INTRODUCTION (continued 2)

“It seems to be my turn, now, to ask a question which I have had on my mind for a long time. What do you call ‘sexual indulgence’ of a child, during his period of early sexuality which, as you say, is a time that was completely overlooked before the advent of psychoanalysis?”

Of course that which is usual and essential in this indulgence had not been overlooked. This is not so remarkable, because it simply couldn’t be overlooked. Sexual tendencies of the child find their expression mainly in masturbation. That this childish “naughtiness” is extraordinarily common was always known to adults. It is considered a grave sin, to be energetically suppressed.

But please do not ask me how such “immoral” tendencies in children—and children admit that they indulge in them because they give them pleasure!—can co-exist with that inborn purity and non-sensuality of which we love to prate. You had better ask our opponents to solve this puzzle for you.

112A much more important problem is facing us now:—What is the position to take towards sexual indulgence in early childhood?

There is not the slightest doubt as to the responsibility incurred by suppressing such actions and, on the other hand, one dare not permit it to go on, limitless.

It appears that sexuality of children is unrestricted among peoples of low civilization and in the lower strata of civilized people. Such tolerance may amount to a strong protection against the possibility of neuroses cropping up in later years, but the question is whether there does not then remain a concurrent, extraordinary loss in regard to an individual’s aptness for cultural achievements. It seems we are facing a case of Scylla and Charybdis there.

However, I shall leave it to you to decide whether such interest, as the study of sex life may have for neurotics, would tend to create an atmosphere, favorable for the awakening of libidinous desires.

113

VI

“I think I know now what your intentions are:—You wish to show me just what knowledge is necessary for the practice of psychoanalysis, so that I may be able to judge whether physicians alone shall be permitted to apply this method. Up to now, you have mainly discussed psychology, and a little biology or sex science, without a decided medical slant. However, I may not have heard everything yet.”

Certainly not. There are still a number of gaps to be filled. But may I ask you a favor? Will you be good enough to describe to me how you imagine psychoanalytical treatment is applied? Just pretend as if it were up to you to analyse a patient.

“Well, I may make quite a mess of this! It is surely not my intention to settle the argument between us, on the basis of such an experiment. However, I shall do as you ask. 114After all, the responsibility falls upon your shoulders.

“Now then: I assume that the patient comes to see me and embarks upon a recital of his complaints. I promise him to cure, or at least improve, his condition, provided that he will follow my instructions. Then, I would ask him to tell me, in all frankness, what he knows, what ideas enter his mind. I should also request him to make a clean breast of everything, even though there may be things which he would hate to mention. Am I adhering to your methods?”

You are! But, in addition you should have the patient tell you all his thoughts, even if they seem unimportant to him or lacking in sense.

“Very well.—The patient, then, starts to relate his story and I listen. And what next? Oh, yes, his information will make it possible for me to conclude what impressions, experiences and desires he may have repressed, because he came face to face with them at a time when his ‘I’ was still weak and too intimidated to face the dilemma squarely.

115“After I have told that to the patient, he will reconstruct the old situations and correct his reactions to them with my assistance. Thus, the repressions, his ‘I’ had been forced to resort to, will disappear and he is cured.—Is that correct?”

Very good, indeed.—I already foresee that more people are going to reproach me for having trained a non-medical man to practise psychoanalysis. I surely must admit that you digested what I told you.

“I have only repeated what you told me, like reciting something that has been committed to memory.

“But I do not feel able to clearly visualize how I really would go about it. I cannot understand why such an analysis should require an hour or more a day, for a period of months. As a rule, the average human being has not met with so many experiences. And as far as repressions during childhood are concerned, I assume that these are probably identical in all cases.”

There are many new experiences to make in the course of an analysis.

116For example: You would find that it is not so simple at all, from the information a patient may volunteer, to draw conclusions as to those of his experiences which he has forgotten, the urges which he once repressed.

A patient may tell you something which, at the moment, has just as little sense for you as for him. You will have to make up your mind that the material which the patient lays before you, in accordance with the instruction you gave him, must be interpreted in a special way. Analogous, perhaps, to the treatment iron ore receives for the purpose of extracting from it valuable steel by some special process. In retaining this picture, for the purpose of comparison, you must know that tons and tons of iron ore contain only very little of the valuable steel for which you are looking. This is one reason which would account for the fact that psychoanalytical treatment is such a long drawn-out process.

“But how is this ‘iron ore’ to be converted, to apply your comparison once more?”

By assuming that the information and ideas of a patient are nothing but distorted pictures 117of those impressions and experiences you are trying to unearth. Hints, as it were, from which you would have to conclude what is really behind them. To press it into a formula: the information a patient yields, be it memories, ideas or dreams, will have to be interpreted first. This interpretation, of course, must be guided by the expectations you formed of the case on the basis of professional knowledge, while listening to the patient’s recital.

“‘Interpretation’! What a dreadful word! I do not like to hear this term because, in applying it, you are depriving me of all confidence. If everything depends on my interpretation, who is going to assure me that my interpretation is correct? Such a state of affairs, according to my mind, simply means that everything is left to fancies and whims.”

Just a moment, now! Things are not as bad as all that. Why exclude processes of your own soul from the same rule which you are ready to admit to that of others?

Provided you have acquired a certain self-discipline and are in the possession of sufficient 118information, your interpretations will not be influenced by personal peculiarities, and are bound to prove correct.

Do not draw the conclusion from this that it is my opinion that the personality of the analyst does not make any difference, for this phase of the analysis. A certain sensitiveness for that which was unconsciously repressed, is necessary; also an aptness with which everybody is not equally endowed. Most of all, it is here where the absolute necessity for a thorough and searching self-analysis of the analyst is proved, for the purpose of precluding any prejudice that may drag a distorted element into the interpretation.

One thing, of course, still remains: Personal Equation, which, as an element of individuality, is destined to play a much more important part in psychoanalysis than anywhere else. Although an abnormal man may develop into an expert physicist, an analyst will always be handicapped by his own anomalies, when it comes to conceive pictures of soul life, free from distortions.

Inasmuch as it is impossible to prove to 119anybody his anomalies, general unanimity in the matter of Psychology of the Depths will prove especially difficult to achieve. There are even a handful of psychologists who claim it to be practically impossible ever to achieve such unanimity, and who also insist that every fool is entitled to proclaim his special brand of foolishness as wisdom.

I admit I am more optimistically inclined. After all, our experiences prove that, even in psychology, harmony of opinion may be achieved to a tolerably satisfactory degree. No doubt, each individual realm of science presents its own individual difficulties which have to be eliminated. Moreover, there are some aspects of the art of interpretation, as applied in analysis which, like some other knowledge, may be acquired by study. For example, those aspects pertaining to the peculiarly indirect representation by symbols.

“To be frank with you: I have lost all ambition, even to dabble theoretically with the application of psychoanalysis. Heaven knows what further surprises are still in store for me!”

120You are perfectly correct to abandon such an intention.

You have already convinced yourself how much training and practice is necessary. And once you have found the correct interpretations, a new problem presents itself. It is then up to you to lay in wait and virtually pounce upon the correct, the psychological moment, if you wish to acquaint your patient of your interpretations with the idea of benefiting him.

“How to tell what is the psychological moment?”

That is a matter of extreme tact which, by the way, may be greatly improved through experience. You would commit a very grave error if you would fling your interpretation, as soon as it had been ascertained, at the patient. This would only lead to resistance, refusal, indignation, but never result in his “I” getting a firm hold of whatever it was that caused his repressions. It is an iron clad rule to permit your patient to approach this elusive cause of repression close enough, to make it possible for him to obtain an immediate and strong 121grip on it, under the correctly timed guidance of the interpretation you may suggest.

