Freud - Complete Works (809 page)

Analysis Terminable And Interminable

5020

   I now pass on to my second
example, which raises the same problem. An unmarried woman, no
longer young, had been cut off from life since puberty by an
inability to walk, owing to severe pains in the legs. Her condition
was obviously of a hysterical nature, and it had defied many kinds
of treatment. An analysis lasting three-quarters of a year removed
the trouble and restored to the patient, an excellent and worthy
person, her right to a share in life. In the years following her
recovery she was consistently unfortunate. There were disasters in
her family, and financial losses, and, as she grew older, she saw
every hope of happiness in love and marriage vanish. But the
one-time invalid stood up to all this valiantly and was a support
to her family in difficult times. I cannot remember whether it was
twelve or fourteen years after the end of her analysis that, owing
to profuse haemorrhages, she was obliged to undergo a
gynaecological examination. A myoma was found, which made a
complete hysterectomy advisable. From the time of this operation,
the woman became ill once more. She fell in love with her surgeon,
wallowed in masochistic phantasies about the fearful changes in her
inside - phantasies with which she concealed her romance - and
proved inaccessible to a further attempt at analysis. She remained
abnormal to the end of her life. The successful analytic treatment
took place so long ago that we cannot expect too much from it; it
was in the earliest years of my work as an analyst. No doubt the
patient’s second illness may have sprung from the same source
as her first one which had been successfully overcome: it may have
been a different manifestation of the same repressed impulses,
which the analysis had only incompletely resolved. But I am
inclined to think that, were it not for the new trauma, there would
have been no fresh outbreak of neurosis.

Analysis Terminable And Interminable

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   These two examples, which have
been purposely selected from a large number of similar ones, will
suffice to start a discussion of the topics we are considering. The
sceptical, the optimistic and the ambitious will take quite
different views of them. The first will say that it is now proved
that even a successful analytic treatment does not protect the
patient, who at the time has been cured, from falling ill later on
of another neurosis - for, indeed, of a neurosis derived from the
same instinctual root - that is to say, from a recurrence of his
old trouble. The others will consider that this is not proved. They
will object that the two examples date from the early days of
analysis, twenty and thirty years ago, respectively; and that since
then we have acquired deeper insight and wider knowledge, and that
our technique has changed in accordance with our new discoveries.
To-day, they will say, we may demand and expect that an analytic
cure shall prove permanent, or at least that if a patient falls ill
again, his new illness shall not turn out to be a revival of his
earlier instinctual disturbance, manifesting itself in new forms.
Our experience, they will maintain, does not oblige us to restrict
so materially the demands that can be made upon our therapeutic
method.

   My reason for choosing these two
examples is, of course, precisely because they lie so far back in
the past. It is obvious that the more recent the successful outcome
of an analysis is, the less utilizable it is for our discussion,
since we have no means of predicting what the later history of the
recovery will be. The optimists’ expectations clearly
presuppose a number of things which are not precisely self-evident.
They assume, firstly, that there really is a possibility of
disposing of an instinctual conflict (or, more correctly, a
conflict between the ego and an instinct) definitively and for all
time; secondly, that while we are treating someone for one
instinctual conflict we can, as it were, inoculate him against the
possibility of any other such conflicts; and thirdly, that we have
the power, for purposes of prophylaxis, to stir up a pathogenic
conflict of this sort which is not betraying itself at the time by
any indications, and that it is wise to do so. I throw out these
questions without proposing to answer them now. Perhaps it may not
be possible at present to give any certain answer to them at
all.

   Some light may probably be thrown
on them by theoretical considerations. But another point has
already become clear: if we wish to fulfil the more exacting
demands upon analytic therapy, our road will not lead us to, or by
way of, a shortening of its duration.

Analysis Terminable And Interminable

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III

   An analytic experience which now
extends over several decades, and a change which has taken place in
the nature and mode of my activity, encourage me to attempt to
answer the questions before us. In earlier days I treated quite a
large number of patients, who, as was natural, wanted to be dealt
with as quickly as possible. Of late years I have been mainly
engaged in training analyses; a relatively small number of severe
cases of illness remained with me for continuous treatment,
interrupted, however, by longer or shorter intervals. With them,
the therapeutic aim was no longer the same. There was no question
of shortening the treatment; the purpose was radically to exhaust
the possibilities of illness in them and to bring about a
deep-going alteration of their personality.

   Of the three factors which we
have recognized as being decisive for the success or otherwise of
analytic treatment - the influence of traumas, the constitutional
strength of the instincts and alterations of the ego - what
concerns us here is only the second, the strength of the instincts.
A moment’s reflection raises a doubt whether the restrictive
use of the adjective ‘constitutional’ (or
‘congenital’) is essential. However true it may be that
the constitutional factor is of decisive importance from the very
beginning, it is nevertheless conceivable that a reinforcement of
instinct coming later in life might produce the same effects. If
so, we should have to modify our formula and say ‘the
strength of the instincts
at the time
’ instead of
‘the
constitutional
strength of the instincts’.
The first of our questions was: ‘Is it possible by means of
analytic therapy to dispose of a conflict between an instinct and
the ego, or of a pathogenic instinctual demand upon the ego,
permanently and definitively?’ To avoid misunderstanding it
is not unnecessary, perhaps, to explain more exactly what is meant
by ‘permanently disposing of an instinctual demand’.
Certainly not ‘causing the demand to disappear so that
nothing more is ever heard from it again’. This is in general
impossible, nor is it at all to be desired. No, we mean something
else, something which may be roughly described as a
‘taming’ of the instinct. That is to say, the instinct
is brought completely into the harmony of the ego, becomes
accessible to all the influences of the other trends in the ego and
no longer seeks to go its independent way to satisfaction. If we
are asked by what methods and means this result is achieved, it is
not easy to find an answer. We can only say: ‘So muss denn
doch die Hexe dran!’ - the Witch Metapsychology. Without
metapsychological speculation and theorizing - I had almost said
‘phantasying’ - we shall not get another step forward.
Unfortunately, here as elsewhere, what our Witch reveals is neither
very clear nor very detailed. We have only a single clue to start
from - though it is a clue of the highest value - namely, the
antithesis between the primary and the secondary processes; and to
that antithesis I shall at this point turn.

