Part 25

If only it were so! But we have made discoveries that we were quite unprepared for at first. There is knowing and knowing; they are not always the same thing. There are various kinds of knowing, which psychologically are not by any means of equal value. _Il y a fagots et fagots_, as Molière says. Knowing on the part of the physician is not the same thing as knowing on the part of the patient and does not have the same effect. When the physician conveys his knowledge to the patient by telling him what he knows, it has no effect. No, it would be incorrect to say that. It does not have the effect of dispersing the symptoms; but it has a different one, it sets the analysis in motion, and the first result of this is often an energetic denial. The patient has learned something that he did not know before—the meaning of his symptom—and yet he knows it as little as ever. Thus we discover that there is more than one kind of ignorance. It requires a considerable degree of insight and understanding of psychological matters in order to see in what the difference consists. But the proposition that symptoms vanish with the acquisition of knowledge of their meaning remains true, nevertheless. The necessary condition is that the knowledge must be founded upon an inner change in the patient which can only come about by a mental operation directed to that end. We are here confronted by problems which to us will soon develop into the _dynamics_ of symptom-formation.

Now I must really stop and ask you whether all that I have been saying is not too obscure and complicated? Am I confusing you by so often qualifying and restricting, spinning out trains of thought and then letting them drop? I should be sorry if it were so. But I have a strong dislike of simplification at the expense of truth, I am not averse from giving you a full impression of the many-sidedness and intricacy of the subject, and also I believe that it does no harm to tell you more about each point than you can assimilate at the moment. I know that every listener and every reader arranges what is offered him as suits him in his own mind, shortens it, simplifies it, and extracts from it what he will retain. Within certain limits it is true that the more we begin with the more we shall have at the end. So let me hope that, in spite of the elaboration, you will have grasped the essential substance of my remarks concerning the meaning of symptoms, the Unconscious, and the connection between the two. You have probably understood also that our further efforts will proceed in two directions; first, towards discovering how people become ill, how they come to take up the characteristic neurotic attitude towards life, which is a clinical problem; and secondly, how they develop the morbid symptoms out of the conditions of a neurosis, which remains a problem of mental dynamics. The two problems must somewhere have a point of contact.

I shall not go further into this to-day; but as our time is not yet up I propose to draw your attention to another characteristic of our two analyses; namely, _the memory gaps or amnesias_, again a point which only later will appear in its full significance. You have heard that the task of the psycho-analytic treatment can be summed up in this formula: everything pathogenic in the Unconscious must be transferred into consciousness. Now you will be perhaps astonished to hear that another formula may be substituted for that one: all gaps in the patient’s memory must be filled in, his amnesias removed. It amounts to the same thing; which means that an important connection is to be recognized between the development of the symptoms and the amnesias. If you consider the case of the first patient analysed you will, however, not find this view of amnesia justified; the patient had not forgotten the scene from which the obsessive act is derived; on the contrary, it was vivid in her memory, nor is there any other forgotten factor involved in the formation of her symptom. The situation is quite analogous, although less clear, in the second case, the girl with the obsessional ceremonies. She, too, had not really forgotten her behaviour in former years, the fact that she had insisted upon the open door between her parents’ bedroom and her own, and that she had turned her mother out of her place in the parents’ bed; she remembered it quite clearly, although with hesitation and unwillingness. What is remarkable about it is that the first patient, although she had carried out her obsessive act such a countless number of times, had not _once_ been reminded of its similarity to the scene after the wedding-night, nor did this recollection ever occur to her when she was directly asked to search for the origin of her obsessive act. The same thing is true in the case of the girl, where not merely the ritual, but the situation which gave rise to it, was repeated identically every evening. In neither case was there really an amnesia, a lapse of memory; but a connection, which should have existed intact and have led to the reproduction, the recollection, of the memory, had been broken. This kind of disturbance of memory suffices for the obsessional neurosis; in hysteria it is different. This latter neurosis is usually characterized by amnesias on a grand scale. As a rule the analysis of each single hysterical symptom leads to a whole chain of former impressions, which upon their return may be literally described as having been hitherto forgotten. This chain reaches, on the one hand, back to the earliest years of childhood, so that the hysterical amnesia is seen to be a direct continuation of the infantile amnesia which hides the earliest impressions of our mental life from all of us. On the other hand, we are astonished to find that the most recent experiences of the patient are liable to be forgotten also, and that in particular the provocations which induced the outbreak of the disease or aggravated it are at least partially obliterated, if not entirely wiped out, by amnesia. From the complete picture of any such recent recollection important details have invariably disappeared or been replaced by falsifications. It happens again and again, almost invariably, that not until shortly before the completion of an analysis do certain recollections of recent experiences come to the surface, which had managed to be withheld throughout it and had left noticeable gaps in the context.