“I am very much afraid that I would never master this art. But suppose that I observe this rule strictly, then what?”

Then it will be your lot to make a discovery which you did not expect to make.

“What kind of a discovery?”

That you had an entirely wrong opinion about your patient. That there is no reason in the world for you to depend on his coöperation or complacency. That, as a matter of fact, your patient is resolved to raise as many obstacles as possible against your combined exertions. With one word: that he does not altogether want to get well!

“Well, that is about the most ludicrous statement you have made so far! I simply don’t believe it! The patient, suffering so intensely, complaining so heartrendingly, sacrificing so much to be cured, actually does not want to get well! Is it possible you really mean what you say?”

I mean every word of it! What I have just stated is the truth. Not the whole truth, but a 122good deal of it. The patient wants, yet does not want, to get well. Because his “I” has lost its unity of purpose, it is preventing him from summing up undivided will power. Were the state of affairs a different one, our patient would not be a neurotic!

The results of his repression have simply invaded his “I,” firmly holding their ground there, so to speak. The “I” is wielding just as little influence over these effects as over the repression itself. Usually, the “I” is not at all aware of the prevailing state of affairs. These patients are of a peculiar type, putting difficulties in our way which we do not expect to encounter. All our social institutions are organized to fit individuals with a unified, normal “I,” which may be classified as either good or bad. This “I” either functions properly, or is impeded by some overwhelming influence. Thus, the forensic alternative: mentally responsible or not responsible.

But all these standard terms do not fit the neurotic!

Doubtless, it is difficult to adapt the demands of social life to their psychological condition. 123During the War, this was proved to a great extent.

Were those neurotics who shirked from military duty, pretending illness, simulants or not?

They were both!

As soon as such patients were treated as simulants, by making it uncomfortable for them to indulge in sickness, they recuperated; and as soon as allegedly cured patients had been returned to the rank and file, they once more became ill. There was simply no way to deal effectively with them.

Analogous to this is the case of the neurotic in everyday life.

They complain about their sickness, at the same time exploiting it to the limit. As a matter of fact, if an attempt is made to cure them of their ailment, they will protect this most cherished possession of theirs with the selfsame fervor with which a lioness defends her offspring. But there would be no sense in blaming neurotics for the contradictory behavior they display.

“Would it not be best, then, not to treat such 124difficult people at all? Simply leave them to themselves? It seems to me that it cannot possibly be worthwhile to spend as much effort on them as appears necessary, according to what you say.”

I do not agree with you on this point.

Doubtless, it seems wiser to simply submit to the complications which life presents, rather than to fight them. Not each and every one of the neurotics we treat may be worth the exertions of an analysis, but there are surely enough worthwhile individuals among them. It must be our goal to decrease the number of persons who are forced to face the exasperations of civilized life with a soul insufficiently prepared. To this end, we must collect experience upon experience, and come to fully grasp many problems. Every analysis is bound to prove instructive, yielding new knowledge, aside from the personal benefit it may confer upon an individual patient.

“Supposing that the ‘I’ of a patient developed such tendencies which would make him wish to retain the sickness of which he complains, would not these tendencies be justified, 125on the basis of certain reasons and motives? It is impossible for me to understand why somebody should want to be sick. What satisfaction could he derive from that?”

Just remember the war neurotics who were exempt from duty, because they were considered sick. In everyday life, sickness may be successfully employed as a screen, behind which to hide professional insufficiencies, or—in the circle of family life—as a means to induce relatives to make sacrifices, demonstrations of affection, or to foist one’s will upon them, generally. All this is quite obvious and comes under the term “sickness profit” (analogous to war profit). It is remarkable, however, that the neurotic, or rather his “I,” proves unable to grasp the connection of such motives with their logical consequences.

The influence of such tendencies to gain “sickness profit” is combated, by forcing the “I” to become aware of them. But there are still other, more obscure motives, for holding on to sickness, which cannot be disposed so easily. As a matter of fact, these reasons cannot be understood, without venturing once 126more into the sphere of psychological theories.

“Oh, go right ahead! A little theory, more or less—what does it matter?”

When I explained to you the relations between the “I” and the “It,” I withheld from you an important part of the soul apparatus. You see, within the “I” itself, there persists a particular faction which we call the “Super-Ego.”

This “Super-Ego” enjoys a privileged position between the “I” and the “It.” It belongs to the “I,” sharing with it its intricate psychological make-up. On the other hand, it entertains very close relations with the “It.” The “Super-Ego” is in reality the record of first impressions as conceived by the “It”; it is the heir of the dissolved Œdipus Complex.

This “Super-Ego,” as a matter of fact, is able to oppose the “I,” act towards it as if it were something inferior and, in general, treat it almost with contempt. For the “I” it is just as important to remain in agreement with the “Super-Ego” as with the “It.” Disagreement between the “Super-Ego” and the “I” is of far-reaching consequences for the soul life.

127Doubtless, you have already surmised that the “Super-Ego” is the agent of that phenomenon which we call our conscience.

For the maintenance of healthy soul life, it is very important that the “Super-Ego” develop normally, that is, becomes sufficiently impersonal. It is just this development which is insufficient in the neurotic, because his Œdipus Complex was not properly transformed. His “Super-Ego,” in regard to the “I,” still assumes the rôle of the strict father to the child, with the morality of the “I” manifesting itself in a primitive manner by meekly submitting to punishment, meted out by the “Super-Ego.” Sickness is resorted to, as the means of this “self-punishment.” The neurotic, behaving as if under a burden of guilt accepts sickness as a punishment to assuage this feeling of delinquency.

“That sounds very mysterious. But the most remarkable thing seems to be that the patient remains unconscious of the power of his conscience.”

Well, we are only now beginning to appreciate the importance of all these vital conditions. 128That is the reason why my explanations were so puzzling to you. But now, I believe I can continue.

All those agents which oppose the recuperation of a patient, we term the “resistance” of the patient. While “sickness profit” is the source of such resistance, the “unconscious feeling of guilt” represents the resistance of the “Super-Ego” of which, as the strongest factor, we are very much in fear.

But there are other manifestations of resistance which become evident in the process of treatment.

If the “I,” at an early period, was induced through fear, to take recourse to a repression, this fear still persists, manifesting itself now as a resistance, as soon as the “I” approaches that which was repressed. It is easy enough to realize that difficulties may be encountered, if a certain tendency, which for decades has proceeded along a specific course, is suddenly expected to swing into a new path opened to it.

Such a condition may be termed the resistance of the “It.”

The battle against all these resistances is our 129main work during the analytical treatment, in comparison with which the task of interpretation almost fades into insignificance. But by this battle and the ensuing defeat of resistances, the “I” of the patient is so transformed and strengthened that his future behavior, after the termination of the treatment, may be regarded with complete equanimity.

On the other hand, you will understand now why our treatment is so protracted. Expanse and multifariousness of the material are not as decisive factors as the question of whether the way is clear. Remember that the same course, which in times of peace, may be traveled in a few hours by railroad, may take an army, during wartime, weeks and weeks, because the resistance of the enemy must first be overcome. Battles to overcome resistance require time in soul life also. I am sorry to say that, up to now, all exertions to shorten the duration of analytical treatments to any appreciable degree, have proved unavailing. It seems that the best way to shorten the length of the treatment, is simply to apply it as correctly as possible.

130“If I ever felt the temptation to dabble with your science and to attempt to analyze a patient, your information in reference to those resistances, that may be encountered, cured me thoroughly of any such ambition.

