In order to progress in our understanding of the neuroses, we need new experiences and we are about to obtain two. Both are very remarkable and were at the time of their discovery, very surprising. You are, of course, prepared for both from our discussions of the past semester.
In the first place: When we undertake to cure a patient, to free him from the symptoms of his malady, he confronts us with a vigorous, tenacious resistance that lasts during the whole time of the treatment. That is so peculiar a fact that we cannot expect much credence for it. The best thing is not to mention this fact to the patient’s relatives, for they never think of it otherwise than as a subterfuge on our part in order to excuse the length or the failure of our treatment. The patient, moreover, produces all the phenomena of this resistance without even recognizing it as such; it is always a great advance to have brought him to the point of understanding this conception and reckoning with it. Just consider, this patient suffers from his symptoms and causes those about him to suffer with him. He is willing, moreover, to take upon himself so many sacrifices of time, money, effort and self-denial in order to be freed. And yet he struggles, in the very interests of his malady, against one who would help him. How improbable this assertion must sound! And yet it is so, and if we are reproached with its improbability, we need only answer that this fact is not without its analogies. Whoever goes to a dentist with an unbearable toothache may very well find himself thrusting away the dentist’s arm when the man makes for his sick tooth with a pair of pincers.
The resistance which the patient shows is highly varied, exceedingly subtle, often difficult to recognize, Protean-like in its manifold changes of form. It means that the doctor must become suspicious and be constantly on his guard against the patient. In psychoanalytic therapy we make use, as you know, of that technique which is already familiar to you from the interpretation of dreams. We tell the patient that without further reflection he should put himself into a condition of calm self-observation and that he must then communicate whatever results this introspection gives him — feelings, thoughts, reminiscences, in the order in which they appear to his mind. At the same time, we warn him expressly against yielding to any motive which would induce him to choose or exclude any of his thoughts as they arise, in whatever way the motive may be couched and however it may excuse him from telling us the thought: “that is too unpleasant,” or “too indiscreet” for him to tell; or “it is too unimportant,” or “it does not belong here,” “it is nonsensical.” We impress upon him the fact that he must skim only across the surface of his consciousness and must drop the last vestige of a critical attitude toward that which he finds. We finally inform him that the result of the treatment and above all its length is dependent on the conscientiousness with which he follows this basic rule of the analytic technique. We know, in fact, from the technique of interpreting dreams, that of all the random notions which may occur, those against which such doubts are raised are invariably the ones to yield the material which leads to the uncovering of the unconscious.
The first reaction we call out by laying down this basic technical rule is that the patient directs his entire resistance against it. The patient tries in every way to escape its requirements. First he will declare that he cannot think of anything, then, that so much comes to his mind that it is impossible to seize on anything definite. Then we discover with no slight displeasure that he has yielded to this or that critical objection, for he betrays himself by the long pauses which he allows to occur in his speaking. He then confesses that he really cannot bring himself to this, that he is ashamed to; he prefers to let this motive get the upper hand over his promise. He may say that he did think of something but that it concerns someone else and is for that reason exempt. Or he says that what he just thought of is really too trivial, too stupid and too foolish. I surely could not have meant that he should take such thoughts into account. Thus it goes on, with untold variations, in the face of which we continually reiterate that “telling everything” really means telling everything.
One can scarcely find a patient who does not make the attempt to reserve some province for himself against the intrusion of the analysis. One patient, whom I must reckon among the most highly intelligent, thus concealed an intimate love relation for weeks; and when he was asked to explain this infringement of our inviolable rule, he defended his action with the argument that he considered this one thing was his private affair. Naturally, analytic treatment cannot countenance such right of sanctuary. One might as well try in a city like Vienna to allow an exception to be made of great public squares like the Hohe Markt or the Stephans Platz and say that no one should be arrested in those places — and then attempt to round up some particular wrong-doer. He will be found nowhere but in those sanctuaries. I once brought myself around to permit such an exception in the case of a man on whose capacity for work a great deal depended, and who was bound by his oath of service, which forbade him to tell anyone of certain things. To be sure, he was satisfied with the results — but not I; I resolved never to repeat such an attempt under these conditions.
