Introduction to Psychoanalysis

Chapter 54 Psychoanalytic Therapy (2)
Therefore, the work of analysis and treatment can be divided into two stages: first, to force the libido to be separated from the symptoms, and to focus on the role of emotional transfer;If this new conflict is to have a successful conclusion, it is necessary to eliminate the repression, so that the libido no longer escapes from the ego and escapes into the subconscious.Since the patient's ego has been transformed with the help of the analyst's suggestion, it is to be expected that this will succeed.In view of the explanatory function introduced into the consciousness through the subconscious material, the ego gradually expands its scope due to the disappearance of the subconscious, and the implantation of educational factors reconciles it with the libido, so the ego also voluntarily gives the libido a certain degree of satisfaction ; The self is also freed due to the sublimation of part of the libido, and the fear of what the libido wants is gradually reduced.The closer our analysis of the course of treatment comes to this ideal description, the greater will be the effect of the treatment.The only obstacles to this therapeutic effect are: firstly, the lack of motivation of the libido and its reluctance to leave the object; and secondly, the patient's narcissism, which prohibits the development of certain emotional transferences from the object.The dynamics of this healing process will then be expressed more clearly as follows: We move part of the libido to us through the action of emotional transfer, and thus gather the full force of the libido to escape the control of the ego.

Here we are concerned with the distribution of libido induced by the analytic treatment, and it is not yet possible to infer directly the nature of the patient's libidinal tendencies before the onset of the disease.If a patient transfers his affection for his father to the analyst and is cured, we must not think that the illness was caused by an unconscious love for his father. The "emotional transference of paternal love" just provides a duel field and allows us to regain control of its libido; its source is elsewhere.The enemy's most important fortress is not necessarily a duel field; the enemy does not necessarily have to set up a battlefield in front of the capital if he wants to defend the capital.After the removal of the affective transference, we can infer from the imagination the dominance of the libido which has been repressed by the disease.

Now, with the help of the theory of libido, we will talk about dreams.The dreams of the psychotic, as well as his faults and free associations, will help to gain the meaning of the symptoms and thus discover the libidinal tendencies.The form in which the desire is fulfilled in the various tendencies will show which desire impulse is repressed, and which object the libido clings to after leaving the ego.Therefore, dream analysis plays a very important role in psychoanalysis, and dream is the most important tool for long-term analysis in terms of single index number.We have seen before that sleep itself weakens repression, so that repressed desires are more clearly expressed in dreams than during the day.The study of dreams is therefore the most convenient method of studying the repressed unconscious, which is freed from the place where the ego's libido rests.

However, the dreams of the mentally ill are not essentially different from those of the healthy; apparently they are indistinguishable at all.Therefore, our analysis of the dreams of mentally ill patients is not suitable for explaining the dreams of ordinary people, which is unavoidably contrary to logic.Therefore, we have to conclude that the difference between the mentally ill and the normal person is only visible during the day, but not in the dream life.Therefore, we apply the conclusions drawn between dreams and symptoms of mentally ill patients to healthy people. We must admit that there are certain dream-causing or disease-causing factors in the mental life of healthy people; therefore, healthy people can also form symptoms. They have a depressive effect and require a certain amount of energy to maintain. There are also powerful repressed impulses in their subconscious minds, and part of their libido has also been separated from the domination of the ego.Therefore, a healthy person can also be called a mentally ill person in essence, and the only symptoms he can form are dreams.In fact, if you study the waking life of a normal person, you will find some facts that contradict your conclusions, so that this healthy life also seems to have many insignificant symptoms.

So we can say that the difference between neurotic health and neurotic pathology, that is, psychosis, can be reduced to a practical difference, and this difference depends on the practical result: how much the person enjoys life.This difference may be traced back to the ratio of the capacity for free domination to the libidinal capacity subject to repression; that is to say, it is only a quantitative difference, not a qualitative one.This view thus provides theoretical support for our belief that psychosis, though based on constitutional factors, is in essence a radically curable possibility.