“But, tell me about the element of personal influence which you have admitted is present in the analysis. Is this not a valuable factor in the battle against resistance?”

I am glad that you bring this question up. This personal influence is our strongest dynamic weapon; it is the agent which we introduce as something new, into the analytical situation, thus lending it impetus.

This could never be accomplished by the intellectual substance of our interpretation alone because the patient, sharing all the prejudices of his environment, need not have more faith in us than our scientific critics. The neurotic coöperates with the analyst simply because he believes in him, and he believes in him because he gradually develops a certain sentimental trend toward the analyst. A child, also, believes only persons to whom it is attached.

131I have already told you how we employ this especially great “suggestive” influence. Not to suppress the symptoms—it is here where the analytical method is utterly unlike any other psycho-therapeutical method!—but as a driving power to induce the “I” of the patient to defeat his resistances.

“And suppose you succeed? Would that insure easy sailing from then on?”

Such ought to be the case. But an unexpected complication arises.

It was perhaps the greatest surprise for the analyst to observe that the sentimental relations which the patient endeavors to establish, are of a very particular nature. Already the first physician who attempted analysis—it was not I—discovered this phenomenon, which served to bewilder him intensely. These sentimental relations are, to express it bluntly, of an amorous nature. Remarkable, isn’t it, if you take into consideration the fact that the analyst does nothing to invite such emotions, but rather endeavors to maintain distance, sentimentally speaking, between the patient and himself.

132All this is so much more remarkable, as these odd sentimental relations utterly disregard all such obstacles, as difference in age, sex, and social strata. This amorousness appears fated. Not that it constitutes a characteristic otherwise alien to spontaneous love. You are well aware that the contrary of this may be only too frequently observed. Although it is the rule in the analytical situation, the latter, as such, cannot serve as a rational explanation for this development. To all appearances, nothing else should result from the relation between the patient and the analyst, than just a certain measure of respect, confidence, gratitude and humane sympathy. However, what really results from it is this condition of attachment, which in itself gives the impression of being some disorder.

“Well, I should say that such a development would tend to favor analytical purposes. If one is enamoured, one is complacent and ready to do almost anything for love’s sweet sake.”

Of course, in the beginning, this condition favors the analysis, but later on, when these sentimental relations gradually become intensified, 133displaying their inherent nature, difficulties crop up which do not promote the aim of the analysis. You see, an enamoured patient is not satisfied merely to obey the analyst. The patient becomes presumptuous, demanding tenderness and sensual gratification. Eventually, jealousy develops and the lovelorn patient gradually arrives at a stage where more and more clearly, a preparedness for enmity and revenge is shown. Simultaneously, analogous to any other form of love, all other impulses of the soul are repressed, submerging the interest in treatment and recuperation. There is no doubt that love has assumed the place of the neurosis, and that our labors have simply resulted in substituting one disturbance for another.

“That sounds hopeless. What can be done? Perhaps analysis in such a case should be discarded. But since you say that every case yields this result, then analysis in general would have to be discarded.”

First, let us take stock of the situation in order to learn from it. Whatever is thus gained may assist us in mastering the situation. After 134all, is it not quite remarkable that we should succeed in transforming a neurotic condition into a state of unwholesome attachment?

Our conviction that neurotic conditions arise partly from abnormally directed sentimental tendencies, gains unquestionable corroboration by our findings. Ascertaining these facts, we feel more assured and dare to make this enamoured condition the object of analysis.

We also make another observation. This condition of amorousness, as part of the analysis, is not always so apparent in all cases, as I have tried to picture it to you.

And why isn’t that the case? We shall soon see.

In the same measure as the sensual and hostile aspects of a patient’s attachment endeavor to manifest themselves, the inherent opposition of the patient against such tendencies asserts itself. He combats them and attempts to repress them, before our very eyes. Thus we come to comprehend the whole development:—The patient merely repeats, in the form of being enamoured with the analyst, experiences 135of his soul life of days gone by. Certain tendencies of his soul, ready to burst forth, and closely connected with the inception of his neurosis, have simply been transferred by him to the analyst. He also repeats before our eyes all those gestures of opposition, gone through before, and would like nothing so much as to repeat in his relations with the analyst, all the phases of that forgotten period of his life.

What the patient is showing us now is accordingly the very nucleus of the most intimate story of his life. He is reproducing this nucleus in a tangible form, as if actual, instead of just remembering this incipient stage of his condition. Thus, the riddle of transferred love has been solved and the analysis, with the assistance of this new discovery which, for a time, almost seemed to wreck it, may be continued.

“That is surely complicated. Does the patient believe so easily that he is not in love, and merely feels forced to revive an old episode, as it were?”

Everything now depends upon the greatest dexterity in handling this “transference,” to 136achieve our objective. You will easily see that the demands of the analytical technique at this point are very exacting. It is here where the most serious mistakes may be committed, or the most splendid results achieved. Any attempt to evade these difficulties, by suppressing or neglecting the transference, would be senseless. Such evasion would not be deserving of the term of analysis. To send a patient home, as soon as the discomfort of a transference neurosis manifests itself, would also be senseless and would amount to cowardice. It would be approximately analogous to calling forth spirits and then running away, as soon as they put in their appearance.

Of course, there is no other way out sometimes. There are cases in which it is impossible to master an unshackled transference, and the analysis must then be terminated. But at least one should wrestle with these evil spirits to the best of one’s ability.

To give in to the demands of a transference—the desires of a patient for tenderness or sensual gratification—is impossible, not only for moral reasons but also as it would prove 137impractical, if resorted to as a means to achieve a successful analysis. A neurotic cannot be healed, by being permitted to indulge in uncorrected repetitions of situations which he unconsciously prepared. When making a compromise with a neurotic, by meeting him halfway, it is necessary to take care not to be manœuvred into the ludicrous position of the clergyman, who tried to convert the insurance agent with the result that the insurance agent did not join the church, but the clergyman took out a policy.

The only way out of the dilemma of transference is to delve into the past of the patient and reconstruct events as they were actually lived through by the patient, or else only pictured, with the assistance of his urge-stimulated imagination. For all this, the analyst requires much dexterity, patience, calmness and self-effacement.

“And where, do you think, did the neurotic meet the original of this transference love?”

In his childhood, and, as a rule, in one of his parents. You will readily remember how much importance we had to attach to these 138earliest of all sentimental relations. Here, the circle is completed.

“You have finished, then? To be frank with you, I am quite bewildered by all you have told me. But, now pray tell me, where to study all that is necessary to practise analysis?”

Two institutes serve this purpose by giving instruction in psychoanalysis. The first is in Berlin, in charge of Dr. Max Eitigon of the local organization. The second is maintained by the Vienna Psychoanalytical Society, with great sacrifice. The authorities, up to now, have thrown many obstacles in the path of the young institute. A third institute will be opened in London, by the local organization there and will be under the direction of Dr. E. Jones.

In all these institutes, the disciples themselves are analysed, and are then given theoretical instruction in all subjects important for them. When permitted to analyse their first, simple cases, they have the advantage of being under the supervision of more experienced analysts. The course usually requires about two years, but even after this period, a disciple 139is still a beginner, and not by far to be considered a master. What else the young analyst needs, he acquires thorough practice, and by intercourse with older colleagues.

The preparatory work for the analytical training is not at all simple: the work is hard, the responsibility tremendous.

Whoever attended such a course, has been analysed himself, has grasped the Psychology of the Unconscious, as far as it can be taught today, is sufficiently versed in the science of sex, and has acquired the difficult technique of psychoanalysis, including the art of interpretation, the method of combating resistances and the manner in which to handle transferences, can no longer be considered a layman, in the field of psychoanalysis. He is able to treat neurotic disturbances and will, in time, be in a position to achieve all that may be expected of this therapy.

