Freud - Complete Works (810 page)

   There is, however, another angle
from which we can approach this problem of the variability in the
effect of analysis. We know that the first step towards attaining
intellectual mastery of our environment is to discover
generalizations, rules and laws which bring order into chaos. In
doing this we simplify the world of phenomena; but we cannot avoid
falsifying it, especially if we are dealing with processes of
development and change. What we are concerned with is discerning a
qualitative
alteration, and as a rule in doing so we
neglect, at any rate to begin with, a
quantitative
factor.
In the real world, transitions and intermediate stages are far more
common than sharply differentiated opposite states. In studying
developments and changes we direct our attention solely to the
outcome; we readily overlook the fact that such processes are
usually more or less incomplete - that is to say, that they are in
fact only partial alterations. A shrewd satirist of old Austria,
Johann Nestroy, once said: ‘Every step forward is only half
as big as it looks at first.’ It is tempting to attribute a
quite general validity to this malicious dictum. There are nearly
always residual phenomena, a partial hanging-back. When an
open-handed Maecenas surprises us by some isolated trait of
miserliness, or when a person who is consistently over-kind
suddenly indulges in a hostile action, such ‘residual
phenomena’ are invaluable for genetic research. They show us
that these praiseworthy and precious qualities are based on
compensation and overcompensation which, as was to have been
expected, have not been absolutely and fully successful. Our first
account of the development of the libido was that an original oral
phase gave way to a sadistic-anal phase and that this was in turn
succeeded by a phallic-genital one. Later research has not
contradicted this view, but it has corrected it by adding that
these replacements do not take place all of a sudden but gradually,
so that portions of the earlier organization always persist
alongside of the more recent one, and even in normal development
the transformation is never complete and residues of earlier
libidinal fixations may still be retained in the final
configuration. The same thing is to be seen in quite other fields.
Of all the erroneous and superstitious beliefs of mankind that have
supposedly been surmounted there is not one whose residues do not
live on among us to-day in the lower strata of civilized peoples or
even in the highest strata of cultural society. What has once come
to life clings tenaciously to its existence. One feels inclined to
doubt sometimes whether the dragons of primaeval days are really
extinct.

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   Applying these remarks to our
present problem, I think that the answer to the question of how to
explain the variable results of our analytic therapy might well be
that we, too, in endeavouring to replace repressions that are
insecure by reliable ego-syntonic controls, do not always achieve
our aim to its full extent - that is, do not achieve it thoroughly
enough. The transformation is achieved, but often only partially:
portions of the old mechanisms remain untouched by the work of
analysis. It is difficult to prove that this is really so; for we
have no other way of judging what happens but by the outcome which
we are trying to explain. Nevertheless, the impressions one
receives during the work of analysis do not contradict this
assumption; indeed, they seem rather to confirm it. But we must not
take the clarity of our own insight as a measure of the conviction
which we produce in the patient. His conviction may lack
‘depth’, as one might say; it is always a question of
the quantitative factor, which is so easily overlooked. If this is
the correct answer to our question, we may say that analysis, in
claiming to cure neuroses by ensuring control over instinct, is
always right in theory but not always right in practice. And this
is because it does not always succeed in ensuring to a sufficient
degree the foundations on which a control of instinct is based. The
cause of such a partial failure is easily discovered. In the past,
the quantitative factor of instinctual strength opposed the
ego’s defensive efforts; for that reason we called in the
work of analysis to help; and now that same factor sets a limit to
the efficacy of this new effort. If the strength of the instinct is
excessive, the mature ego, supported by analysis, fails in its
task, just as the helpless ego failed formerly. Its control over
instinct is improved, but it remains imperfect because the
transformation in the defensive mechanism is only incomplete. There
is nothing surprising in this, since the power of the instruments
with which analysis operates is not unlimited but restricted, and
the final upshot always depends on the relative strength of the
psychical agencies which are struggling with one another.

   No doubt it is desirable to
shorten the duration of analytic treatment, but we can only achieve
our therapeutic purpose by increasing the power of analysis to come
to the assistance of the ego. Hypnotic influence seemed to be an
excellent instrument for our purposes; but the reasons for our
having to abandon it are well known. No substitute for hypnosis has
yet been found. From this point of view we can understand how such
a master of analysis as Ferenczi came to devote the last years of
his life to therapeutic experiments, which, unhappily, proved to be
vain.

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IV

   The two further questions -
whether, while we are treating one instinctual conflict, we can
protect a patient from future conflicts, and whether it is feasible
and expedient, for prophylactic purposes, to stir up a conflict
which is not at the time manifest - must be treated together; for
obviously the first task can only be carried out in so far as the
second one is - that is, in so far as a possible future conflict is
turned into an actual present one upon which influence is then
brought to bear. This new way of stating the problem is at bottom
only an extension of the earlier one. Whereas in the first instance
we were considering how to guard against a return of the same
conflict, we are now considering how to guard against its possible
replacement by
another
conflict. This sounds a very
ambitious proposal, but all we are trying to do is to make clear
what limits are set to the efficacy of analytic therapy.

