Freud - Complete Works (808 page)
An Outline Of Psycho-Analysis
5011
So long as the ego works in full
harmony with the super-ego it is not easy to distinguish between
their manifestations; but tensions and estrangements between them
make themselves very plainly visible. The torments caused by the
reproaches of conscience correspond precisely to a child’s
fear of loss of love, a fear the place of which has been taken by
the moral agency. On the other hand, if the ego has successfully
resisted a temptation to do something which would be objectionable
to the super-ego, it feels raised in its self-esteem and
strengthened in its pride, as though it had made some precious
acquisition. In this way the super-ego continues to play the part
of an external world for the ego, although it has become a portion
of the internal world. Throughout later life it represents the
influence of a person’s childhood, of the care and education
given him by his parents and of his dependence on them - a
childhood which is prolonged so greatly in human beings by a family
life in common. And in all this it is not only the personal
qualities of these parents that is making itself felt, but also
everything that had a determining effect on them themselves, the
tastes and standards of the social class in which they lived and
the innate dispositions and traditions of the race from which they
sprang. Those who have a liking for generalizations and sharp
distinctions may say that the external world, in which the
individual finds himself exposed after being detached from his
parents, represents the power of the present; that his id, with its
inherited trends, represents the organic past; and that the
super-ego, which comes to join them later, represents more than
anything the cultural past, which a child has, as it were, to
repeat as an after-experience during the few years of his early
life. It is unlikely that such generalizations can be universally
correct. Some portion of the cultural acquisitions have undoubtedly
left a precipitate behind them in the id; much of what is
contributed by the super-ego will awaken an echo in the id; not a
few of the child’s new experiences will be intensified
because they are repetitions of some primaeval phylogenetic
experience.
‘Was du ererbt von deinen Vätern hast,
Erwirb es, um es zu besitzen.’¹
Thus the super-ego takes up a
kind of intermediate position between the id and the external
world; it unites in itself the influences of the present and the
past. In the establishment of the super-ego we have before us, as
it were, an example of the way in which the present is changed into
the past. . . .
*
*
*
* *
¹
[‘What thou hast inherited from thy
fathers, acquire it to make it thine’]
5012
ANALYSIS TERMINABLE AND INTERMINABLE
(1937)
5013
Intentionally left blank
5014
ANALYSIS TERMINABLE AND INTERMINABLE
I
Experience has taught us that psycho-analytic
therapy - the freeing of someone from his neurotic symptoms,
inhibitions and abnormalities of character - is a time-consuming
business. Hence, from the very first, attempts have been made to
shorten the duration of analyses. Such endeavours required no
justification; they could claim to be based on the strongest
considerations of reason and expediency. But there was probably
still at work in them as well some trace of the impatient contempt
with which the medical science of an earlier day regarded the
neuroses as being uncalled-for consequences of invisible injuries.
If it had now become necessary to attend to them, they should at
least be disposed of as quickly as possible.
A particularly energetic attempt
in this direction was made by Otto Rank, following upon his book,
The Trauma of Birth
(1924). He supposed that the true source
of neurosis was the act of birth, since this involves the
possibility of a child’s ‘primal fixation’ to his
mother not being surmounted but persisting as a ‘primal
repression’. Rank hoped that if this primal trauma were dealt
with by a subsequent analysis the whole neurosis would be got rid
of. Thus this one small piece of analytic work would save the
necessity for all the rest. And a few months should be enough to
accomplish this. It cannot be disputed that Rank’s argument
was bold and ingenious; but it did not stand the test of critical
examination. Moreover, it was a child of its time, conceived under
the stress of the contrast between the post-war misery of Europe
and the ‘prosperity’ of America, and designed to adapt
the tempo of analytic therapy to the haste of American life. We
have not heard much about what the implementation of Rank’s
plan has done for cases of sickness. Probably not more than if the
fire-brigade, called to deal with a house that had been set on fire
by an overturned oil-lamp, contented themselves with removing the
lamp from the room in which the blaze had started. No doubt a
considerable shortening of the brigade’s activities would be
effected by this means. The theory and practice of Rank’s
experiment are now things of the past - no less than American
‘prosperity’ itself.
