The Collected Works of Sigmund Freud. Sigmund Freud
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a pupil of Bernheim’s, whom I sought out in Nancy in 1889, and whose book on suggestion I translated into German. For years I practised hypnotic treatment, at first by means of prohibitory suggestions alone, and later by this method in combination with investigation of the patient after the manner of Breuer. So I can speak from experience about the results of hypnotic or suggestive therapy. If we judge Bernheim’s method according to the old doctor’s password that an ideal therapy must be rapid, reliable and not unpleasant for the patient, we find it fulfills at least two of these requirements. It can be carried out much more rapidly, indescribably more rapidly than the analytic method, and it brings the patient neither trouble nor discomfort. In the long run it becomes monotonous for the physician, since each case is exactly the same; continually forbidding the existence of the most diverse symptoms under the same ceremonial, without being able to grasp anything of their meaning or their significance. It is second-rate work, not scientific activity, and reminiscent of magic, conjuring and hocus-pocus; yet in the face of the interest of the patient this cannot be considered. The third requisite, however, was lacking. The procedure was in no way reliable. It might succeed in one case, and fail with the next; sometimes much was accomplished, at other times little, one knew not why. Worse than this capriciousness of the technique was the lack of permanency of the results. After a short time, when the patient was again heard from, the old malady had reappeared, or it had been replaced by a new malady. We could start in again to hypnotize. At the same time we had been warned by those who were experienced that by frequent repetitions of hypnotism we would deprive the patient of his self-reliance and accustom him to this therapy as though it were a narcotic. Granted that we did occasionally succeed as well as one could wish; with slight trouble we achieved complete and permanent results. But the conditions for such a favorable outcome remained unknown. I have had it happen that an aggravated condition which I had succeeded in clearing up completely by a short hypnotic treatment returned unchanged when the patient became angry and arbitrarily developed ill feeling against me. After a reconciliation I was able to remove the malady anew and with even greater thoroughness, yet when she became hostile to me a second time it returned again. Another time a patient whom I had repeatedly helped through nervous conditions by hypnosis, during the treatment of an especially stubborn attack, suddenly threw her arms around my neck. This made it necessary to consider the question, whether one wanted to or not, of the nature and source of the suggestive authority.
So much for experience. It shows us that in renouncing direct suggestion we have given up nothing that is not replaceable. Now let us add a few further considerations. The practice of hypnotic therapy demands only a slight amount of work of the patient as well as of the physician. This therapy fits in perfectly with the estimation of neuroses to which the majority of physicians subscribe. The physician says to the neurotic, “There is nothing the matter with you; you are only nervous, and so I can blow away all your difficulties with a few words in a few minutes.” But it is contrary to our dynamic conceptions that we should be able to move a great weight by an inconsiderable force, by attacking it directly and without the aid of appropriate preparations. So far as conditions are comparable, experience shows us that this performance does not succeed with the neurotic. But I know this argument is not unassailable; there are also “redeeming features.”
In the light of the knowledge we have gained from psychoanalysis we can describe the difference between hypnotic and psychoanalytic suggestion as follows: Hypnotic therapy seeks to hide something in psychic life, and to gloss it over; analytic therapy seeks to lay it bare and to remove it. The first method works cosmetically, the other surgically. The first uses suggestion in order to prevent the appearance of the symptoms, it strengthens suppression, but leaves unchanged all other processes that have led to symptom development. Analytic therapy attacks the illness closer to its sources, namely in the conflicts out of which the symptoms have emerged, it makes use of suggestion to change the solution of these conflicts. Hypnotic therapy leaves the patient inactive and unchanged, and therefore without resistance to every new occasion for disease. Analytic treatment places upon the physician, as well as upon the patient, a difficult responsibility; the inner resistance of the patient must be abolished. The psychic life of the patient is permanently changed by overcoming these resistances, it is lifted upon a higher plane of development and remains protected against new possibilities of disease. The work of overcoming resistance is the fundamental task of the analytic cure. The patient, however, must take it on himself to accomplish this, while the physician, with the aid of suggestion, makes it possible for him to do so. The suggestion works in the nature of an education. We are therefore justified in saying that analytic treatment is a sort of after-education.
I hope I have made it clear to you wherein our technique of using suggestion differs therapeutically from the only use possible in hypnotic therapy. With your knowledge of the relation between suggestion and transference you will readily understand the capriciousness of hypnotic therapy which attracted our attention, and you will see why, on the other hand, analytic suggestion can be relied upon to its limits. In hypnosis we depend on the condition of the patient’s capacity for transference, yet we are unable to exert any influence on this capacity. The transference of the subject may be negative, or, as is most frequent, ambivalent; the patient may have protected himself against suggestion by very special adjustments, yet we are unable to learn anything concerning them. In psychoanalysis we work with the transference itself, we do away with the forces opposing it, prepare the instrument with which we are to work. So it becomes possible to derive entirely new uses from the power of suggestion; we are able to control it, the patient does not work himself into any state of mind he pleases, but in so far as we are able to influence him at all, we can guide the suggestion.
Now you will say, regardless of whether we call the driving force of our analysis transference or suggestion, there is still the danger that through our influence on the patient the objective certainty of our discoveries becomes doubtful. That which becomes a benefit to therapy works harm to the investigation. This objection is most often raised against psychoanalysis, and it must be admitted that even if it does not hit the mark, it cannot be waved aside as stupid. But if it were justified, psychoanalysis would be nothing more than an extraordinarily well disguised and especially workable kind of treatment by suggestion, and we may lay little weight upon all its assertions concerning the influences of life, psychic dynamics, and the unconscious. This is in fact the opinion held by our opponents; we are supposed especially to have “balked into” the patients everything that supports the importance of sexual experiences, and often the experiences themselves, after the combinations themselves have grown up in our degenerate imaginations. We can refute these attacks most easily by calling on the evidence of experience rather than by resorting to theory. Anyone who has himself performed a psychoanalysis has been able to convince himself innumerable times that it is impossible thus to suggest anything to the patient. There is no difficulty, of course, in making the patient a disciple of any one theory, and thus causing him to share the possible error of the physician. With respect to this he behaves just like any other person, like a student, but he has influenced only his intelligence, not his disease. The solving of his conflicts and the overcoming of his resistances succeeds only if we have aroused in him representations of such expectations as can agree with reality. What was inapplicable in the assumptions of the physician falls away during the course of the analysis; it must be withdrawn and replaced by something more nearly correct. By employing a careful technique we seek to prevent the occurrence of temporary results arising out of suggestion, yet there is no harm if such temporary results occur, for we are never satisfied with early successes. We do not consider the analysis finished until all the obscurities of the case are cleared up, all amnestic gaps filled out and the occasions which originally called out the suppressions discovered. We see in results that are achieved too quickly a hindrance rather than a furtherance of analytic work and repeatedly we undo these results again by purposely breaking up the transference upon which they rest. Fundamentally it is this feature which distinguishes analytical treatment from the purely suggestive technique and frees analytic results from the suspicion of having been suggested. Under every other suggestive treatment the transference itself is most carefully upheld and the influence left unquestioned; in analytic treatment, however, the transference becomes the subject of treatment and is subject to criticism in whatever form it may appear. At the end of an analytic cure the transference itself must be abolished; therefore the effect of the treatment, whether positive or negative, must be founded not upon suggestion but