Sigmund Freud - The Collected Works of Sigmund Freud

Unfortunately, everything is different in psychoanalysis. In psychoanalysis nothing occurs but the interchange of words between the patient and the physician. The patient talks, tells of his past experiences and present impressions, complains, confesses his wishes and emotions. The physician listens, tries to direct the thought processes of the patient, reminds him of things, forces his attention into certain channels, gives him explanations and observes the reactions of understanding or denial which he calls forth in the patient. The uneducated relatives of our patients — persons who are impressed only by the visible and tangible, preferably by such procedure as one sees in the moving picture theatres — never miss an opportunity of voicing their scepticism as to how one can “do anything for the malady through mere talk.” Such thinking, of course, is as shortsighted as it is inconsistent. For these are the very persons who know with such certainty that the patients “merely imagine” their symptoms. Words were originally magic, and the word retains much of its old magical power even today. With words one man can make another blessed, or drive him to despair; by words the teacher transfers his knowledge to the pupil; by words the speaker sweeps his audience with him and determines its judgments and decisions. Words call forth effects and are the universal means of influencing human beings. Therefore let us not underestimate the use of words in psychotherapy, and let us be satisfied if we may be auditors of the words which are exchanged between the analyst and his patient.

But even that is impossible. The conversation of which the psychoanalytic treatment consists brooks no auditor, it cannot be demonstrated. One can, of course, present a neurasthenic or hysteric to the students in a psychiatric lecture. He tells of his complaints and symptoms, but of nothing else. The communications which are necessary for the analysis are made only under the conditions of a special affective relationship to the physician; the patient would become dumb as soon as he became aware of a single impartial witness. For these communications concern the most intimate part of his psychic life, everything which as a socially independent person he must conceal from others; these communications deal with everything which, as a harmonious personality, he will not admit even to himself.

You cannot, therefore, “listen in” on a psychoanalytic treatment. You can only hear of it. You will get to know psychoanalysis, in the strictest sense of the word, only by hearsay. Such instruction even at second hand, will place you in quite an unusual position for forming a judgment. For it is obvious that everything depends on the faith you are able to put in the instructor.

Imagine that you are not attending a psychiatric, but an historical lecture, and that the lecturer is telling you about the life and martial deeds of Alexander the Great. What would be your reasons for believing in the authenticity of his statements? At first sight, the condition of affairs seems even more unfavorable than in the case of psychoanalysis, for the history professor was as little a participant in Alexander’s campaigns as you were; the psychoanalyst at least tells you of things in connection with which he himself has played some role. But then the question turns on this — what set of facts can the historian marshal in support of his position? He can refer you to the accounts of ancient authors, who were either contemporaries themselves, or who were at least closer to the events in question; that is, he will refer you to the books of Diodor, Plutarch, Arrian, etc. He can place before you pictures of the preserved coins and statues of the king and can pass down your rows a photograph of the Pompeiian mosaics of the battle of Issos. Yet, strictly speaking, all these documents prove only that previous generations already believed in Alexander’s existence and in the reality of his deeds, and your criticism might begin anew at this point. You will then find that not everything recounted of Alexander is credible, or capable of proof in detail; yet even then I cannot believe that you will leave the lecture hall a disbeliever in the reality of Alexander the Great. Your decision will be determined chiefly by two considerations; firstly, that the lecturer has no conceivable motive for presenting as truth something which he does not himself believe to be true, and secondly, that all available histories present the events in approximately the same manner. If you then proceed to the verification of the older sources, you will consider the same data, the possible motives of the writers and the consistency of the various parts of the evidence. The result of the examination will surely be convincing in the case of Alexander. It will probably turn out differently when applied to individuals like Moses and Nimrod. But what doubts you might raise against the credibility of the psychoanalytic reporter you will see plainly enough upon a later occasion.

At this point you have a right to raise the question, “If there is no such thing as objective verification of psychoanalysis, and no possibility of demonstrating it, how can one possibly learn psychoanalysis and convince himself of the truth of its claims?” The fact is, the study is not easy and there are not many persons who have learned psychoanalysis thoroughly; but nevertheless, there is a feasible way. Psychoanalysis is learned, first of all, from a study of one’s self, through the study of one’s own personality. This is not quite what is ordinarily called self-observation, but, at a pinch, one can sum it up thus. There is a whole series of very common and universally known psychic phenomena, which, after some instruction in the technique of psychoanalysis, one can make the subject matter of analysis in one’s self. By so doing one obtains the desired conviction of the reality of the occurrences which psychoanalysis describes and of the correctness of its fundamental conception. To be sure, there are definite limits imposed on progress by this method. One gets much further if one allows himself to be analyzed by a competent analyst, observes the effect of the analysis on his own ego, and at the same time makes use of the opportunity to become familiar with the finer details of the technique of procedure. This excellent method is, of course, only practicable for one person, never for an entire class.

There is a second difficulty in your relation to psychoanalysis for which I cannot hold the science itself responsible, but for which I must ask you to take the responsibility upon yourselves, ladies and gentlemen, at least in so far as you have hitherto pursued medical studies. Your previous training has given your mental activity a definite bent which leads you far away from psychoanalysis. You have been trained to reduce the functions of an organism and its disorders anatomically, to explain them in terms of chemistry and physics and to conceive them biologically, but no portion of your interest has been directed to the psychic life, in which, after all, the activity of this wonderfully complex organism culminates. For this reason psychological thinking has remained strange to you and you have accustomed yourselves to regard it with suspicion, to deny it the character of the scientific, to leave it to the laymen, poets, natural philosophers and mystics. Such a delimitation is surely harmful to your medical activity, for the patient will, as is usual in all human relationships, confront you first of all with his psychic facade; and I am afraid your penalty will be this, that you will be forced to relinquish a portion of the therapeutic influence to which you aspire, to those lay physicians, nature-cure fakers and mystics whom you despise.

I am not overlooking the excuse, whose existence one must admit, for this deficiency in your previous training. There is no philosophical science of therapy which could be made practicable for your medical purpose. Neither speculative philosophy nor descriptive psychology nor that so-called experimental psychology which allies itself with the physiology of the sense organs as it is taught in the schools, is in a position to teach you anything useful concerning the relation between the physical and the psychical or to put into your hand the key to the understanding of a possible disorder of the psychic functions. Within the field of medicine, psychiatry does, it is true, occupy itself with the description of the observed psychic disorders and with their grouping into clinical symptom-pictures; but in their better hours the psychiatrists themselves doubt whether their purely descriptive account deserves the name of a science. The symptoms which constitute these clinical pictures are known neither in their origin, in their mechanism, nor in their mutual relationship. There are either no discoverable corresponding changes of the anatomical organ of the soul, or else the changes are of such a nature as to yield no enlightenment. Such psychic disturbances are open to therapeutic influence only when they can be identified as secondary phenomena of an otherwise organic affection.