140

VII

“You have explained to me, at great length, what psychoanalysis is, and what knowledge is necessary to practise it with a chance for success. It certainly could not have hurt me to listen to you.

“However, I do not see how your informations are expected to influence my personal view. Neuroses, it would appear, are a certain form of disturbance, and psychoanalysis a certain method to treat such cases—a special medical treatment, as it were.

“I understand that it is the rule that any physician who intends to specialize in the one phase or the other of his science is not satisfied with the training he received before winning his diploma, but rather goes on studying the intricacies of his special field. This is especially a necessity, in case he intends to establish himself in a big city, the only place which opens a satisfactory field for specialists. Anybody 141who is going to specialize in surgical work, will practise, for a few years, in the surgical ward. Corresponding specialized work will be taken up by the eye or the nose and throat specialist, and the psychiatrist may forever remain on the staff of a city or county institution or a private sanitarium.

“The same method of development may be expected of the psychoanalyst. Whoever decides to take up this new medical specialty, after finishing his studies proper, will have to attend those institutes, for the duration of two years, which you have mentioned before, provided it really takes as long as that to gain the necessary knowledge. He will then also learn that it would be to his advantage to join a psychoanalytical society, in order to remain in contact with his colleagues.

“I really cannot understand why there is any necessity for raising this question of lay-analyses?”

Any physician, proceeding along the lines you suggested, shall be welcome to us. As a matter of fact, four-fifths of those whom I consider my disciples, are physicians. However, 142permit me to enlighten you as to relations, as they actually developed between physicians and psychoanalysis, and what development they appear to be taking in the future.

Past developments do not give physicians any right to claim a monopoly of psychoanalysis. As a matter of fact, physicians, in the past, have done about everything to damage psychoanalysis, beginning with superficial mockery and going even so far as to indulge in serious defamation. Of course, you may correctly say that all this belongs to the past, and should not have any influence on the future. I fully agree, but I am afraid that the future will not live up to your expectations.

At this point, permit me to interpret for you the term of “quack,” not in the way it is legally employed, but rather in the sense in which it should be logically applied. As far as the law is concerned, a “quack” is an individual who treats sick people, without being in the possession of a diploma. I, however, would rather qualify the term “quack” in this way: A “quack” is anybody who undertakes the treatment 143of a disease, without having the indispensable knowledge and ability.

On the basis of this definition, I venture to assert that—not only in the European countries—physicians, as far as psychoanalysis is concerned, constitute the majority of “quacks.” Frequently, physicians will employ psychoanalysis, without having studied it, and without sufficiently understanding it.

Do not tell me that this would display a lack of conscience, which you would not suspect in any physician. You might be tempted to say that, after all, a physician ought to know that a medical diploma does not constitute a “Letter of Marque,” and that a sick person should not be considered outlawed. As far as a physician is concerned, it should be taken for granted that he is proceeding in good faith, even if he makes a mistake.

However, facts are facts. Let us hope that it will be possible to explain these facts in a manner, which you apparently wish. I, for my part, shall try to explain to you how it is possible that a physician, in matters of psychoanalysis, 144takes liberties he would carefully avoid in any other specialized field.

In the first place, it must be taken in consideration that the training the medical student received is almost the very opposite of that which would be required of him, as a preparation for psychoanalysis. His attention has simply been focused upon facts which may be objectively ascertained, such as present themselves in anatomy, physics, and chemistry, and which must be understood properly and applied correctly, to achieve results.

As far as the psychological aspects of life are concerned, no interest is created in the medical student. The study of higher mental achievements is not considered to belong within the field of medicine, but rather into the realm of another science. Psychiatry alone is supposed to attend to disturbances of psychological functions, and it is only too well known in which way, and with what objective in view this is done: psychiatry simply tries to discover the physical reasons for psychological disturbances, treating them in turn like any other ailment.

145Psychiatry is correct in that respect, and medical training apparently excellent. Should it be maintained that psychiatry is one-sided, it will be necessary to fix the point of view from which such a reproach may arise.

Inherently, all science is one-sided, and must be one-sided, inasmuch as any science is limited to certain subjects, points of view, and methods. It is a nonsense which I do not wish to support that one science may be played against any other. Physics after all, does not minimize the value of chemistry; it cannot replace the latter nor be substituted for it. And, surely, psychoanalysis is especially one-sided, as the science of the psychological Unconscious.

Thus, the right to one-sidedness should not be denied to medicine.

However, a more practical point of view is gained if observations are not made as to scientific medicine, but rather as to practical healing. Sick people, presenting complicated problems, should impress upon us the fact that psychological manifestations—be they ever so hard to comprehend—cannot be simply eliminated 146from the picture. The neurotic, more than any other patient, presents an undesirable complication. He offers a dilemma, not less embarrassing to medicine than to law. However, as long as such cases exist, they are a responsibility especially of medicine. Nevertheless, medical training, sorry to say, is not paying sufficient attention to such conditions,—doing nothing for them. Absolutely nothing at all!

As there are very close inter-relations between those things we consider physical and those which we look upon as psychological, it may be expected that the day will come when organic biology and chemistry will finally approach the understanding of neurotic manifestations. This day, to be sure, seems to be in the distant future. At present, such ailments are still unapproachable, from a medical angle.

If medical training would only deny information to the student in the field of neurosis, this would be tolerable. But medical training is doing more. It implants into the young student an incorrect and harmful point of 147view. Physicians, whose interest for psychological facts has not been awakened, have naturally a tendency of making little of such facts, going even so far as to decry them as unscientific. Conditions of neurotic character are hardly ever taken seriously by them, while their lack of knowledge serves to breed disrespect for psychological research. Thus, neurosis is not accorded sufficient attention.

Of course, these neurotics must be treated when they consult physicians, and new discoveries must be tried out right along. But why go in for a protracted period of preparation? It can be done without that! After all, who knows whether there is really any value to that which is taught in psychoanalytical institutes?

Thus, as usual, lack of information results in a most daring spirit of enterprise. Only true initiates are modest, because they realize how insufficient their knowledge is!

From all this, it follows that it is impossible to draw upon a comparison of psychoanalysis with other branches of medicine, as you attempted to do.

148As far as surgery, and ophthalmology, are concerned, medical schools and post graduate courses offer sufficient opportunities for training. The psychoanalytical institutes are limited in number, young in years, and lack the aureola of authority. Medical science has not recognized them, nor does it give a hoot about them. On the other hand, the young physician who has been forced to believe his teachers, to such a degree, that he hardly ever had a chance to form his own judgment, will only be too glad to try his hand at playing the critic, in a field where there is no established authority as yet.

There are still other circumstances which favor the mushroom-like increase of young physicians as psychoanalytical “quacks.”

If a physician would undertake cataract operations, without sufficient training as an eye specialist, he would soon enough lose his patients. Compared to this, the application of psychoanalysis hardly involves any danger. The public, generally observing effective cataract operations, expects results from a physician pretending to be an eye specialist. However, 149if a nerve specialist does not achieve results, apparently nobody is surprised. We surely have not been spoiled by the efficacy of therapeutical treatment of nerve cases, and it seems to suffice that the physician “tried everything.” Nature must simply assert herself and time exert its healing propensities.

If the patient happens to be a young girl, it is first the menstruation which is expected to work wonders, then marriage, and in later years, change of life. In the end, death itself may finally prove the great healer.