These derangements in the capacity to recall memories are, as I have said, characteristic of hysteria, in which disease it also happens even that states occur as symptoms (the hysterical attacks) without necessarily leaving a trace of recollection behind them. Since it is otherwise in the obsessional neurosis, you may infer that these amnesias are part of the psychological character of the hysterical change and are not a universal trait of neurosis in general. The importance of this difference will be diminished by the following consideration. Two things are combined to constitute the meaning of a symptom; its _whence_ and its _whither_ or _why_; that is, the impressions and experiences from which it sprang, and the purpose which it serves. The _whence_ of a symptom is resolved into impressions which have been received from without, which were necessarily at one time conscious, and which may have become unconscious by being forgotten since that time. The _why_ of the symptom, its tendency, is however always an endo-psychic process, which may possibly have been conscious at first, but just as possibly may never have been conscious and may have remained in the Unconscious from its inception. Therefore it is not very important whether the amnesia has also infringed upon the _whence_, the impressions upon which the symptom is supported, as happens in hysteria; the _whither_, the tendency of the symptom, which may have been unconscious from the beginning, is what maintains the symptom’s dependence upon the Unconscious, in the obsessional neurosis no less strictly than in hysteria.

By thus emphasizing the unconscious in mental life we have called forth all the malevolence in humanity in opposition to psycho-analysis. Do not be astonished at this and do not suppose that this opposition relates to the obvious difficulty of conceiving the Unconscious or to the relative inaccessibility of the evidence which supports its existence. I believe it has a deeper source. Humanity has in the course of time had to endure from the hands of science two great outrages upon its naïve self-love. The first was when it realized that our earth was not the centre of the universe, but only a tiny speck in a world-system of a magnitude hardly conceivable; this is associated in our minds with the name of Copernicus, although Alexandrian doctrines taught something very similar. The second was when biological research robbed man of his peculiar privilege of having been specially created, and relegated him to a descent from the animal world, implying an ineradicable animal nature in him: this transvaluation has been accomplished in our own time upon the instigation of Charles Darwin, Wallace, and their predecessors, and not without the most violent opposition from their contemporaries. But man’s craving for grandiosity is now suffering the third and most bitter blow from present-day psychological research which is endeavouring to prove to the “ego” of each one of us that he is not even master in his own house, but that he must remain content with the veriest scraps of information about what is going on unconsciously in his own mind. We psycho-analysts were neither the first nor the only ones to propose to mankind that they should look inward; but it appears to be our lot to advocate it most insistently and to support it by empirical evidence which touches every man closely. This is the kernel of the universal revolt against our science, of the total disregard of academic courtesy in dispute, and the liberation of opposition from all the constraints of impartial logic. And besides this, we have been compelled to disturb the peace of the world in yet another way, as you will soon hear.

NINETEENTH LECTURE RESISTANCE AND REPRESSION

We now need more data before we can advance further in our understanding of the neuroses; two observations lie to hand for us. Both are very remarkable and at first were very surprising. You are of course prepared for both of them by the work we did last year.

First: when we undertake to cure a patient of his symptoms he opposes against us a vigorous and tenacious _resistance_ throughout the entire course of the treatment. This is such an extraordinary thing that we cannot expect much belief in it. It is best to say nothing about it to the patient’s relations, for they invariably regard it as a pretext set up by us to excuse the length or the failure of the treatment. The patient, too, exhibits all the manifestations of this resistance without recognizing it as such, and it is a great step forward when we have brought him to realize this fact and to reckon with it. To think that the patient, whose symptoms cause him and those about him such suffering, who is willing to make such sacrifices in time, money, effort, and self-conquest in order to be freed from them,—that he should, in the interests of his illness, resist the help offered him. How improbable this statement must sound! And yet it is so, and if the improbability is made a reproach against us we need only reply that it is not without its analogies; for a man who has rushed off to a dentist with a frightful toothache may very well fend him off when he takes his forceps to the decayed tooth.

