension
of the human mind. This prospect of scientific gain has been the
proudest and happiest feature of analytic work. Are we to sacrifice
it for the sake of any considerations of a practical sort?