Moreover, whatever the medical analyst employed in the treatment of such a case, is so inconspicuous, as to offer no cause for reproach. After all, he did not resort to instruments, nor did he write prescriptions. He just talked and talked, trying either to talk something into the patient, or out of the patient.

How could such treatment do any damage, especially as extreme care had been taken not to touch upon painful or exciting matters? The medical analyst, once he has thrown the strict instructions overboard that were given to him, will surely have tried to improve upon 150psychoanalysis by extracting from it certain features—poisonous fangs, as it were—to make analysis more acceptable to the patient. How splendid, if he really went only as far as that and not so far as to awaken resistances which he would be unable to cope with. He would be apt to make himself disliked in such a case!

Justice demands that it be admitted that an untrained analyst cannot do as much harm to a patient, as an untrained surgeon. The possible injury may amount to unnecessary expenditure of money and time, and chances for a cure may have either been destroyed, or else spoilt to a certain degree. In addition to this, the reputation of psychoanalytical therapy as a whole would suffer. All this is quite undesirable, but surely not as serious as the damage that may arise from the knife of a surgical “quack.” According to my observations, permanent aggravation of an ailment is not to be expected from the incorrect application of psychoanalysis. Reactions of an undesirable nature disappear quickly. In comparison to the traumata inflicted by life itself, which resulted 151in the disturbances, a little incorrect treatment does not amount to anything. The unsuitable therapeutical attempt has simply not benefited the patient.

“I have listened to your description of the ‘quack’ without interrupting you, and have gained the impression that your position in regard to physicians is barbed with hostility. The reason for this enmity is obvious, from the many hints you have dropped. At any rate, I am of the opinion that as long as psychoanalysis is to be employed, it should be only by such persons as are thoroughly trained for it. But it seems that you believe that even those physicians who may take up psychoanalysis, in the course of time, will not go in for the necessary thorough training?”

Exactly! As long as the relation between the medical schools and the psychological institutes prevail as they do today, I do not think that young physicians will resist the temptation of making things easy for themselves.

“It appears to me that you constantly avoid making any direct statement in regard to the problem of lay-analyses. Apparently, what 152you wish me to surmise now is that it would be your suggestion to withhold, as a means of revenge, as an act of punishment, so to speak, the monopoly of practising psychoanalysis from physicians, because such physicians as employ analysis, are beyond control. You would, however, permit the application of such medical activity to laymen.”

I am not so sure that you surmised my motives correctly. Perhaps, I may later on be in a position to prove to you that my point of view is not as partial as all that. But be that as it may, I strongly emphasize my demand that nobody should be permitted to practise psychoanalysis, unless he has obtained this privilege on the basis of thorough training. Whether such a person is a qualified physician or not does not seem important to me.

“What, then, are your practical suggestions?”

I am not as far as that yet. I don’t even know whether I shall ever get that far. There is some other question which I wish to take up with you, and by way of introduction, touch upon a certain point.

153It is reported that the authorities, on the strength of suggestions made by medical bodies, may put a sweeping prohibition for the practise of psychoanalysis by laymen on the statute books. Such prohibition would naturally also hit the non-medical members of psychoanalytical societies—men and women who have undergone a very thorough training and improved themselves greatly by practice. Should such a sweeping prohibition become an actual fact, the incongruous condition would then present itself whereby people really capable of applying psychoanalysis properly, would be excluded from this practice, while on the other hand, this privilege would be extended to individuals insufficiently informed, and not specially trained for such work.

Of course, no legislature aims at so absurd an effect.

But the dilemma that presents itself with this piece of legislature, is neither important nor difficult. It would concern only a handful of people who would not even suffer appreciably. Analogous to measures enacted by 154monarchical Austria, republican Austria could also resort to exception laws. Under the Hapsburg régime, it happened that certain “quacks” whose ability in the treatment of certain diseases was convincing, were privileged ad personam to treat sick people. These were mostly cases of rustic healers, who enjoyed the recommendation of one of those exalted, once so plentiful, archduchesses. However, it should be possible to assume that the benefit of such exception laws should also pertain to city inhabitants, who are recommended by mere experts.

Of course, if the law is put on the statutes in accordance with the wording of the bill now pending, the Vienna Psychoanalytical Institute, for example, would no longer be permitted to accept students, unless they belonged to the medical profession. All these endeavors to restrict the application of psychoanalysis hark back, more or less, to obsolete legislature, dealing with quackery as such. This seems anachronistic, inasmuch as at the time of the enactment of these anti-quackery laws, the 155particular nature of neurotic disturbances had not yet been discovered and psychoanalysis did not yet exist.

I am now approaching the question which appears most essential to me: Is the practice of psychoanalysis of such a nature as to lend itself to the interference of legislative authorities, or would it not be much better to leave psychoanalysis to its natural development?

Of course, I shall not decide this question, but I am taking the liberty of submitting it to you. It appears that in Austria, not unlike other countries, by the way, there prevails a real furor prohibendi, a veritable mania for prohibition and general interference, a trend which usually, as is only too well known, makes for unsatisfactory results. According to my own personal view, a superabundance of ordinances and prohibitions will only serve to injure the dignity of the law. It may usually be observed that wherever there are just a few laws, these laws are strictly adhered to, whereas where laws exist in great numbers, the temptation arises to break them.

156Furthermore, a man cannot be considered an anarchist, simply because he believes that legislative statutes—in the view of their very origin—cannot very well be regarded as something holy that must never be touched. Legislative measures sometimes are insufficient, or gradually become that, at the same time outraging our innate sense for justice and common sense. Then the time is on hand, where there is no other means of correcting such unbearable conditions than to simply trespass against such laws. It seems advisable, for the purpose of maintaining respect for laws and ordinances, not to enact any which may be difficult to enforce.

Much of what has been said here about the application of psychoanalysis by physicians would have to be repeated with regard to lay-analyses proper, which the legislatures of some countries are now prepared to prohibit. In view of the fact that the application of the analysis is a very simple procedure, consisting merely of conversation without resorting to instruments or prescriptions, it would be rather difficult to prove that a layman actually 157employed psychoanalysis, if he stoutly maintained that he had merely benefited a person by administering a good “talking to.” Such assistance, to a person in need of it, could not very well be prohibited simply because a physician may once in a while resort to the identical thing!

In English speaking countries, Christian Science has gained tremendous popularity. To my mind, it constitutes a dialectic abnegation of such evils as life presents, by resorting to the teaching of Christian religion. I do not hesitate to state that such measures strike me as a regrettable fallacy of the human mind. But who in the United States or England would ever think of prohibiting Christian Science or seek to punish its followers?

Generally speaking, is governmental authority always so certain to be on the right side? Assumed even that many, left to their own devices, would encounter danger and experience harm, would it not just the same be much better if governmental authority would merely indicate dangerous ground, but on the whole leave it to the individual to be 158taught by experience and mutual influence?

Psychoanalysis is so new, the broad masses so insufficiently informed about it, the official view of science still so vacillating, that it appears to me as premature to impede its progress by legislative measures.

Why not leave it to the patients themselves to learn that it is dangerous for them to apply for psychological assistance to persons who are not sufficiently informed?

If people are sufficiently enlightened and warned, prohibition will surely prove superfluous.

On Italian highways, poles, carrying high tension electric power, display this warning: “Chi tocca, muore!” Which has proven perfectly sufficient. In contrast to this, in other countries, for example Austria and Germany, this warning is of an insulting verbosity:— “Inasmuch as touching these high tension wires is dangerous to life, it is herewith strictly prohibited to meddle with them!” Why this prohibition? Whoever cherishes his life will not touch them, and whoever wants 159to commit suicide will surely not be detained by the warning.