The resistance shown by patients is highly varied and exceedingly subtle, often hard to recognize and protean in the manifold forms it takes; the analyst needs to be continually suspicious and on his guard against it. In psycho-analytic therapy we employ the technique which is already familiar to you through dream-interpretation: we require the patient to put himself into a condition of calm self-observation, without trying to think of anything, and then to communicate everything which he becomes inwardly aware of, feelings, thoughts, remembrances, in the order in which they arise in his mind. We expressly warn him against giving way to any kind of motive which would cause him to select from or to exclude any of the ideas (associations), whether because they are too “disagreeable,” or too “indiscreet” to be mentioned, or too “unimportant” or “irrelevant” or “nonsensical” to be worth saying. We impress upon him that he has only to attend to what is on the surface consciously in his mind, and to abandon all objections to whatever he finds, no matter what form they take; and we inform him that the success of the treatment, and, above all, its duration, will depend upon his conscientious adherence to this fundamental technical rule. We know from the technique of dream-interpretation that it is precisely those associations against which innumerable doubts and objections are raised that invariably contain the material leading to the discovery of the unconscious.

The first thing that happens as a result of instituting this technical rule is that it becomes the first point of attack for the resistance. The patient attempts to escape from it by every possible means. First he says nothing comes into his head, then that so much comes into his head that he can’t grasp any of it. Then we observe with displeasure and astonishment that he is giving in to his critical objections, first to this, then to that; he betrays it by the long pauses which occur in his talk. At last he admits that he really cannot say something, he is ashamed to, and he lets this feeling get the better of his promise. Or else, he has thought of something but it concerns someone else and not himself, and is therefore to be made an exception to the rule. Or else, what he has just thought of is really too unimportant, too stupid and too absurd, I could never have meant that he should take account of such thoughts. So it goes on, with untold variations, to which one continually replies that telling everything really means telling everything.

One hardly ever meets with a patient who does not attempt to make a reservation in some department of his thoughts, in order to guard them against intrusion by the analysis. One patient, who in the ordinary way was remarkably intelligent, concealed a most intimate love-affair from me for weeks in this way; when accused of this violation of the sacred rule he defended himself with the argument that he considered this particular story his private affair. Naturally analytic treatment cannot countenance a right of sanctuary like this; one might as well try to allow an exception to be made in certain parts of a town like Vienna, and forbid that any arrests should be made in the market-place or in the square by St. Stephen’s church, and then attempt to take up a “wanted” man. Of course he would never be found anywhere but in those safe places. Once I decided to permit a man to make an exception of such a point; for a great deal depended on his recovering his capacity for work and he was bound by his oath as a civil servant not to communicate certain matters to any other person. He was content with the result, it is true, but I was not: I made up my mind never again to repeat the attempt under such conditions.

Obsessional patients are exceedingly clever at making the technical rule almost useless by bringing their over-conscientiousness and doubt to bear upon it. Patients with anxiety-hysteria sometimes succeed in reducing it to absurdity by only producing associations which are so far removed from what is wanted that they yield nothing for analysis. However, I do not intend to introduce you to these technical difficulties of the treatment. It is enough to know that finally, with resolution and perseverance, we do succeed in extracting from the patient a certain amount of obedience for the rule of the technique; and then the resistance takes another line altogether. It appears as intellectual opposition, employs arguments as weapons, and turns to its own use all the difficulties and improbabilities which normal but uninstructed reasoning finds in analytical doctrines. We then have to hear from the mouth of the individual patient all the criticisms and objections which thunder about us in chorus in scientific literature. What the critics outside shout at us is nothing new, therefore. It is indeed a storm in a teacup. Still, the patient can be argued with; he is very glad to get us to instruct him, teach him, defeat him, point out the literature to him so that he can learn more; he is perfectly ready to become a supporter of psycho-analysis on the condition that analysis shall spare him personally. We recognize resistance in this desire for knowledge, however; it is a digression from the particular task in hand and we refuse to allow it. In the obsessional neurosis the resistance makes use of special tactics which we are prepared for. It permits the analysis to proceed uninterruptedly along its course, so that more and more light is thrown upon the problems of the case, until we begin to wonder at last why these explanations have no practical effect and entail no corresponding improvement in the symptoms. Then we discover that the resistance has fallen back upon the doubt characteristic of the obsessional neurosis and is holding us successfully at bay from this vantage-point. The patient has said to himself something of this kind: “This is all very pretty and very interesting. I should like to go on with it. I am sure it would do me a lot of good if it were true. But I don’t believe it in the least, and as long as I don’t believe it, it doesn’t affect my illness.” So it goes on for a long time, until at last this reservation itself is reached and then the decisive battle begins.

