The Collected Works of Sigmund Freud. Sigmund Freud

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СКАЧАТЬ which translates unconscious into conscious, the ego grows at the expense of the unconscious; it learns forgiveness toward the libido, and becomes inclined to permit some sort of satisfaction for it. The ego’s timidity in the face of the demands of the libido is now lessened by the prospect of occupying some of the libido through sublimation. The more the processes of the treatment correspond to this theoretic description the greater will be the success of psychoanalytic therapy. It is limited by the lack of mobility of the libido, which can stand in the way of releasing its objects, and by the obstinate narcism which will not permit the object-transference to effect more than just so much. Perhaps we shall obtain further light on the dynamics of the healing process by the remark that we are able to gather up the entire libido which has become withdrawn from the control of the ego by drawing a part of it to ourselves in the process of transference.

      It is to be remembered that we cannot reach a direct conclusion as to the disposition of the libido during the disease from the distributions of the libido which are effected during and because of the treatment. Assuming that we have succeeded in curing the case by means of the creation and destruction of a strong father-transference to the physician, it would be wrong to conclude that the patient had previously suffered from a similar and unconscious attachment of his libido to his father. The father-transference is merely the battlefield upon which we were able to overcome the libido; the patient’s libido had been concentrated here from its other positions. The battlefield need not necessarily have coincided with the most important fortresses of the enemy. Defense of the hostile capital need not take place before its very gates. Not until we have again destroyed the transference can we begin to reconstruct the distribution of the libido that existed during the illness.

      From the standpoint of the libido theory we might say a last word in regard to the dream. The dreams of neurotics, as well as their errors and haphazard thoughts, help us in finding the meaning of the symptoms and in discovering the disposition of the libido. In the form of the wish fulfillment they show us what wish impulses have been suppressed, and to what objects the libido, withdrawn from the ego, has been attached. That is why interpretation of dreams plays a large role in psychoanalytic treatment, and is in many cases, for a long time, the most important means with which we work. We already know that the condition of sleep itself carries with it a certain abatement of suppressions. Because of this lessening of the pressure upon it, it becomes possible for the suppressed impulse to create in the dream a much clearer expression than the symptom can furnish during the day. So dream-study is the easiest approach to a knowledge of the libidinous suppressed unconscious which has been withdrawn from the ego.

      Dreams of neurotics differ in no essential point from the dreams of normal persons; you might even say they cannot be distinguished. It would be unreasonable to explain the dreams of the nervous in any way which could not be applied to the dreams of the normal. So we must say the difference between neurosis and health applies only during the day, and does not continue in dream life. We find it necessary to attribute to the healthy numerous assumptions which have grown out of the connections between the dreams and the symptoms of the neurotic. We are not in a position to deny that even a healthy man possesses those factors in his psychic life which alone make possible the development of the dream and of the symptom as well. We must conclude, therefore, that the healthy have also made use of suppressions and are put to a certain amount of trouble to keep those impulses under control; the system of their unconscious, too, conceals impulses which are suppressed, yet are still possessed of energy, and a part of their libido is also withdrawn from the control of their ego. So the healthy man is virtually a neurotic, but dreams are apparently the only symptoms which he can manifest. Yet if we subject our waking hours to a more penetrating analysis we discover, of course, that they refute this appearance and that this seemingly healthy life is shot through with a number of trivial, practically unimportant symptom formations.

      The difference between nervous health and neurosis is entirely a practical one which is determined by the available capacity for enjoyment and accomplishment retained by the individual. It varies presumably with the relative proportion of the energy totals which have remained free and those which have been bound by suppressions, and is quantitative rather than qualitative. I do not have to remind you that this conception is the theoretical basis for the certainty that neuroses can be cured, despite their foundation in constitutional disposition.

      This is accordingly what we may make out of the identity between the dreams of the healthy and those of the neurotic for the definition of health. As regards the dream itself, we must note further that we cannot separate it from its relation to neurotic symptoms. We must recognize that it is not completely defined as a translation of thoughts into an archaic form of expression, that is, we must assume it discloses a disposition of libido and of object-occupations which have actually taken place.

      We have about come to the end. Perhaps you are disappointed that I have dealt only with theory in this chapter on psychoanalytic therapy, and have said nothing concerning the conditions under which the cure is undertaken, or of the successes which it achieves. But I shall omit both. I shall omit the first because I had intended no practical training in the practice of psychoanalysis, and I shall neglect the second for numerous reasons. At the beginning of our talks I emphasized the fact that under favorable circumstances we attain results which can be favorably compared with the happiest achievements in the field of internal therapy, and, I may add, these results could not have been otherwise achieved. If I were to say more I might be suspected of wishing to drown the voices of disparagement, which have become so loud, by advertising our claims. We psychoanalysts have repeatedly been threatened by our medical colleagues, even in open congresses, that the eyes of the suffering public must be opened to the worthlessness of this method of treatment by a statistical collection of analytic failures and injuries. But such a collection, aside from the biased, denunciatory character of its purpose, would hardly be able to give a correct picture of the therapeutic values of analysis. Analytic therapy is, as you know, still young; it took a long time to establish the technique, and this could be done only during the course of the work and under the influence of accumulating experience. As a result of the difficulties of instruction the physician who begins the practice of psychoanalysis is more dependent upon his capacity to develop on his own account than is the ordinary specialist, and the results he achieves in his first years can never be taken as indicative of the possibilities of analytic therapy.

      Many attempts at treatment failed in the early years of analysis because they were made on cases that were not at all suited to the procedure, and which today we exclude by our classification of symptoms. But this classification could be made only after practice. In the beginning we did not know that paranoia and dementia praecox are, in their fully developed phases, inaccessible, and we were justified in trying out our method on all kinds of conditions. Besides, the greatest number of failures in those first years were not due to the fault of the physician or because of unsuitable choice of subjects, but rather to the unpropitiousness of external conditions. We have hitherto spoken only of internal resistances, those of the patient, which are necessary and may be overcome. External resistances to psychoanalysis, due to the circumstances of the patient and his environment, have little theoretical interest, but are of great practical importance. Psychoanalytic treatment may be compared to a surgical operation, and has the right to be undertaken under circumstances favorable to its success. You know what precautions the surgeon is accustomed to take: a suitable room, good light, assistance, exclusion of relatives, etc. How many operations would be successful, do you think, if they had to be performed in the presence of all the members of the family, who would put their fingers into the field of operation and cry aloud at every cut of the knife? The interference of relatives in psychoanalytical treatment is a very great danger, a danger one does not know how to meet. We are armed against the internal resistances of the patient which we recognize as necessary, but how are we to protect ourselves against external resistance? It is impossible to approach the relatives of the patient with any sort of explanation, one cannot influence them to hold aloof from the whole affair, and one cannot get into league with them because we then run the danger of losing the confidence of the patient, who rightly demands that we in whom he confides take his part. Besides, those who know the rifts that are often formed in family life will not be surprised as analysts when they discover СКАЧАТЬ