“But there are cases which may be quoted as precedent for the prohibition of lay-analyses. For example, the law against the practice of hypnosis by laymen, and another enacted against occult séances and the organization of spiritualistic societies.”^[1]

I must admit that it is beyond me to admire these measures. As far as the last mentioned prohibition is concerned, it surely constitutes a case of grave over-officiousness, encroaching upon intellectual freedom. As far as I am personally concerned, I do not think that anybody would suspect me of having faith in occult phenomena, or of being interested in its general acceptance. However, such prohibitive measures will never serve to stifle the interest that some people manifest for the alleged secrets of an occult world. Such officious interference may do a lot of damage by preventing impartial seekers for truth to arrive at a finding which would do away with 160occult misconceptions. Here also, we observe the fact that other countries do not interfere with so-called “parapsychic” research, but only Austria.

As far as hypnosis is concerned, it is somewhat different from analysis. Hypnosis is nothing else but induction of an abnormal condition of the soul, serving the layman merely as a means of entertainment. Had hypnotic therapy fulfilled its early promise, conditions would have evolved similar to those now prevailing in psychoanalysis.

Aside from this, the history of hypnosis contributes another precedent for the fate of psychoanalysis. When I was still a young instructor of neuropathology, physicians fervently fought against hypnosis, claiming it to be nothing but a fake, an infernal delusion, a most dangerous practice. Today, this same hypnosis has been monopolized by them. They are resorting to it as a method of examination. For some nerve specialists, hypnosis is their most important stock in trade.

However, I have already told you that I 161do not intend to discuss whether restriction by law or a hands-off policy would be the most correct procedure, concerning psychoanalysis. I know very well that this is a question of principle which will be decided by the inclination of influential people rather than by strict argumentation. What seems to me to suggest a policy of laissez faire I have already mentioned. But if the decision should be one for active interference, then, to be sure, it would appear to me as a one-sided and unjust measure to enact a sweeping prohibition against the practice of psychoanalysis by laymen. Then, it would be up to the legislature to fix the conditions under which the application of psychoanalysis would be permissible for those who would be privileged to employ it. It would also be necessary to appoint an authority who could be appealed to for information, who would decide what constitutes psychoanalysis, what the training would be, and how to administer it.

Thus, things must either be left alone or else order must be created and the situation, 162in general, clarified. But there is no use in simply interfering with a complicated situation, by means of a prohibition, which is based without much discretion, upon obsolete acts of an antiquated legislature.

163

VIII

“But the physicians! It seems I am really unable to bring you to the main point of our conversation. You are continually evading me. After all, the question before us is whether physicians should be given the exclusive right to employ psychoanalysis, that is, after they have fulfilled certain conditions, if you should insist upon such. According to your own statement, the majority of ‘quacks,’ dabbling with psychoanalysis, does not consist of physicians. You also admit that the greatest number of your disciples and followers are physicians. I have heard that these do not share your point of view, in regard to lay-analyses.

“Of course, it is to be expected that your disciples agree with you in the question of sufficient training. Just the same, they hold the laymen should be excluded from the practice of psychoanalysis. Is that really the case? And if so, how do you account for it?”

164You are correctly informed. Not all, but a great number of my medically trained collaborators do not side with me in this matter, but insist that psychoanalytical treatment of neurotics be exclusively reserved for physicians. From this, you may gather that even within the limits of our own camps, there prevails a difference of opinion. Although my point of view is very well known, the divergence of opinion in matters of lay-analyses, in no way interferes with an otherwise splendid harmony.

How to explain this position of some of my disciples?

I am not so sure, but I assume that professional pride is behind it. You see, their process of development has been different from mine. That they find themselves somewhat isolated from their colleagues, is still annoying them. They would like to be considered, by the profession as a whole, as members in good standing, so to say. Thus, in order to win the tolerance of their Æsculapian brothers, they are willing to make a sacrifice, whose value is apparently not clear to them.

165Of course, I may be wrong here. To assume that fear of competition is dictating their position, would not only amount to suspecting them of a low motive, but also condemn them for a peculiar shortsightedness. After all, as long as they are ready to initiate colleagues into psychoanalysis, it can be of no importance to them whether they will have to share prospective patients with them, or with laymen.

Probably, there is something else to be considered. They may be impressed by certain features which, in the practice of psychoanalysis assure the physician of an unquestionable advantage over the layman.

“There you are:—‘Assure the advantage’! At last, you admit this advantage! I should think this admission settles our argument.”

I admit this advantage. Perhaps by doing so I shall prove to you that I am not as passionately deluded as you think. I postponed mentioning these conditions, because in airing them, additional theoretical discussion is necessary.

“What are you driving at now?”

There is first the question of diagnosis. Before 166admitting a patient, suffering from nervous disturbances, to psychoanalytical treatment, one naturally desires to have as much assurance as possible that this therapy is suitable in that particular case, that is, that the patient has a good chance of being benefited by psychoanalysis. This can only be the case, if he is actually suffering from neurosis.

“I should think that would be easily ascertained, by the symptoms he complains about.”

You are putting your finger just on the point, where new complications may arise. It is not always possible to be perfectly sure of such a case. The patient, in spite of displaying all the visible symptoms of neurosis, may actually be suffering from something else. The incipient stage of a mental disease, for example, or the beginning of a process destroying his brain. To distinguish between such symptoms is not always easy or possible. Responsibility for such a decision must naturally be assumed by the physician alone. And as mentioned before, it is not so easy for him. For the longest time, an ailment may appear absolutely 167harmless, until finally manifesting its malignant character. Nervous people, as a rule, fear that they may be on the road to some mental disease.

Assumed that a physician has not correctly diagnosed a case, or has been unable to discover its true nature, nothing has been lost, no damage has been done. Analytical treatment, although not doing any harm to the patient, would have been superfluous in such a case. It might have given any number of people a chance to lay the blame for the unfortunate development of the case at the door of psychoanalysis. Unjustly so, to be sure, but such a likelihood should be avoided nevertheless.

“That sounds hopeless. It apparently tears out, by the very roots, everything you told me about the nature and development of a neurosis.”

Not at all. It only strengthens the fact that neurotics are a nuisance and a dilemma for all parties concerned, including the psychoanalysts. I may be able to alleviate your new apprehensions if I make myself clearer. Probably it would be more correct to say of such 168cases, as we now have under discussion, that they actually present neuroses. However, these neuroses are not psychic but rather somatic, that is, they do not originate from the soul, but rather from the body. Do you understand me?

“I do. But I am at a loss to connect all this with the psychological aspect.”

That can easily be done, if only complications of the living substance are sufficiently taken into consideration. What was the inherent feature of a neurosis? That the “I,” constituting the very essence of the soul, so to speak, developed and improved by the influence of the outer world, proved unable to fulfill its mediating functions between the “It” and reality; that the “I,” on account of its weakness, shirked its duties in regard to the “It,” thus incurring repressions from which it suffers. It is because such weakness of the “I” regularly takes place in all of us in childhood that events of our tender years exert such great importance in later life.

In the few years of our childhood, we have to cover the enormous distance of development 169from primitive man of the Stone Age to civilized man of today. In addition to this tremendous burden, the child has to ward off the urges of an early sexuality. Small wonder, then, that our “I” takes recourse to repressions, thus exposing itself to childhood neuroses, the effects of which in turn furnish the disposition for nervous disturbances in more mature years.