Therefore, we can deduce their healthy attributes from the consistency between the dreams of healthy people and those of mentally ill patients.However, as far as dreams are concerned, we can draw the following inferences: first, dreams are necessarily related to psychotic symptoms; second, we do not think that the basic nature of dreams can be condensed into "translation of thoughts thirdly, we must use dreams to reveal the libidinal tendency and the desire to dominate the object of the activity at that time.

Now, our presentation is coming to an end.Perhaps you are disappointed that we have psychoanalytic therapy as our subject and what we are talking about is still theory.Of course, I also have some considerations. The reason why I didn’t discuss the treatment is because I never intended to let you receive practical training and implement analysis therapy. The reason why I didn’t talk about the effect of treatment is also motivated by several aspects. .When I first began my lectures, I stated several times that we, under the right circumstances, are as effective as the best achievements in medicine, and that our achievements cannot be achieved by any other means.In this way, if I exaggerate beyond this point, I will be suspected of selling melons to offset those refuted remarks.Psycho-analysis is often intimidated by friends of the medical profession who meet in public places.Let's put aside the maliciousness of this behavior for the time being, and the collection of failure materials may not be an effective evidence, so we can estimate the correctness of the analysis results.You know that psychoanalytic therapy is still young and still needs a lot of experience to perfect its technique of analysis.The teaching of psychoanalytic therapy is also quite difficult, so beginners must have the ability to surpass other professional students, and the conclusions of the early years must not be used to judge the greatest achievement of analytical therapy.

In the early days of psychoanalysis, many treatment plans inevitably failed, perhaps because analysts at that time also had to treat various diseases that were not suitable for analytic therapy. Therefore, we can now exclude these diseases because of certain characteristics.Features can also only be found from exploration.At first we did not know that paranoia and schizophrenia were sufficiently developed for psychoanalysis to remain ineffective; of course we can also use this therapy for all kinds of neurotic phenomena.But the failure in the early years is not the fault of the doctor, or the choice of the disease or the unfavorable external circumstances.Earlier we only talked about the unavoidable but surmountable internal resistance of the patient, but in the patient's living environment, there are many external resistances that oppose analysis, which are also very important in practice.Psychoanalytic treatment, like surgical operations, must be carried out under the most appropriate circumstances in order to be successful.As you know, surgeons must make various arrangements before performing an operation.Let me ask you, if all surgical operations are performed in front of the patient's family members, and the family members surround and watch, screaming constantly, how much is the possibility of success?With regard to psychoanalysis, the interference of friends and relatives is likewise a danger which we are not yet able to deal with.We should take strict precautions against the internal resistance of patients, but how should we defend against these external resistances?For those relatives and friends, no explanation can convince them, and they can't let them go; let alone tell the truth, so that the patient's faith in the doctor will be lost.As an analyst, do not be so surprised that relatives and friends do not want the patient to recover.If the cause of psychosis is family conflict, psychoanalytic treatment will inevitably expose the evil in it, so the family will not favor this treatment.So, there is no need to feel guilty about failing or interrupting our efforts.

So, now I just want to give an example to illustrate.In this case, for reasons of professional ethics, I chose to accept it.Many years ago, I gave an analytical treatment to a young girl who was afraid to go out of the house for a long time because of fear, and she was afraid to stay at home alone.After a long hesitation she revealed that she had seen her mother having an affair with a rich man and had been deeply concerned ever since.She did not skillfully or subtly hinted at her mother during the discussion in the analysis therapy: first, she asked to change her view of her mother's behavior; Fear helps; third, insist on not opening the door when the mother wants to go out.Her mother had suffered from neurosis, which had been cured many years ago after hydrotherapy.More precisely, she met the man at the spa, and they became close friends and fell in love with each other.She couldn't help being suspicious of her daughter's strong hints, and finally she understood the original intention of her daughter's fear of being alone, which was to put her under house arrest and deprive her of the freedom to communicate with her lover.She then ended her daughter's analytic treatment and sent her to an asylum for the mentally ill.For many years, this young girl has been a "victim of psychoanalysis," and I have been vilified for it.Due to the shackles of professional ethics, I cannot defend myself and cannot disclose this secret to the world.Years later, when a colleague of mine interviewed the girl, her mother had openly made friends with the rich man, and her father had acquiesced.However, her treatment was ruined by it.