Compulsion neurotics are exceedingly adept at making this technical rule almost useless by bringing to bear all their over-conscientiousness and their doubts upon it. Patients suffering from anxiety-hysteria sometimes succeed in reducing it to absurdity by producing only notions so remote from the thing sought for that analysis is quite unprofitable. But it is not my intention to go into the way in which these technical difficulties may be met. It is enough to know that finally, by means of resolution and perseverance, we do succeed in wresting a certain amount of obedience from the patient toward this basic rule of the technique; the resistance then makes itself felt in other ways. It appears in the form of an intellectual resistance, battles by means of arguments, and makes use of all difficulties and improbabilities which a normal yet uninstructed thinking is bound to find in the theory of analysis. Then we hear from one voice alone the same criticisms and objections which thunder about us in mighty chorus in the scientific literature. Therefore the critics who shout to us from outside cannot tell us anything new. It is a veritable tempest in a teapot. Still the patient can be argued with, he is anxious to persuade us to instruct him, to teach him, to lead him to the literature, so that he may continue working things out for himself. He is very ready to become an adherent of psychoanalysis on condition that analysis spare him personally. But we recognize this curiosity as a resistance, as a diversion from our special objects, and we meet it accordingly. In those patients who suffer from compulsion neuroses, we must expect the resistance to display special tactics. They frequently allow the analysis to take its way, so that it may succeed in throwing more and more light on the problems of the case, but we finally begin to wonder how it is that this clearing up brings with it no practical progress, no diminution of the symptom. Then we may discover that the resistance has entrenched itself in the doubts of the compulsion neurosis itself and in this position is able successfully to resist our efforts. The patient has said something like this to himself: “This is all very nice and interesting. And I would be glad to continue it. It would affect my malady considerably if it were true. But I don’t believe that it is true and as long as I don’t believe it, it has nothing to do with my sickness.” And so it may go on for a long time until one finally has shaken this position itself; it is then that the decisive battle takes place.
The intellectual resistances are not the worst, one can always get ahead of them. But the patient can also put up resistances, within the limits of the analysis, whose conquest belongs to the most difficult tasks of our technique. Instead of recalling, he actually goes again through the attitudes and emotions of his previous life which, by means of the so-called “transference,” can be utilized as resistances to the physician and the treatment. If the patient is a man, he takes this material as a rule from his relations to his father, in whose place he now puts the physician, and in so doing constructs a resistance out of his struggle for independence of person and opinion; out of his ambition to equal or to excel his father; out of his unwillingness to assume the burden of gratitude a second time in his life. For long times at a stretch one receives the impression that the patient desires to put the physician in the wrong and to let him feel his helplessness by triumphing over him, and that this desire has completely replaced his better intention of making an end to his sickness. Women are adepts at exploiting, for the purposes of the resistance, a tender, erotically tinged transference to the physician. When this leaning attains a certain intensity, all interest for the actual situation of the treatment is lost, together with every sense of the responsibility which was assumed by undertaking it. The never-failing jealousy as well as the embitterment over the inevitable repudiation, however gently effected, all must serve to spoil the personal understanding between patient and physician and thus to throw out one of the most powerful propelling forces of the analysis.
Resistances of this sort must not be narrow-mindedly condemned. They contain so much of the most important material of the patient’s past and reproduce it in such a convincing manner, that they become of the greatest aid to the analysis, if a skillful technique is able to turn them in the right direction. It is only remarkable that this material is at first always in the service of the resistance, for which it serves as a barrier against the treatment. One can also say that here are traits of character, adjustments of the ego which were mobilized in order to defeat the attempted change. We are thus able to learn how these traits arose under the conditions of the neurosis, as a reaction to its demands, and to see features more clearly in this character which could otherwise not have shown up so clearly or at least not to this extent, and which one may therefore designate as latent. You must also not get the impression that we see an unforeseen endangering of the analytic influence in the appearance of these resistances. On the contrary, we know that these resistances must come to light; we are dissatisfied only when we do not provoke them in their full strength and so make them plain to the patient Indeed, we at last understand that overcoming these resistances is the essential achievement of analysis and is that portion of the work which alone assures us that we have accomplished something with the patient.