Everything now depends upon how the growing up individual will be treated by fate. If life is too hard, the divergence between urges and the opposition of reality too great, the “I” may remain unsuccessful in its endeavors to mediate between the two. This is the more probable, the more the “I” is encroached upon by such infantile dispositions as it may have acquired in tender years. Thus, the process of repression is repeated; urges tear themselves free from the sovereignty of the “I” to gain, by way of regression, a substitute for the gratification they crave, while the poor “I” has become helplessly neurotic.

Let us hold on firmly to this: that the most important, the pivotal point in the whole situation, 170so to speak, is the relative strength of the “I” in all its phases. It is easy, then, to complete our whole etiological survey, that is our endeavor to assign causes to the phenomena observed. We already know the normal causes for nervousness to be the infantile weakness of the “I,” the checking of early sexual urges, and the influence of chance episodes in our childhood.

But is there no possibility that there are also some other contributory factors, antedating childhood? For example, an inborn strength and unruliness of those urges which constitute the “It,” presenting right from the very start a task much too difficult for the “I”? Or could a certain weakness, existing for reasons unknown, in the development of the “I” be held responsible? Of course, all these possibilities will exert an etiological importance, in some cases of surpassing value.

The specific driving power of the “It” must always be taken into consideration, and wherever it is developed to an excessive degree, there are only meagre chances for a successful application of our therapy. Of the reasons 171that block the development of the “I,” we still know too little to account for such cases of neurosis which arise on a constitutional basis. It may be assumed that neurosis hardly ever develops unless there are constitutional or congenital factors increasing the possibility for such a condition. However, if it is correct that the relative weakness of the “I” is the deciding factor for the development of neuroses, then it would also appear possible that later, physical disturbances may result in a neurosis provided it also results in a weakening of the “I.”

This happens only too frequently. Such a physical disturbance may aim at the “It,” intensifying its urges to an extent where the “I” is not able to cope with them any more. As an example for such developments, the changes induced in woman by the disturbances of menstruation and menopause could perhaps be drawn upon. Other reasons that may weaken the “I” are general physical disturbances, organic diseases of the central nervous system. All of these may result in interference with those sources from which the soul apparatus 172draws its strength, to lead, in turn, to an encroachment of its more delicate functions, which are necessary to maintain unimpaired the whole “I” organization. In all these cases, neurosis presents about the same picture. However, while manifesting the same psychological mechanism, neuroses develop on the basis of a multifarious, frequently highly complicated etiology; that is, they arise from a great number of various causes.

“That suits me better. At last you have spoken like a physician. And now I am waiting for you to admit that so complicated a condition as a neurosis should only be treated by a physician.”

I am afraid you are expecting too much. What we have just discussed belonged in the realm of pathology. Psychoanalysis, however, is a therapeutical process. I admit, no, I even insist, that a physician should first diagnose each and every case where psychoanalysis seems applicable. Fortunately, the greater number of neuroses are of a psychical nature and not pathologically induced. As soon as the physician has ascertained this, he may safely 173leave the treatment to the lay-analyst. We have always followed this procedure within our analytical societies. Thanks to this close coöperation between the medically trained and non-trained members, errors almost never occur.

There is another emergency when the analyst has to invite the assistance of a physician. It is possible that, in the course of psychoanalytical treatment, symptoms—mostly of physical nature—appear which may either be part of the neurosis, or else manifestations of independent, organic disturbances. Here, the decision must once more be left to the physician.

“From all this, there follows that the analysts, even during the analysis, cannot dispense with the physician. This is another argument against lay-analyses.”

No, this possibility cannot be drawn upon as an argument against lay-analyses, because in an analogous case the medically trained analyst would not proceed any differently.

“I do not understand that.”

There is a rule that even a medically trained analyst, running across such dubious symptoms 174in the course of the treatment, is not to depend on his own judgment, but to consult some colleague, preferably a specialist of internal diseases.

“Why this rule, apparently so superfluous?”

This rule is not superfluous at all. There are several reasons for it. In the first place, it is hard to combine organic and psychical treatment. In the second place, the particular condition of transference frequently prevailing in analyses may make it inadvisable for the analyst to subject his patient to physical examination. In the third place, there are all the reasons in the world for the analyst to doubt his own opinion, inasmuch as he is so intensely interested in the psychical aspects of the case.

“I now understand your position towards lay-analyses. You insist that there must be lay-analysts. However, as you have to admit their insufficiency for the task, you compile everything that could serve to excuse them, and make things in general easier for them. To be frank with you, I cannot understand why we should have lay-analysts at all, inasmuch as they would never be more than second-class 175therapeutists. This need not include those few laymen who have already received their training, but institutes for psychological training should not accept laymen any more.”

I would assent to all this, if I could be shown that such restrictions would benefit all parties interested. You will admit that these interests are tri-fold:—There is the interest of the patient, the interest of the physicians, and last but not least, the interest of science which, in turn, includes the interest of all patients of the future. Let us investigate these three points.

It does not matter whether the patient be analysed by a physician or a layman, as long as any danger of mistaking his condition is excluded by being properly examined by a physician before the beginning of the treatment, or re-examined as soon as developments, in the course of the analysis, make this advisable. It is much more important for the patient that the analyst possesses those personal qualities which invite full confidence, and that he has that knowledge and experience which alone qualify him to apply psychoanalysis. To some 176people, it may seem that it might undermine the authority of the analyst to have his patient know that he is no physician and must obtain the advice of a medically trained expert in certain matters. However, although we have never kept a patient in the dark, as to the qualifications of an analyst, we have come to the conclusion that the patients have no prejudice against a non-medically trained analyst; they are only too glad to accept the benefits of treatment, wherever they offer themselves—a fact resented by the medical profession for the longest time.

It also must be considered that analysts, practising today, are men and women with academic training and degrees, pedagogues, of great experience and impressive personality. The analysis, to which all candidates of psychoanalytical institutes are required to submit, is the best means of testing their personal suitability for the performance of so exerting an activity as an analysis presents.

In reference to the interest of the physicians, I do not believe that medicine has anything to gain by annexing psychoanalysis. Today, medical 177training requires five years, with almost a whole sixth year taken up with examinations. Ever so often, new demands in regard to training are made with which the young student must comply, if his medical education is to be considered adequate. Generally speaking, while it is difficult today to enter the medical profession, the practice of medicine is neither very satisfactory nor very advantageous. And as soon as the undoubtedly justified necessity is realized that the physician be also informed of the psychological aspects of diseases, thus including in medical training a partial preparation for psychoanalysis, there would follow an extension of the medical curriculum and a corresponding extension of the period of training. I do not know how physicians would like such a development, arising from the monopoly they claim on psychoanalysis. But these demands would then have to be fulfilled and at a time when, in general, the material aspects of those strata of society which contribute the greatest contingent to the medical profession, are such that young physicians must establish a practice, as soon as possible.

178However, the medical profession may not intend to include preparation for psychoanalysis into the medical curriculum proper. The general opinion may be that it is much more practical for the young physician to acquire psychoanalytical knowledge only after having completed his medical education. It may be said that such a procedure would not involve any actual loss of time, inasmuch as a young man under thirty never gains that confidence of patients which is an indispensable condition for benefiting a patient psychoanalytically. Of course, it could be said that a young physician, too, who has just won his diploma, cannot command too much respect, as regards his opinion of the physical ailments of his patients, and that the young analyst could very well utilize his time, by working in a psychological clinic, under the supervision of an experienced practitioner.