Analysis Terminable And Interminable

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   If now we take up our first
question once more, we find that our new line of approach
inevitably leads us to a particular conclusion. The question was
whether it is possible to dispose of an instinctual conflict
permanently and definitively - i.e. to ‘tame’ an
instinctual demand in that fashion. Formulated in these terms, the
question makes no mention at all of the strength of the instinct;
but it is precisely on this that the outcome depends. Let us start
from the assumption that what analysis achieves for neurotics is
nothing other than what normal people bring about for themselves
without its help. Everyday experience, however, teaches us that in
a normal person any solution of an instinctual conflict only holds
good for a particular strength of instinct, or, more correctly,
only for a particular relation between the strength of the instinct
and the strength of the ego.¹ If the strength of the ego
diminishes, whether through illness or exhaustion, or from some
similar cause, all the instincts which have so far been
successfully tamed may renew their demands and strive to obtain
substitutive satisfactions in abnormal ways.² Irrefutable
proof of this statement is supplied by our nightly dreams; they
react to the sleeping attitude assumed by the ego with an awakening
of instinctual demands.

  
¹
Or, to be perfectly accurate, where that
relation falls within certain limits.

  
²
Here we have a justification of the claim
to aetiological importance of such non-specific factors as
overwork, shock, etc. These factors have always been assured of
general recognition, but have had to be pushed into the background
precisely by psycho-analysis. It is impossible to define health
except in metapsychological terms: i.e. by reference to the dynamic
relations between the agencies of the mental apparatus which have
been recognized - or (if that is preferred) inferred or conjectured
- by us.

Analysis Terminable And Interminable

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   The material on the other side is
equally unambiguous. Twice in the course of individual development
certain instincts are considerably reinforced: at puberty, and, in
women, at the menopause. We are not in the least surprised if a
person who was not neurotic before becomes so at these times. When
his instincts were not so strong, he succeeded in taming them; but
when they are reinforced he can no longer do so. The repressions
behave like dams against the pressure of water. The same effects
which are produced by these two physiological reinforcements of
instinct, may be brought about in an irregular fashion by
accidental causes at any other period of life. Such reinforcements
may be set up by fresh traumas, enforced frustrations, or the
collateral influence of instincts upon one another. The result is
always the same, and it underlines the irresistible power of the
quantitative factor in the causation of illness.

   I feel as though I ought to be
ashamed of so much ponderous exposition, seeing that everything I
have said has long been familiar and self-evident. It is a fact
that we have always behaved as if we knew all this; but, for the
most part, our theoretical concepts have neglected to attach the
same importance to the
economic
line of approach as they
have to the
dynamic
and
topographical
ones. My excuse
is therefore that I am drawing attention to this neglect.

   Before we decide on an answer to
this question, however, we must consider an objection whose force
lies in the fact that we are probably predisposed in its favour.
Our arguments, it will be said, are all deduced from the processes
which take place spontaneously between the ego and the instincts,
and they presuppose that analytic therapy can accomplish nothing
which does not, under favourable and normal conditions, occur of
itself. But is this really so? Is it not precisely the claim of our
theory that analysis produces a state which never does arise
spontaneously in the ego and that this newly created state
constitutes the essential difference between a person who has been
analysed and a person who has not? Let us bear in mind what this
claim is based on. All repressions take place in early childhood;
they are primitive defensive measures taken by the immature, feeble
ego. In later years no fresh repressions are carried out; but the
old ones persist, and their services continue to be made use of by
the ego for mastering the instincts. New conflicts are disposed of
by what we call ‘after-repression’. We may apply to
these infantile repressions our general statement that repressions
depend absolutely and entirely on the relative strength of the
forces involved and that they cannot hold out against an increase
in the strength of the instincts. Analysis, however, enables the
ego, which has attained greater maturity and strength, to undertake
a revision of these old repressions; a few are demolished, while
others are recognized but constructed afresh out of more solid
material. These new dams are of quite a different degree of
firmness from the earlier ones; we may be confident that they will
not give way so easily before a rising flood of instinctual
strength. Thus the real achievement of analytic therapy would be
the subsequent correction of the original process of repression, a
correction which puts an end to the dominance of the quantitative
factor.

Analysis Terminable And Interminable

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   Thus far our theory, which we
cannot give up except under irresistible compulsion. And what does
our
experience
have to say to this? Perhaps our experience
is not yet wide enough for us to come to a settled conclusion. It
confirms our expectations often enough, but not always. One has an
impression that one ought not to be surprised if it should turn out
in the end that the difference between a person who has not been
analysed and the behaviour of a person after he has been analysed
is not so thorough-going as we aim at making it and as we expect
and maintain it to be. If this is so, it would mean that analysis
sometimes
succeeds in eliminating the influence of an
increase in instinct, but not invariably, or that the effect of
analysis is limited to increasing the power of resistance of the
inhibitions, so that they are equal to much greater demands than
before the analysis or if no analysis had taken place. I really
cannot commit myself to a decision on this point, nor do I know
whether a decision is possible at the present time.