In the years before the European War, people from many countries often came to see a doctor, so I ignored the slander of others.Therefore, I made a rule: I will not accept any patients who cannot live independently, and I cannot diagnose and treat them on my behalf.The psychoanalyst does not have to make this provision.You may think that this is my warning to the relatives and friends of the patient, or maybe I am just for the sake of psychoanalysis to make the patient leave the family or only people who have left home and friends can receive treatment.However, this is not necessarily true; it is beneficial to the treatment if the patient still resists the pressures imposed on him in daily life during treatment.The relatives and friends of those patients must also exercise restraint in their words and deeds, so as not to destroy this favorable condition, and the last thing should be to discredit the doctor's professional efforts.But how do we enable those who do not know us to do so?Naturally, you will think that the patient's living environment and social cultivation have a great influence on the treatment.

Even if we can say that most of the failures of psychoanalytic treatment are due to the obstacles of external factors, it will inevitably reduce the efficacy of psychoanalytic treatment.Proponents have advised us that we can analyze the success of therapeutics and count them against failures.I can't agree with this, because it is worthless to make statistics with different cases; in fact, many cases I have treated cannot be compared.And most cases are barely documented.That's because the patient keeps these facts a secret and refuses to tell anyone after recovery.Their most important objection to psychoanalysis is that human beings are often incoherent in their dealings and are hardly influenced by sound reasoning.A new treatment sometimes inspires intense admiration, other times it is met with radical skepticism.For example, Koch was the first to announce the results of tuberculosis research, and Jenner's vaccination technique was actually a blessing from heaven, but it was also opposed by people.The most biased against psychoanalysis is the following example.After we cured a patient who was difficult to respond to other treatments, someone said: "It's nothing, the patient will get better after such a long time." If the patient has experienced four episodes of depression and mania, He came here for treatment within a week after the onset of depression. Three weeks later, the mania relapsed. His relatives and other famous doctors believed that the mania was caused by analysis and treatment.For prejudice, there is really nothing to do but be patient; and wait for these prejudices to disappear in the wind and sand of time.One day in the future, these people will judge the same thing with very different eyes; then why the previous thinking was different is an unknowable secret.

Now, perhaps, the opposition to psychoanalytic therapy has gradually died down.The theory of psychoanalysis has spread in many countries, and the number of doctors using analytical treatment has also increased day by day.When I was young, the treatment of hypnotic suggestion was as furious as the refutation of psychoanalysis by "sane" people today.Hypnotism as a therapeutic method also failed to meet expectations; we psychoanalysis can now be called the rightful heir of hypnotism.However, the encouragement and inspiration gained from hypnosis should not be forgotten.Generally speaking, people's slander against psychoanalysis is mostly limited to the poor analysis or the intensification of contradictions caused by the sudden interruption of treatment.You have seen how we approach the care of patients, and whether our work is harming them, you must be able to make your own judgments.Misuse of analytic therapy is also possible, especially in the hands of a doctor without medical ethics or professional ethics, and emotional transfer will be a dangerous tool.However, medical skills are bound to make mistakes. If you don't wield a knife, how can you be a surgeon?
Now, my speech is coming to an end.I am deeply ashamed and sorry for the many shortcomings in my speech. This is definitely not a courtesy.I especially want to apologize for the fact that I accidentally mentioned a problem, and I often promised you that I would elaborate on it later, but then I never had the chance to fulfill the previous appointment.The psychoanalysis we are discussing is in a stage of vigorous development, so I have briefly outlined many places, which are not complete.There are also many places where conclusions have been prepared, but no conclusions have been made.My purpose is only to make you understand and be interested in psychoanalysis, not to make you an expert in psychoanalysis.

(End of this chapter)