Analysis Terminable And Interminable
5015
I myself had adopted another way
of speeding up an analytic treatment even before the war. At that
time I had taken on the case of a young Russian, a man spoilt by
wealth, who had come to Vienna in a state of complete helplessness,
accompanied by a private doctor and an attendant.¹ In the
course of a few years it was possible to give him back a large
amount of his independence, to awaken his interest in life and to
adjust his relations to the people most important to him. But there
progress came to a stop. We advanced no further in clearing up the
neurosis of his childhood, on which his later illness was based,
and it was obvious that the patient found his present position
highly comfortable and had no wish to take any step forward which
would bring him nearer to the end of his treatment. It was a case
of the treatment inhibiting itself: it was in danger of failing as
a result of its - partial - success. In this predicament I resorted
to the heroic measure of fixing a time limit for the analysis. At
the beginning of a year’s work I informed the patient that
the coming year was to be the last one of his treatment, no matter
what he achieved in the time still left to him. At first he did not
believe me, but once he was convinced that I was in deadly earnest,
the desired change set in. His resistances shrank up, and in these
last months of his treatment he was able to reproduce all the
memories and to discover all the connections which seemed necessary
for understanding his early neurosis and mastering his present one.
When he left me in the midsummer of 1914, with as little suspicion
as the rest of us of what lay so shortly ahead, I believed that his
cure was radical and permanent.
¹
See my paper published with the
patient’s consent, ‘From the History of an Infantile
Neurosis’ (1918
b
). It contains no detailed account of
the young man’s adult illness, which is touched on only when
its connection with his infantile neurosis absolutely requires
it.
Analysis Terminable And Interminable
5016
In a footnote added to this
patient’s case history in 1923, I have already reported that
I was mistaken. When, towards the end of the war, he returned to
Vienna, a refugee and destitute, I had to help him to master a part
of the transference which had not been resolved. This was
accomplished in a few months, and I was able to end my footnote
with the statement that ‘since then the patient has felt
normal and has behaved unexceptionably, in spite of the war having
robbed him of his home, his possessions, and all his family
relationships’. Fifteen years have passed since then without
disproving the truth of this verdict; but certain reservations have
become necessary. The patient has stayed on in Vienna and has kept
a place in society, if a humble one. But several times during this
period his good state of health has been interrupted by attacks of
illness which could only be construed as offshoots of his perennial
neurosis. Thanks to the skill of one of my pupils, Dr. Ruth Mack
Brunswick, a short course of treatment has on each occasion brought
these conditions to an end. I hope that Dr. Mack Brunswick herself
will shortly report on the circumstances. Some of these attacks
were still concerned with residual portions of the transference;
and, where this was so, short-lived though they were, they showed a
distinctly paranoid character. In other attacks, however, the
pathogenic material consisted of pieces of the patient’s
childhood history, which had not come to light while I was
analysing him and which now came away - the comparison is
unavoidable - like sutures after an operation, or small fragments
of necrotic bone. I have found the history of this patient’s
recovery scarcely less interesting than that of his illness.
I have subsequently employed this
fixing of a time-limit in other cases as well, and I have also
taken the experiences of other analysts into account. There can be
only one verdict about the value of this blackmailing device: it is
effective provided that one hits the right time for it. But it
cannot guarantee to accomplish the task completely. On the
contrary, we may be sure that, while part of the material will
become accessible under the pressure of the threat, another part
will be kept back and thus become buried, as it were, and lost to
our therapeutic efforts. For once the analyst has fixed the
time-limit he cannot extend it; otherwise the patient would lose
all faith in him. The most obvious way out would be for the patient
to continue his treatment with another analyst, although we know
that such a change will involve a fresh loss of time and abandoning
fruits of work already done. Nor can any general rule be laid down
as to the right time for resorting to this forcible technical
device; the decision must be left to the analyst’s tact. A
miscalculation cannot be rectified. The saying that a lion only
springs once must apply here.
Analysis Terminable And Interminable
5017
II
The discussion of the technical
problem of how to accelerate the slow progress of an analysis leads
us to another, more deeply interesting question: is there such a
thing as a natural end to an analysis - is there any possibility at
all of bringing an analysis to such an end? To judge by the common
talk of analysts it would seem to be so, for we often hear them
say, when they are deploring or excusing the recognized
imperfections of some fellow-mortal: ‘His analysis was not
finished’ or ‘he was never analysed to the
end.’
We must first of all decide what
is meant by the ambiguous phrase ‘the end of an
analysis’. From a practical standpoint it is easy to answer.
An analysis is ended when the analyst and the patient cease to meet
each other for the analytic session. This happens when two
conditions have been approximately fulfilled: first, that the
patient shall no longer be suffering from his symptoms and shall
have overcome his anxieties and his inhibitions; and secondly, that
the analyst shall judge that so much repressed material has been
made conscious, so much that was unintelligible has been explained,
and so much internal resistance conquered, that there is no need to
fear a repetition of the pathological processes concerned. If one
is prevented by external difficulties from reaching this goal, it
is better to speak of an
incomplete
analysis rather than of
an
unfinished
one.