You must also take into account the fact that any accidental occurrences which arise during the treatment will be made use of by the patient as a disturbance — every diverting incident, every statement about analysis from an inimical authority in his circle, any chance illness or any organic affection which complicates the neurosis; indeed, he even uses every improvement of his condition as a motive for abating his efforts. You will then have gained an approximate, though still an incomplete picture of the forms and devices of the resistance which must be met and overcome in the course of every analysis. I have given this point such detailed consideration because I am about to inform you that our dynamic conception of the neurosis is based on this experience with the resistance of neurotic patients against the banishment of their symptoms. Breuer and I both originally practiced psycho-therapy by means of hypnosis. Breuer’s first patient was treated throughout under a condition of hypnotic suggestibility, and I at first followed his example. I admit that my work at that time progressed easily and agreeably and also took much less time. But the results were capricious and not permanent; therefore I finally gave up hypnotism. Then only did I realize that no insight into the forces which produce these diseases was possible as long as one used hypnotism. The condition of hypnosis could prevent the physician from realizing the existence of a resistance. Hypnosis drives back the resistance and frees a certain field for the work of analysis, but similarly to the doubt in the compulsion neurosis, in so doing it clogs the boundaries of this field till they become impenetrable. That is why I can say that true psychoanalysis began when the help of hypnotism was renounced.
But if the establishment of the resistance thus becomes a matter of such importance, then surely we must give our caution full rein, and follow up any doubts as to whether we are not all too ready in our assumption of their existence. Perhaps there really are neurotic cases in which associations appear for other reasons, perhaps the arguments against our hypothesis really deserve more consideration and we are unjustified in conveniently rejecting all intellectual criticisms of analysis as a resistance. Indeed, ladies and gentlemen, but our judgment was by no means readily arrived at. We had opportunity to observe every critical patient from the first sign of the resistance till after its disappearance. In the course of the treatment, the resistance is moreover constantly changing in intensity. It is always on the increase as we approach a new theme, is strongest at the height of its elaboration, and dies down again when this theme has been abandoned. Furthermore, unless we have made some unusual and awkward technical error, we never have to deal with the full measure of resistance of which the patient is capable. We could therefore convince ourselves that the same man took up and discarded his critical attitude innumerable times in the course of the analysis. Whenever we are on the point of bringing before his consciousness some piece of unconscious material which is especially painful to him, then he is critical in the extreme. Even though he had previously understood and accepted a great deal, nevertheless all record of these gains seems now to have been wiped out. He may, in his desire to resist at any cost, present a picture of veritable emotional feeblemindedness. If one succeeds in helping him to overcome this new resistance, then he regains his insight and his understanding. Thus his criticism is not an independent function to be respected as such; it plays the role of handy-man to his emotional attitude and is guided by his resistance. If something displeases him, he can defend himself against it very ingeniously and appear most critical. But if something strikes his fancy, then he may show himself easily convinced. Perhaps none of us are very different, and the patient under analysis shows this dependence of the intellect on the emotional life so plainly only because, under the analysis, he is so hard pressed.
In what way shall we now account for the observation that the patient so energetically resists our attempts to rid him of his symptoms and to make his psychic processes function in a normal way? We tell ourselves that we have here come up against strong forces which oppose any change in the condition; furthermore, that these forces must be identical with those which originally brought about the condition. Some process must have been functional in the building up of these symptoms, a process which we can now reconstruct by means of our experiences in solving the meaning of the symptoms. We already know from Breuer’s observations that the existence of a symptom presupposes that some psychic process was not carried to its normal conclusion, so that it could not become conscious. The symptom is the substitute for that which did not take place. Now we know where the forces whose existence we suspect must operate. Some violent antagonism must have been aroused to prevent the psychic process in question from reaching consciousness, and it therefore remained unconscious. As an unconscious thought it had the power to create a symptom. The same struggle during the analytic treatment opposes anew the efforts to carry this unconscious thought over into consciousness. This process we felt as a resistance. That pathogenic process which is made evident to us through the resistance, we will name repression.
