Introduction to Psychoanalysis

Chapter 30 Psychoanalysis and Psychiatry (2)
The old woman's clinical symptoms were roughly the same.We don't need to have a lot of psychiatric experience to know: first, she was too calm when expressing her illness, or concealed too much, so she was different from other mental patients; second, she did believe the content of the anonymous letter.

What is the attitude of a psychiatrist to such cases?It is not difficult to infer from his reaction to the symptomatic behavior of the waiter who did not close the waiting room door.He analyzed that this is just an accidental phenomenon and has no psychological value, so there is no need to study it.However, he should no longer take that attitude about the case of the jealous woman.Symptomatic behavior may seem innocuous, but the symptoms themselves attract too much attention.Subjectively, it is accompanied by intense pain, and objectively, it is suspected of causing family breakdown, so it should naturally attract the attention of psychiatrists.First, the psychiatrist classifies the basic attributes of the symptom.The idea of ​​the old woman being tortured cannot be said to be meaningless in itself; it is certainly possible that the old woman's husband had a relationship with the woman.But there is something else insignificant and puzzling about this notion.Apart from the anonymous letter, the patient had absolutely no reason to suppose that her faithful husband had done anything like this, though it was not an ordinary thing.She knew that there was no evidence for the news, and she could analyze its sources satisfactorily; so she should know that there was no reason for this jealousy;We refer to this illogical or realistic concept as "delusion".The distress of the old woman was thus caused by a "delusion of jealousy," which is clearly the essential feature of the case.

Assuming this first point is true, our interest in psychiatry must be greatly increased.Since a certain delusion is not eliminated by the fact of existence, it certainly does not originate from existence.However, where is its source?Delusions already have various contents. Why is the content of the delusions in this case partial to jealousy?We originally pinned our hopes on a psychiatrist, but as a result of consulting, we still couldn't know the answer.We had many problems and he only discussed one of them.He was going to study the old woman's family history, which might give us an answer, and he thought that if similar or different deliriums were common in her family, she too was most likely delusional.In other words, the elderly woman's delusions were due to her genetic predisposition to such delusions.Although this sentence is intriguing, does this already exhaust everything we want to know?Is this the only reason for this case?Can we assume, without any analysis, that the fact that the patient has this delusion and not others is meaningless and arbitrary?Can so-called genetic predisposition really determine everything?Doesn't she have any scruples about what kind of experiences and emotions she has had in her life, can't she avoid a certain moment of delusion?You may wonder why scientific theories of psychosis do not give further explanations.I can tell you: "A man can give as much as he has; only a liar can deceive with empty words." The psychiatrist just doesn't know how to explain further.Although you have rich experience, you can only rely on diagnosis and guess the development and changes of the disease for comfort.

But could psychoanalysis have any better results?I can assure you that there are.I hope to tell you that even in such obscure cases, we can discover some facts that allow for a deeper understanding.First, I draw your attention to the inexplicable detail that the anonymous letter, the basis of the old woman's delusions, had been brought up by herself, and she had told the treacherous maid the day before in gossip that if her husband really had an affair with the girl Adultery, there is nothing more terrible than this.It was her words that aroused the maid's malicious thoughts.Therefore, the old woman's delusion was not due to the anonymous letter, but her delusion originated from inner fear or a desire.In addition, the points discovered by the short two-hour psychoanalysis are also worthy of our attention.After the old woman had finished describing her illness, I asked her to describe her thoughts, opinions and memories, but she was flatly refused.She said that she had said everything, and she had no thoughts; after two hours, since she claimed to be well, she would never have such delusions again, so the psychoanalysis was over. One of the reasons why she said this was naturally The second is the fear of accepting psychoanalysis again.During these two hours she had said a few words which made it possible and obligatory for us to make another explanation which would account for the origin of the old lady's delusions of jealousy.It turned out that she had a crush on the son-in-law who invited me to see the doctor.And she knew nothing, or very little, of it; in view of the relationship between mother and son, her infatuation was well hidden behind her harmless affection.From the information we know, we can also see what this good wife and mother thinks in her heart.This fascination with the impossible wonder, of course, could not enter her conscious mind, but it remained there, and the subconscious was a heavy burden on her.Once the stress has built up, it is natural to want it to go away.The easiest way to get rid of it is to rely on the transfer mechanism formed by jealousy.If not only she is in love with a young man, but her husband is also having an affair with a woman, she need not be troubled by the infidelity of her affection.She imagined her husband's betrayal as a placebo for her painful self-blame.She will never know about her love affair; but delusion gives her convenience, forming the "reflection" of her private love in delusion, that is, fabricating the husband's adultery with the woman and forming compulsion, delusion and consciousness inside the thought.Of course, all the accusations are in vain and useless; just because all the accusations are directed at the "reflection", rather than the powerful "original" hidden deep in the subconscious, that is, her love for her son-in-law.