   However much our therapeutic
ambition may be tempted to undertake such tasks, experience flatly
rejects the notion. If an instinctual conflict is not a currently
active one, is not manifesting itself, we cannot influence it even
by analysis. The warning that we should let sleeping dogs lie,
which we have so often heard in connection with our efforts to
explore the psychical underworld, is peculiarly inapposite when
applied to the conditions of mental life. For if the instincts are
causing disturbances, it is a proof that the dogs are not sleeping;
and if they seem really to be sleeping, it is not in our power to
awaken them. This last statement, however, does not seem to be
quite accurate and calls for a more detailed discussion. Let us
consider what means we have at our disposal for turning an
instinctual conflict which is at the moment latent into one which
is currently active. Obviously there are only two things that we
can do. We can bring about situations in which the conflict does
become currently active, or we can content ourselves with
discussing it in the analysis and pointing out the possibility of
its arising. The first of these two alternatives can be carried out
in two ways: in reality, or in the transference - in either case by
exposing the patient to a certain amount of real suffering through
frustration and the damming up of libido. Now it is true that we
already make use of a technique of this kind in our ordinary
analytic procedure. What would otherwise be the meaning of the rule
that analysis must be carried out ‘in a state of
frustration’? But this is a technique which we use in
treating a conflict which is already currently active. We seek to
bring this conflict to a head, to develop it to its highest pitch,
in order to increase the instinctual force available for its
solution. Analytic experience has taught us that the better is
always the enemy of the good and that in every phase of the
patient’s recovery we have to fight against his inertia,
which is ready to be content with an incomplete solution.

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   If, however, what we are aiming
at is a prophylactic treatment of instinctual conflicts that are
not currently active but merely potential, it will not be enough to
regulate sufferings which are already present in the patient and
which he cannot avoid. We should have to make up our minds to
provoke fresh sufferings in him; and this we have hitherto quite
rightly left to fate. We should receive admonitions from all sides
against the presumption of vying with fate in subjecting poor human
creatures to such cruel experiments. And what sort of experiments
would they be? Could we, for purposes of prophylaxis, take the
responsibility of destroying a satisfactory marriage, or causing a
patient to give up a post upon which his livelihood depends?
Fortunately, we never find ourselves in the position of having to
consider whether such interventions in the patient’s real
life are justified; we do not possess the plenary powers which they
would necessitate, and the subject of our therapeutic experiment
would certainly refuse to co-operate in it. In practice, then, such
a procedure is virtually excluded; but there are, besides,
theoretical objections to it. For the work of analysis proceeds
best if the patient’s pathogenic experiences belong to the
past, so that his ego can stand at a distance from them. In states
of acute crisis analysis is to all intents and purposes unusable.
The ego’s whole interest is taken up by the painful reality
and it withholds itself from analysis, which is attempting to go
below the surface and uncover the influences of the past. To create
a fresh conflict would thus only be to make the work of analysis
longer and more difficult.

   It will be objected that these
remarks are quite unnecessary. Nobody thinks of purposely conjuring
up new situations of suffering in order to make it possible for a
latent instinctual conflict to be treated. This would not be much
to boast of as a prophylactic achievement. We know, for instance,
that a patient who has recovered from scarlet fever is immune to a
return of the same illness; yet it never occurs to a doctor to take
a healthy person who may possibly fall ill of scarlet fever and
infect him with scarlet fever in order to make him immune to it.
The protective measure must not produce the same situation of
danger as is produced by the illness itself, but only something
very much slighter, as is the case with vaccination against
small-pox and many other similar procedures. In analytic
prophylaxis against instinctual conflicts, therefore, the only
methods which come into consideration are the other two which we
have mentioned: the artificial production of new conflicts in the
transference (conflicts which, after all, lack the character of
reality), and the arousing of such conflicts in the patient’s
imagination by talking to him about them and making him familiar
with their possibility.

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   I do not know whether we can
assert that the first of these two milder procedures is altogether
ruled out in analysis. No experiments have been particularly made
in this direction. But difficulties at once suggest themselves,
which do not throw a very promising light on such an undertaking.
In the first place, the choice of such situations for the
transference is very limited. The patients cannot themselves bring
all their conflicts into the transference; nor is the analyst able
to call out all their possible instinctual conflicts from the
transference situation. He may make them jealous or cause them to
experience disappointments in love; but no technical purpose is
required to bring this about. Such things happen of themselves in
any case in most analyses. In the second place, we must not
overlook the fact that all measures of this sort would oblige the
analyst to behave in an unfriendly way to the patient, and this
would have a damaging effect upon the affectionate attitude - upon
the positive transference - which is the strongest motive for the
patient’s taking a share in the joint work of analysis. Thus
we should on no account expect very much from this procedure.

   This therefore leaves only the
one method open to us - the one which was in all probability the
only one originally contemplated. We tell the patient about the
possibilities of other instinctual conflicts, and we arouse his
expectation that such conflicts may occur in him. What we hope is
that this information and this warning will have the effect of
activating in him one of the conflicts we have indicated, in a
modest degree and yet sufficiently for treatment. But this time
experience speaks with no uncertain voice. The expected result does
not come about. The patient hears our message, but there is no
response. He may think to himself: ‘This is very interesting,
but I feel no trace of it.’ We have increased his knowledge,
but altered nothing else in him. The situation is much the same as
when people read psycho-analytic writings. The reader is
‘stimulated’ only by those passages which he feels
apply to himself - that is, which concern conflicts that are active
in him at the time. Everything else leaves him cold. We can have
analogous experiences, I think, when we give children sexual
enlightenment. I am far from maintaining that this is a harmful or
unnecessary thing to do, but it is clear that the prophylactic
effect of this liberal measure has been greatly over-estimated.
After such enlightenment, children know something they did not know
before, but they make no use of the new knowledge that has been
presented to them. We come to see that they are not even in so
great a hurry to sacrifice for this new knowledge the sexual
theories which might be described as a natural growth and which
they have constructed in harmony with, and dependence on, their
imperfect libidinal organization - theories about the part played
by the stork, about the nature of sexual intercourse and about the
way in which babies are made. For a long time after they have been
given sexual enlightenment they behave like primitive races who
have had Christianity thrust upon them and who continue to worship
their old idols in secret.