We are now ready to obtain a more definite idea of this process of repression. It is the preliminary condition for the formation of symptoms; it is also a thing for which we have no parallel. If we take as prototype an impulse, a psychological process which is striving to convert itself into action, we know that it may succumb before a rejection, which we call “repudiation” or “condemnation.” In the course of this struggle, the energy which the impulse had at its disposal was withdrawn from it, it becomes powerless; yet it may subsist in the form of a memory. The whole process of decision occurs with the full knowledge of the ego. The state of affairs is very different if we imagine that this same impulse has been subjected to repression. In that case, it would retain its energy and there would be no memory of it left; in addition, the process of repression would be carried out without the knowledge of the ego. Through this comparison, however, we have come no nearer understanding the nature of repression.
I now go into the theoretical ideas which alone have shown themselves useful in making the conception of repression more definite. It is above all necessary that we progress from a purely descriptive meaning of the word “unconscious” to its more systematic meaning; that is, we come to a point where we must call the consciousness or unconsciousness of a psychic process only one of its attributes, an attribute which is, moreover, not necessarily unequivocal. If such a process remained unconscious, then this separation from consciousness is perhaps only an indication of the fate to which it has submitted and not this fate itself. To bring this home to us more vividly, let us assume that every psychological process — with one exception, which I will go into later — first exists in an unconscious state or phase and only goes over from this into a conscious phase, much as a photographic picture is first a negative and then becomes a picture by being printed. But not every negative need become a positive, and just as little is it necessary that every unconscious psychological process should be changed into a conscious one. We find it advantageous to express ourselves as follows: Any particular process belongs in the first place to the psychological system of the unconscious; from this system it can under certain conditions go over into the system of the conscious. The crudest conception of these systems is the one which is most convenient for us, namely, a representation in space. We will compare the system of the unconscious to a large ante-chamber, in which the psychic impulses rub elbows with one another, as separate beings. There opens out of this ante-chamber another, a smaller room, a sort of parlor, which consciousness occupies. But on the threshold between the two rooms there stands a watchman; he passes on the individual psychic impulses, censors them, and will not let them into the parlor if they do not meet with his approval. You see at once that it makes little difference whether the watchman brushes a single impulse away from the threshold, or whether he drives it out again after it has already entered the parlor. It is a question here only of the extent of his watchfulness, and the timeliness of his judgment. Still working with this simile, we proceed to a further elaboration of our nomenclature. The impulses in the ante-chamber of the unconscious cannot be seen by the conscious, which is in the other room; therefore for the time being they must remain unconscious. When they have succeeded in pressing forward to the threshold, and have been sent back by the watchman, then they are unsuitable for consciousness and we call them suppressed. Those impulses, however, which the watchman has permitted to cross the threshold have not necessarily become conscious; for this can happen only if they have been successful in attracting to themselves the glance of the conscious. We therefore justifiably call this second room the system of the fore-conscious. In this way the process of becoming conscious retains its purely descriptive sense. Suppression then, for any individual impulse, consists in not being able to get past the watchman from the system of the unconscious to that of the fore-conscious. The watchman himself is long since known to us; we have met him as the resistance which opposed us when we attempted to release the suppression through analytic treatment.
Now I know you will say that these conceptions are as crude as they are fantastic, and not at all permissible in a scientific discussion. I know they are crude — indeed, we even know that they are incorrect, and if we are not very much mistaken we have a better substitute for them in readiness. Whether they will continue then to appear so fantastic to you I do not know. For the time being, they are useful conceptions, similar to the manikin Ampère who swims in the stream of the electric current. In so far as they are helpful in the understanding of our observation, they are by no means to be despised. I should like to assure you that these crude assumptions go far in approximating the actual situation — the two rooms, the watchman on the threshold between the two, and consciousness at the end of the second room in the role of an onlooker. I should also like to hear you admit that our designations —unconscious, fore-conscious, and conscious are much less likely to arouse prejudice, and are easier to justify than others that have been used or suggested — such as sub-conscious, inter-conscious, between-conscious, etc.