Let us now summarize the results of the psycho-analytic investigations concerning this case.Obviously, we're going to assume that the information we've gathered is reliable, and you have nothing to worry about.First, the delusion is no longer meaningless or incomprehensible; on the contrary, it has a meaningful and reasonable motivation, which is closely related to the patient's emotional experience.Secondly, this kind of delusion is an inevitable reaction originating from another spiritual process, and this spiritual process can be inferred according to various appearances; the reason why delusion is delusional is that it has the characteristics of opposing reality and objective logic. This feature has a special connection with the spiritual process described above.Delusions are born of desire and are intended for self-soothing.In the end, it was the experience behind the condition that judged the delusion to be a jealous delusion rather than something else.You will also see two important points of similarity in the symptomatic behaviors we have analyzed: first, the meaning implied by the symptoms; and second, the relation of the symptoms to unconscious desires.

Of course, this does not fully resolve all the difficult questions raised by this case.In fact, there are still many problems that have not been solved, and some special situations cannot be solved at all.For example, why did the happy old woman fall in love with her son-in-law?Besides, with regard to this kind of love, there are also various possibilities to resolve it. Why do you have to spread your worries on your husband as a relief?You can't feel that we shouldn't mention this issue.We gathered enough information to offer a range of possible explanations for some issues.The age of the patient is at a critical period, which makes her sexual desire surge, which she does not like.Perhaps this is enough; there may be other reasons, namely, that the husband's sexual ability may have been difficult to satisfy his wife in recent years.After observation, we found that there is only this kind of man in the world who is always loyal, especially caresses his wife, and considers his mental uneasiness.Another important fact is the perverted love for the daughter's husband.The relationship between mother and daughter is inherently close, so sexual love about daughters is often transferred to the mother.Perhaps I should say to you that from time immemorial the relationship between mother-in-law and son-in-law has been regarded as a particularly sexual one, and that some savage tribes have developed a strong taboo from it.Whether in its positive or negative role, this relationship is beyond the limits of civilized society.Is the case we have just analyzed caused by one of the above three factors, or two, or perhaps all three?I can't tell you, because we only had a short two-hour analysis and couldn't continue after that.

I understand that the above discussion may not be understandable to you.And the reason why I say these words is to compare psychiatry and psychoanalysis.But I have one thing to ask you about this: do you see a conflict between the two?Of course, psychiatry does not use psychoanalysis and does not discuss the content of delusions. It only analyzes genetic phenomena and gives us the general causes of illness, but ignores the more recent and specific causes.So is this conflict inevitable?Can the two complement each other?Could it be that the hereditary factor fails to incorporate the importance of experience?You will find that there is indeed no conflict between the researches of psychiatry and psychoanalysis, so it is not the discipline of psychiatry itself that opposes psychoanalysis, but those scholars of psychiatry.The relationship between psychoanalysis and psychiatry is similar to the relationship between histology and anatomy, one is the study of the surface form of the organ, and the other is the study of the structure of the organ, such as tissue or other elements.It is difficult to see any contradiction between these two studies, they complement and terminate each other.You have to understand that anatomy is the basis of the entire medical research nowadays, but sociology strictly forbids medical scientists to dissect corpses to study the internal structure of the human body, just as they now curse us for using psychoanalysis to spy on human spiritual life.Perhaps in the future we will know that psychiatry cannot be called scientifically based without knowledge of the subconscious life of the psyche.

Despite the protests against psychoanalysis, some of you may like it and wish its healing powers could be justified.You have to understand that psychoanalysis has never had the ability to break through delusions.Now that psychoanalysis knows the mechanism by which delusions arise, can it be treated?For now, too, we say to you, "No." Psychoanalysis, like any other therapy, has not yet had the power to cure delusions.Although we know the patient's experience, we have no way to make the patient understand it himself.You can also see that we can only make preliminary studies of the above-mentioned fantasies.So you may think that this kind of psychoanalysis is fruitless anyway, and maybe it is inappropriate.Not so in my mind.It is our right, and at the same time our duty, to study, whether it is immediate or not.One day, all our trivial knowledge may be mutated into abilities and become healing powers, but we don't know when that day will come.Furthermore, although psychoanalysis cannot treat delusions and other psychotic or neurological diseases, it is an important tool for scientific research.There is no doubt that we have not practiced this; the material of our study is man, who has life and will, and must have a motive to take part in the study; unless he has no such motive.Therefore, I would like to conclude today's lecture with the following sentence: For most neurological diseases, our acquired knowledge has indeed produced therapeutic capabilities, and these diseases are originally difficult to treat, but in some cases Under such circumstances, the results we have achieved can be said to be second to none in terms of medical skills.

(End of this chapter)