The Collected Works of Sigmund Freud. Sigmund Freud
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this development. When the cure, however, first has taken possession of the patient, the productivity of the illness in this new phase is concentrated entirely on one aspect: the relation of the patient to the physician. And so transference may be compared to the cambrium layer between the wood and the bark of a tree, from which the formation of new tissues and the growth of the trunk proceed at the same time. When the transference has once attained this significance the work upon the recollections of the patient recedes into the background. At that point it is correct to say that we are no longer concerned with the patient’s former illness, but with a newly created, transformed neurosis, in place of the former. We followed up this new edition of an old condition from the very beginning, we saw it originate and grow; hence we understand it especially well, because we ourselves are the center of it, its object. All the symptoms of the patient have lost their original meaning and have adapted themselves to a new meaning, which is determined by its relation to transference. Or, only such symptoms as are capable of this transformation have persisted. The control of this new, artificial neurosis coincides with the removal of the illness for which treatment was sought in the first place, namely, with the solution of our therapeutic problem. The human being who, by means of his relations to the physician, has freed himself from the influences of suppressed impulses, becomes and stays free in his individual life, when the influence of the physician is subsequently removed.
Transference has attained extraordinary significance, has become the centre of the cure, in the conditions of hysteria, anxiety and compulsion neuroses. Their conditions therefore are properly included under the term transference neuroses. Whoever in his analytic experience has come into contact with the existence of transference can no longer doubt the character of those suppressed impulses that express themselves in the symptoms of these neuroses and requires no stronger proof of their libidinous character. We may say that our conviction that the meaning of the symptoms is substituted libidinous gratification was finally confirmed by this explanation of transference.
Now we have every reason to correct our former dynamic conception of the healing process, and to bring it into harmony with our new discernment. If the patient is to fight the normal conflict that our analysis has revealed against the suppressions, he requires a tremendous impetus to influence the desirable decision which will lead him back to health. Otherwise he might decide for a repetition of the former issue and allow those factors which have been admitted to consciousness to slip back again into suppression. The deciding vote in this conflict is not given by his intellectual penetration — which is neither strong nor free enough for such an achievement — but only by his relation to the physician. Inasmuch as his transference carries a positive sign, it invests the physician with authority and is converted into faith for his communications and conceptions. Without transference of this sort, or without a negative transfer, he would not even listen to the physician and to his arguments. Faith repeats the history of its own origin; it is a derivative of love and at first requires no arguments. When they are offered by a beloved person, arguments may later be admitted and subjected to critical reflection. Arguments without such support avail nothing, and never mean anything in life to most persons. Man’s intellect is accessible only in so far as he is capable of libidinous occupation with an object, and accordingly we have good ground to recognize and to fear the limit of the patient’s capacity for being influenced by even the best analytical technique, namely, the extent of his narcism.
The capacity for directing libidinous occupation with objects towards persons as well must also be accorded to all normal persons. The inclination to transference on the part of the neurotic we have mentioned, is only an extraordinary heightening of this common characteristic. It would be strange indeed if a human trait so wide-spread and significant had never been noticed and turned to account. But that has been done. Bernheim, with unerring perspicacity, based his theory of hypnotic manifestations on the statement that all persons are open to suggestion in some way or other. Suggestibility in his sense is nothing more than an inclination to transference, bounded so narrowly that there is no room for any negative transfer. But Bernheim could never define suggestion or its origin. For him it was a fundamental fact, and he could never tell us anything regarding its origin. He did not recognize the dependence of suggestibility upon sexuality and the activity of the libido. We, on the other hand, must realize that we have excluded hypnosis from our technique of neurosis only to rediscover suggestion in the shape of transference.
But now I shall pause and let you put in a word. I see that an objection is looming so large within you that if it were not voiced you would be unable to listen to me. “So at last you confess that like the hypnotists, you work with the aid of suggestion. That is what we have been thinking for a long time. But why choose the detour over reminiscences of the past, revealing of the unconscious, interpretation and retranslation of distortions, the tremendous expenditure of time and money, if the only efficacious thing is suggestion? Why do you not use suggestion directly against symptoms, as the others do, the honest hypnotists? And if, furthermore, you offer the excuse that by going your way you have made numerous psychological discoveries which are not revealed by direct suggestion, who shall vouch for their accuracy? Are not they, too, a result of suggestion, that is to say, of unintentional suggestion? Can you not, in this realm also, thrust upon the patient whatever you wish and whatever you think is so?”
Your objections are uncommonly interesting, and must be answered. But I cannot do it now for lack of time. Till the next time, then. You shall see, I shall be accountable to you. Today I shall only end what I have begun. I promised to explain, with the aid of the factor of transference, why our therapeutic efforts have not met with success in narcistic neuroses.
This I can do in a few words and you will see how simply the riddle can be solved, how well everything harmonizes. Observation shows that persons suffering from narcistic neuroses have no capacity for transference, or only insufficient remains of it. They reject the physician not with hostility, but with indifference. That is why he cannot influence them. His words leave them cold, make no impression, and so the mechanism of the healing process, which we are able to set in motion elsewhere, the renewal of the pathogenic conflict and the overcoming of the resistance to the suppression, cannot be reproduced in them. They remain as they are. Frequently they are known to attempt a cure on their own account, and pathological results have ensued. We are powerless before them.
On the basis of our clinical impressions of these patients, we asserted that in their case libidinous occupation with objects must have been abandoned, and object-libido must have been transformed into ego-libido. On the strength of this characteristic we had separated it from the first group of neurotics (hysteria, anxiety and compulsion neuroses). Their behavior under attempts at therapy confirms this supposition. They show no neurosis. They, therefore, are inaccessible to our efforts and we cannot cure them.
TWENTY-EIGHTH LECTURE
GENERAL THEORY OF THE NEUROSES
ANALYTICAL THERAPY
You know our subject for today. You asked me why we do not make use of direct suggestion in psychoanalytic therapy, when we admit that our influence depends substantially upon transference, i.e., suggestion, for you have come to doubt whether or not we can answer for the objectivity of our psychological discoveries in the face of such a predominance of suggestion. I promised to give you a comprehensive answer.
Direct suggestion is suggestion directed against the expression of the symptoms, a struggle between your authority and the motives of the disease. You pay no attention during this process to the motives, but only demand of the patient that he suppress their expression in symptoms. So it makes no difference in principle whether you hypnotize the patient or not. Bernheim, with his usual perspicacity, asserted that suggestion is the essential phenomenon underlying hypnotism, that hypnotism itself is already a result of suggestion, is a suggested condition. Bernheim was especially fond of practising suggestion upon a person in the waking state, and could achieve the same results as with suggestion under hypnosis.
What shall I deal with first, the evidence of experience or theoretic considerations?
Let us begin with