This becomes all the more important to me if you should warn me that this arrangement of the psychic apparatus, such as I have assumed in the explanation of neurotic symptoms, must be generally applicable and must hold for normal functioning as well. In that, of course, you are right. We cannot follow this up at present, but our interest in the psychology of the development of the symptom must be enormously increased if through the study of pathological conditions we have the prospect of finding a key to the normal psychic occurrences which have been so well concealed.
You will probably recognize what it is that supports our assumptions concerning these two systems and their relation to consciousness. The watchman between the unconscious and the fore-conscious is none other than the censor under whose control we found the manifest dream to obtain its form. The residue of the day’s experiences, which we found were the stimuli which set off the dream, are fore-conscious materials which at night, during sleep, had come under the influence of unconscious and suppressed wishes. Borne along by the energy of the wish, these stimuli were able to build the latent dream. Under the control of the unconscious system this material was worked over, went through an elaboration and displacement such as the normal psychic life or, better said, the fore-conscious system, either does not know at all or tolerates only exceptionally. In our eyes the characteristics of each of the two systems were betrayed by this difference in their functioning. The dependent relation between the fore-conscious and the conscious was to us only an indication that it must belong to one of the two systems. The dream is by no means a pathological phenomenon; it may appear in every healthy person under the conditions of sleep. Any assumption as to the structure of the psychic apparatus which covers the development of both the dream and the neurotic symptom has also an undeniable claim to be taken into consideration in any theory of normal psychic life.
So much, then, for suppression. It is, however, only a prerequisite for the evolution of the symptom. We know that the symptom serves as a substitute for a process kept back by suppression. Yet it is no simple matter to bridge this gap between the suppression and the evolution of the substitute. We have first to answer several questions on other aspects of the problem concerning the suppression and its substantiation: What kind of psychological stimuli are at the basis of the suppression; by what forces is it achieved; for what motives? On these matters we have only one insight that we can go by. We learned in the investigation of resistance that it grows out of the forces of the “I,” in other words from obvious and latent traits of character. It must be from the same traits also that suppression derived support; at least they played a part in its development. All further knowledge is still withheld from us.
A second observation, for which I have already prepared, will help us further at this point. By means of analysis we can assign one very general purpose to the neurotic symptom. This is of course nothing new to you. I have already shown it to you in the two cases of neuroses. But, to be sure, what is the significance of two cases! You have the right to demand that it be shown to you innumerable times. But I am unable to do this. Here again your own experience must step in, or your belief, which may in this matter rely upon the unanimous account of all psychoanalysts.
You will remember that in these two cases, whose symptoms we subjected to searching investigation, the analysis introduced us to the most intimate sexual life of these patients. In the first case, moreover, we could identify with unusual clearness the purpose or tendency of the symptoms under investigation. Perhaps in the second case it was slightly covered by another factor — one we will consider later. Now, the same thing that we saw in these two examples we would see in all other cases that we subjected to analysis. Each time, through analysis, we would be introduced to the sexual wishes and experiences of the patient, and every time we would have to conclude that their symptoms served the same purpose. This purpose shows itself to be the satisfaction of sexual wishes; the symptoms serve as a sexual satisfaction for the patient, they are a substitute for such satisfactions as they miss in reality.
Recall the compulsive act of our first patient. The woman longs for her intensely beloved husband, with whom she cannot share her life because of his shortcoming and weaknesses. She feels she must remain true to him, she can give his place to no one else. Her compulsive symptom affords her that for which she pines, ennobles her husband, denies and corrects his weaknesses — above all, his impotence. This symptom is fundamentally a wish-fulfillment, exactly as is a dream; moreover, it is what a dream not always is, an erotic wish-fulfillment. In the case of our second patient you can see that one of the component purposes of her ceremonial was the prevention of the intercourse of her parents or the hindrance of the creation of a new child thereby. You have perhaps also guessed that essentially she strove to put herself in the place of her mother. Here again we find the removal of disturbances to sexual satisfaction and the fulfillment of personal sexual wishes. We shall soon turn to the complications of whose existence we have given you several indications.