It seems to me that the aforementioned demand amounts to a waste of energy which, in view of economic conditions, does not seem justified. Although analytical training invades the field of medical training, it neither includes 179this training, nor is included by it. If a psychoanalytical college were to be organized, which today may strike one as being a fantastic idea, the curriculum of this institution would have to include much of what is taught in medical schools. Aside from the Psychology of the Depths, which would naturally always be the main subject taught, Biology would have to be included in the course, and Science of Sex would also be one of the major subjects. In addition, adequate instruction would have to be given on such disturbances which belong in the realm of Psychiatry. Psychoanalytical training would have to include a number of subjects which have no connection with medicine, and never enter the physician’s practice, such as History of Civilization, Mythology, Psychology of Religion, and Literature. Without being well acquainted with these subjects, the analyst will be unable to grasp the problems that will face him in the course of his practice.

Most of the subjects, however, belonging to medical training, will not be of any use to him and although all this knowledge is highly 180valuable for those who need it, it would not assist the analyst to understand a neurotic condition nor to alleviate it. In case the objection is made here that specialists in other fields of medical endeavor, also do not need all the details they acquire in the course of their training, it must be said that such a case could not be considered analogous. For many branches of medicine, such facts as, for example, Pathology presents, are of great importance. The analyst, however, reaches out for a variety of experiences, with different phenomena, underlying different laws. Although philosophy may succeed in bridging the chasm between body and soul, as far as our own experience is concerned, this chasm, nevertheless, exists, presenting itself in an especially striking light, as regards our practical endeavors.

It seems unjust and impractical to force a person to take a roundabout route via medical training, if this person be bent upon relieving another individual from the agonies of a phobia or a fixed idea. Moreover, such a procedure would be ineffective, as long as psychoanalysis in general is not suppressed.

181Just imagine that somewhere in the country, there is a certain mountain top that can be reached by two different roads, the one being short and straight, and the other long and winding. An attempt is made to block the short road by a “no-trespass” sign. There is some chance of this sign being respected, if the short road is steep and difficult to climb, whereas the long road is easy to travel. However, if the detour should be the more difficult road, you can easily surmise how little the trespassing sign would be respected.

I am very much afraid it will be just as difficult to force the laymen to study medicine, as it is for me to induce physicians to study psychoanalysis. Human nature is like that.

“If you are correct in your assumption that analytical treatment cannot be administered without a special training, but that on the other hand the medical curriculum could not bear the burden of psychoanalytical training, and that medical knowledge, to the greatest extent, is superfluous for the analyst, how will we ever achieve the ideal medical personality, 182the physician who can cope with all the demands of his profession?”

I am unable to foresee how to solve these difficulties, and I do not feel called upon to make any suggestions. I only perceive two things clearly: firstly, that the analysis seems to constitute a dilemma, but certainly the neurotic is also a dilemma; secondly, that for the time being, all interests would be served if physicians resolve to tolerate a class of therapeutists who will relieve them of the arduous treatment of those tremendously frequent psychical neuroses, in addition benefiting the patients by remaining in constant contact with them.

“Is that your last word in reference to the problem of lay-analyses, or is there something else?”

There is a third interest to be considered:—that of science. Although what I have to say in that respect may not mean much to you, it nevertheless means a good deal to me.

We do not consider it advisable that psychoanalysis be swallowed up by medicine, finally to be shelved in a text-book of psychiatry, 183under the chapter heading of Therapy, together with such other treatments as Hypnotic Suggestion, Auto Suggestion, Persuasion which, due to lack of knowledge, were indebted for their short lives to the indolence and ignorance of the broad masses. Psychoanalysis deserves a better fate, which, let us hope, it will really attain.

As the Psychology of the Depths, the teaching of the Unconscious, psychoanalysis may prove indispensable to all sciences which deal with the development of human culture, and such of its great achievements as art, religion, and civilized society. Psychoanalysis has already appreciably assisted these sciences in the solution of their problems. But all this is insignificant, compared to what may be achieved through psychoanalysis in the future, when students of History, Psychology of Religion, and Etymology, will avail themselves to the fullest extent of the assistance psychoanalysis will be able to render them.

The employment of psychoanalysis for the treatment of neuroses is only one of its possibilities, and time may yet prove that this is 184not even the most important of them. At any rate, it would be unfair to sacrifice all other advantages of psychoanalysis, simply because there is just one phase where the application of psychoanalysis encroaches upon the preserves of medicine.

Here another aspect manifests itself which cannot be interfered with, without causing damage. If the representatives of the different sciences should really take up the study of psychoanalysis, to apply it in their own spheres of interest, it would not suffice for them to merely avail themselves of such results as have been recorded in psychoanalytical literature. They will have to come to an understanding of psychoanalysis in the only way possible, that is, by submitting themselves to analysis.

Thus, to the neurotics in need of analysis, a second class of persons would be added: those who undergo analysis for intellectual reasons and who would welcome that intensification of their efficiency which would result incidentally from analysis. To undertake these analyses, a number of analysts would be necessary for whom medical knowledge would be of 185specially limited importance. However, these instructor-analysts—as they ought to be called—are in need of an especially thorough training, which they can only obtain if they are given opportunities to study interesting and convincing cases. Inasmuch as healthy persons do not feel the necessity and curiosity to be analysed, neurotics would have to be the objects of study for the instructor-analysts. Their study would be guided by expert analysts, with a special eye to their future, non-medical work. Of course, all this necessitates a certain amount of freedom of action, and would not brook petty interference.

Perhaps you do not believe in these strictly theoretical endeavors of psychoanalysis, and are not ready to admit their importance, in connection with the practical side of the problem of lay-analyses. In that case, let me remind you that there is another field for the application of psychoanalysis, outside the hunting ground of the “quack”—a field which physicians will hardly claim as their own. I allude to the application of psychoanalysis to pedagogy.

186As soon as a child manifests the first signs of an undesirable development, by being moody, stubborn and inattentive, neither the child specialist nor the school physician will be able to do anything for him; not even when a child shows such clear signs of nervous disturbances as timidity, lack of appetite, vomiting, and sleeplessness. A treatment which combines analytical influence with pedagogic measures and is applied by persons who are not above delving into the child’s own world and who understand how to penetrate the soul life of the child, will succeed not only in dissolving nervous disturbances, but also in reversing incipient traits of character.

The importance which we were forced to attach to apparently unimportant neurotic conditions of children, in view of the fact that they very often serve as a disposition for disturbances in later life, would prove that the analyses of children constitute a splendid means of prophylaxis. Although psychoanalysis still has its enemies, I do not know what means are at their disposal to hinder the activity of a pedagogic analyst, or analytical 187pedagogue, and I doubt whether this could be done so easily.

To return once more to the problem of the analytical treatment of adults, suffering from nervous disturbances, we have not yet exhausted all points of view. Civilized life of today exerts an almost unbearable pressure, which necessitates corrective measures. Does it seem too fantastic to expect that psychoanalysis, in spite of the many difficulties it encounters, should be called upon to furnish this corrective agent? Maybe some American millionaire will one day donate enough money for the psychoanalytical training of the social workers of his country, thus creating an emergency corps, to fight neurotic conditions brought about by present-day life.

“You mean some sort of a new Salvation Army?”

Why not? After all, our fancy always follows existing patterns. The stream of eager students that will then flood towards Europe, will, of course, have to pass Vienna, because there the development of psychoanalysis may have prematurely died, on account of governmental 188interference. You smile? I’m not saying this to sway your judgment. I know you don’t believe me, and I surely cannot guarantee that my predictions will come true. But there is one thing I know: it is not at all important what the opinions of individuals and of individual governments may be, in respect to the problem of lay-analyses. All this can only have limited effects. What is really important is that potentialities for the development of psychoanalysis cannot be affected by ordinances and prohibitions.

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