The intellectual resistances are not the worst; one can always get the better of them. But the patient knows how to set up resistances within the boundaries of analysis proper, and the defeat of these is one of the most difficult tasks of the technique. Instead of remembering certain of the feelings and states of mind of his previous life, he reproduces them, lives through again such of them as, by means of what is called the ‘transference,’ may be made effective in opposition against the physician and the treatment. If the patient is a man, he usually takes this material from his relationship with his father, in whose place he has now put the physician; and in so doing he erects resistances out of his struggles to attain to personal independence and independence of judgement, out of his ambition, the earliest aim of which was to equal or to excel the father, out of his disinclination to take the burden of gratitude upon himself for the second time in his life. There are periods in which one feels that the patient’s desire to put the analyst in the wrong, to make him feel his impotence, to triumph over him, has completely ousted the worthier desire to bring the illness to an end. Women have a genius for exploiting in the interests of resistance a tender erotically-tinged transference to the analyst; when this attraction reaches a certain intensity all interest in the actual situation of treatment fades away, together with every obligation incurred upon undertaking it. The inevitable jealousy and the embitterment consequent upon the unavoidable rejection, however considerately it is handled, is bound to injure the personal relationship with the physician, and so to put out of action one of the most powerful propelling forces in the analysis.

Resistances of this kind must not be narrowly condemned. They contain so much of the most important material from the patient’s past life and bring it back in so convincing a fashion that they come to be of the greatest assistance to the analysis, if a skilful technique is employed correctly to turn them to the best use. What is noteworthy is that this material always serves at first as a resistance and comes forward in a guise which is inimical to the treatment. Again it may be said that they are character-traits, individual attitudes of the Ego, which are thus mobilized to oppose the attempted alterations. One learns then how these character-traits have been developed in connection with the conditions of the neurosis and in reaction against its demands, and observes features in this character which would not otherwise have appeared, at least, not so clearly: that is, which may be designated latent. Also you must not carry away the impression that we look upon the appearance of these resistances as an unforeseen danger threatening our analytic influence. No, we know that these resistances are bound to appear; we are dissatisfied only if we cannot rouse them definitely enough and make the patient perceive them as such. Indeed, we understand at last that the overcoming of these resistances is the essential work of the analysis, that part of the work which alone assures us that we have achieved something for the patient.

Besides this, you must take into account that all accidental occurrences arising during the treatment are made use of by the patient to interfere with it, anything which could distract him or deter him from it, every hostile expression of opinion from anyone in his circle whom he can regard as an authority, any chance organic illness or one complicating the neurosis; indeed, he even converts every improvement in his condition into a motive for slackening his efforts. Then you will have obtained an approximate, though still incomplete, picture of the forms and the measures taken by the resistances which must be met and overcome in the course of every analysis. I have given such a detailed consideration to this point because I am about to inform you that our dynamic conception of the neuroses is founded upon this experience of ours of the resistances that neurotic patients set up against the cure of their symptoms. Breuer and I both originally practised psycho-therapy by the hypnotic method. Breuer’s first patient was treated throughout in a state of hypnotic suggestibility; at first I followed his example. I admit that at that time my work went forward more easily and agreeably and also took much less time: but the results were capricious and not permanent; therefore I finally gave up hypnotism. And then I understood that no comprehension of the dynamics of these affections was possible as long as hypnosis was employed. In this condition the very existence of resistances is concealed from the physician’s observation. Hypnosis drives back the resistances and frees a certain field for the work of the analysis, but dams them up at the boundaries of this field so that they are insurmountable; it is similar in effect to the doubt of the obsessional neurosis. Therefore I may say that true psycho-analysis only began when the help of hypnosis was discarded.