I do not want to make reservations as to the universal applicability of these declarations later on, and therefore I wish to call to your attention the fact that everything that I say here about suppression, symptom-development and symptom-interpretation has been learned from three types of neuroses — anxiety-hysteria, conversion-hysteria, and compulsion-neuroses — and for the time being is relevant to these forms only. These three conditions, which we are in the habit of combining into one group under the name of “transference neuroses,” also limit the field open to psychoanalytic therapy. The other neuroses have not been nearly so well studied by psychoanalysis — in one group, in fact, the impossibility of therapeutic influence has been the reason for the neglect. But you must not forget that psychoanalysis is still a very young science, that it demands much time and care in preparation for it, that not long ago it was still in the cradle, so to speak. Yet at all points we are about to penetrate into the understanding of those other conditions which are not transference neuroses. I hope I shall still be able to speak to you of the developments that our assumptions and results have undergone by being correlated with this new material, and to show you that these further studies have not led to contradictions but rather to the production of still greater uniformity. Granted that everything, then, that has been said here, holds good for the three transference neuroses, allow me to add a new bit of information to the evaluation of its symptoms. A comparative investigation into the causes of the disease discloses a result that may be confined into the formula: in some way or other these patients fell ill through self-denial when reality withheld from them the satisfaction of their sexual wishes. You recognize how excellently well these two results are found to agree. The symptoms must be understood, then, as a substitute satisfaction for that which is missed in life.
To be sure, there are all kinds of objections possible to the declaration that neurotic symptoms are substitutes for sexual satisfaction. I shall still go into two of them today. If you yourself have analytically examined a fairly large number of neurotics you will perhaps gravely inform me that in one class of cases this is not at all applicable, the symptoms appear rather to have the opposite purpose, to exclude sexual satisfaction, or discontinue it. I shall not deny the correctness of your interpretation. The psychoanalytic content has a habit of being more complicated than we should like to have it. Had it been so simple, perhaps we should have had no need for psychoanalysis to bring it to light. As a matter of fact, some of the traits of the ceremonial of our second patient may be recognized as of this ascetic nature, inimical to sexual satisfaction; for example, the fact that she removes the clocks, which have the magic qualities of preventing nightly erections, or that she tries to prevent the falling and breaking of vessels, which symbolizes a protection of her virginity. In other cases of bed-ceremonials which I was able to analyze, this negative character was far more evident; the ceremonial might consist throughout of protective regulations against sexual recollections and temptations. On the other hand, we have often discovered in psychoanalysis that opposites do not mean contradictions. We might extend our assertion and say the symptoms purpose either a sexual satisfaction or a guard against it; that in hysteria the positive wish-fulfillment takes precedence, while in the compulsion neuroses the negative, ascetic characteristics have the ascendancy. We have not yet been able to speak of that aspect of the mechanism of the symptoms, their two-sidedness, or polarity, which enables them to serve this double purpose, both the sexual satisfaction and its opposite. The symptoms are, as we shall see, compromise results, arising from the integration of two opposed tendencies; they represent not only the suppressed force but also the suppressing factor, which was originally potent in bringing about the negation. The result may then favor either one side or the other, but seldom is one of the influences entirely lacking. In cases of hysteria, the meeting of the two purposes in the same symptom is most often achieved. In compulsion-neuroses, the two parts often become distinct; the symptom then has a double meaning, it consists of two actions, one following the other, one releasing the other. It will not be so easy to put aside a further misgiving. If you should look over a large number of symptom-interpretations, you would probably judge offhand that the conception of a sexual substitute-satisfaction has been stretched to its utmost limits in these cases. You will not hesitate to emphasize that these symptoms offer nothing in the way of actual satisfaction, that often enough they are limited to giving fresh life to sensations or phantasies from some sexual complex. Further, you will declare that the apparent sexual satisfaction so often shows a childish and unworthy character, perhaps approximates an act of onanism, or is reminiscent of filthy naughtiness, habits that are already forbidden and broken in childhood. Finally, you will express your surprise that one should designate as a sexual satisfaction appetites which can only be described as horrible or ghastly, even unnatural. As to these last points, we shall come to no agreement until we have submitted man’s sexual life to a thorough investigation, and thus ascertained what one is justified in calling sexual.
Last updated Sunday, March 27, 2016 at 11:54