The other meaning of the
‘end’ of an analysis is much more ambitious. In this
sense of it, what we are asking is whether the analyst has had such
a far-reaching influence on the patient that no further change
could be expected to take place in him if his analysis were
continued. It is as though it were possible by means of analysis to
attain to a level of absolute psychical normality - a level,
moreover, which we could feel confident would be able to remain
stable, as though, perhaps, we had succeeded in resolving every one
of the patient’s repressions and in filling in all the gaps
in his memory. We may first consult our experience to enquire
whether such things do in fact happen, and then turn to our theory
to discover whether there is any
possibility
of their
happening.
Analysis Terminable And Interminable
5018
Every analyst will have treated a
few cases which have had this gratifying outcome. He has succeeded
in clearing up the patient’s neurotic disturbance, and it has
not returned and has not been replaced by any other such
disturbance. Nor are we without some insight into the determinants
of these successes. The patient’s ego had not been noticeably
altered and the aetiology of his disturbance had been essentially
traumatic. The aetiology of every neurotic disturbance is, after
all, a mixed one. It is a question either of the instincts being
excessively strong - that is to say, recalcitrant to taming by the
ego - or of the effects of early (i.e. premature) traumas which the
immature ego was unable to master. As a rule there is a combination
of both factors, the constitutional and the accidental. The
stronger the constitutional factor, the more readily will a trauma
lead to a fixation and leave behind a developmental disturbance;
the stronger the trauma, the more certainly will its injurious
effects become manifest even when the instinctual situation is
normal. There is no doubt that an aetiology of the traumatic sort
offers by far the more favourable field for analysis. Only when a
case is a predominantly traumatic one will analysis succeed in
doing what it is so superlatively able to do; only then will it,
thanks to having strengthened the patient’s ego, succeed in
replacing by a correct solution the inadequate decision made in his
early life. Only in such cases can one speak of an analysis having
been definitively ended. In them, analysis has done all that it
should and does not need to be continued. It is true that, if the
patient who has been restored in this way never produces another
disorder calling for analysis, we do not know how much his immunity
may not be due to a kind fate which has spared him ordeals that are
too severe.
Analysis Terminable And Interminable
5019
A constitutional strength of
instinct and an unfavourable alteration of the ego acquired in its
defensive struggle in the sense of its being dislocated and
restricted - these are the factors which are prejudicial to the
effectiveness of analysis and which may make its duration
interminable. One is tempted to make the first factor - strength of
instinct - responsible as well for the emergence of the second -
the alteration of the ego; but it seems that the latter too has an
aetiology of its own. And, indeed, it must be admitted that our
knowledge of these matters is as yet insufficient. They are only
now becoming the subject of analytic study. In this field the
interest of analysts seems to me to be quite wrongly directed.
Instead of an enquiry into how a cure by analysis comes about (a
matter which I think has been sufficiently elucidated) the question
should be asked of what are the obstacles that stand in the way of
such a cure.
This brings me to two problems
which arise directly out of analytic practice, as I hope to show by
the following examples. A certain man, who had himself practised
analysis with great success, came to the conclusion that his
relations both to men and women - to the men who were his
competitors and to the woman whom he loved - were nevertheless not
free from neurotic impediments; and he therefore made himself the
subject of an analysis by someone else whom he regarded as superior
to himself. This critical illumination of his own self had a
completely successful result. He married the woman he loved and
turned into a friend and teacher of his supposed rivals. Many years
passed in this way, during which his relations with his former
analyst also remained unclouded. But then, for no assignable
external reason, trouble arose. The man who had been analysed
became antagonistic to the analyst and reproached him for having
failed to give him a complete analysis. The analyst, he said, ought
to have known and to have taken into account the fact that a
transference-relation can never be purely positive; he should have
given his attention to the possibilities of a negative
transference. The analyst defended himself by saying that, at the
time of the analysis, there was no sign of a negative transference.
But even if he had failed to observe some very faint signs of it -
which was not altogether ruled out, considering the limited horizon
of analysis in those early days - it was still doubtful, he
thought, whether he would have had the power to activate a topic
(or, as we say, a ‘complex’) by merely pointing it out,
so long as it was not currently active in the patient himself at
the time. To activate it would certainly have required some
unfriendly piece of behaviour in reality on the analyst’s
part. Furthermore, he added, not every good relation between an
analyst and his subject during and after analysis was to be
regarded as a transference; there were also friendly relations
which were based on reality and which proved to be viable.