The Collected Works of Sigmund Freud. Sigmund Freud
instinctive tendencies and their relative intensity as given by the constitution of the patient, and finally the nature of the digression in the abnormal process of its development. Assume for a moment that it were possible to influence these functions chemically, to increase or to decrease the quantity of the libido that happens to be present, to strengthen one impulse at the expense of another. This would be causal therapy in its true sense and our analysis would have furnished the indispensable preparatory work of reconnaissance. You know that there is as yet no possibility of so influencing the processes of the libido. Our psychic therapy interposes elsewhere, not exactly at those sources of the phenomena which have been disclosed to us, but sufficiently far beyond the symptoms, at an opening in the structure of the disease which has become accessible to us by means of peculiar conditions.
What must we do in order to replace the unconscious by the conscious in our patient? At one time we thought this was quite simple, that all we had to do was to reconstruct the unconscious and then tell the patient about it. But we already know this was a shortsighted error. Our knowledge of the unconscious has not the same value as his; if we communicate our knowledge to him it will not stand in place of the unconscious within him, but will exist beside it, and only a very small change will have been effected. We must rather think of the unconscious as localized, and must seek it in memory at the point where it came into existence by means of a suppression. This suppression must be removed before the substitution of the conscious for the unconscious can be successfully effected. How can such a suppression be removed? Here our task enters a second phase. First to find the suppression, then to remove the resistance by which this suppression is maintained.
How can we do away with resistance? In the same way — by reconstructing it and confronting the patient with it. For resistance arises from suppression, from the very suppression which we are trying to break up, or from an earlier one. It has been established by the counter-attack that was instigated to suppress the offensive impulse. And so now we do the very thing we intended at the outset: interpret, reconstruct, communicate — but now we do it in the right place. The counter-seizure of the idea or resistance is not part of the unconscious but of the ego, which is our fellow-worker. This holds true even if resistance is not conscious. We know that the difficulty arises from the ambiguity of the word “unconscious,” which may connote either a phenomenon or a system. That seems very difficult, but it is only a repetition, isn’t it? We were prepared for it a long time ago. We expect resistance to be relinquished, the counter-siege to collapse, when our interpretation has enabled the ego to recognize it. With what impulses are we able to work in such a case? In the first place, the patient’s desire to become well, which has led him to accommodate himself to cooperate with us in the task of the cure; in the second place, the help of his intelligence, which is supported by the interpretation we offer him. There is no doubt that after we have made clear to him what he may expect, the patient’s intelligence can identify resistances, and find their translation into the suppressions more readily. If I say to you, “Look up into the sky, you can see a balloon there,” you will find it more readily than if I had just asked you to look up to see whether you could discover anything. And unless the student who for the first time works with a microscope is told by his teacher what he may look for, he will not see anything, even if it is present and quite visible.
And now for the fact! In a large number of forms of nervous illness, in hysteria, conditions of anxiety and compulsion neuroses, one hypothesis is correct. By finding the suppression, revealing resistance, interpreting the thing suppressed, we really succeed in solving the problem, in overcoming resistance, in removing suppression, in transforming the unconscious into the conscious. While doing this we gain the clearest impression of the violent struggle that takes place in the patient’s soul for the subjugation of resistance — a normal psychological struggle, in one psychic sphere between the motives that wish to maintain the counter-siege and those which are willing to give it up. The former are the old motives that at one time effected suppression; among the latter are those that have recently entered the conflict, to decide it, we trust, in the sense we favor. We have succeeded in reviving the old conflict of the suppression, in reopening the case that had already been decided. The new material we contribute consists in the first place of the warning, that the former solution of the conflict had led to illness, and the promise that another will pave the way to health; secondly, the powerful change of all conditions since the time of that first rejection. At that time the ego had been weak, infantile and may have had reason to denounce the claims of the libido as if they were dangerous. Today it is strong, experienced and is supported by the assistance of the physician. And so we may expect to guide the revived conflict to a better issue than a suppression, and in hysteria, fear and compulsion neuroses, as I have said before, success justifies our claims.
There are other forms of illness, however, in which our therapeutic procedure never is successful, even though the causal conditions are similar. Though this may be characterized topically in a different way, in them there was also an original conflict between the ego and libido, which led to suppression. Here, too, it is possible to discover the occasions when suppressions occurred in the life of the patient. We employ the same procedure, are prepared to furnish the same promises, give the same kind of help. We again present to the patient the connections we expect him to discover, and we have in our favor the same interval in time between the treatment and these suppressions favoring a solution of the conflict; yet in spite of these conditions, we are not able to overcome the resistance, or to remove the suppression. These patients, suffering from paranoia, melancholia, and dementia praecox, remain untouched on the whole, and proof against psychoanalytic therapy. What is the reason for this? It is not lack of intelligence; we require, of course, a certain amount of intellectual ability in our patients; but those suffering from paranoia, for instance, who effect such subtle combinations of facts, certainly are not in want of it. Nor can we say that other motive forces are lacking. Patients suffering from melancholia, in contrast to those afflicted with paranoia, are profoundly conscious of being ill, of suffering greatly, but they are not more accessible. Here we are confronted with a fact we do not understand, which bids us doubt if we have really understood all the conditions of success in other neuroses.
In the further consideration of our dealings with hysterical and compulsion neurotics we soon meet with a second fact, for which we were not at all prepared. After a while we notice that these patients behave toward us in a very peculiar way. We thought that we had accounted for all the motive forces that could come into play, that we had rationalized the relation between the patient and ourselves until it could be as readily surveyed as an example in arithmetic, and yet some force begins to make itself felt that we had not considered in our calculations. This unexpected something is highly variable. I shall first describe those of its manifestations which occur frequently and are easy to understand.
We see our patient, who should be occupying himself only with finding a way out of his painful conflicts, become especially interested in the person of the physician. Everything connected with this person is more important to him than his own affairs and diverts him from his illness. Dealings with him are very pleasant for the time being. He is especially cordial, seeks to show his gratitude wherever he can, and manifests refinements and merits of character that we hardly had expected to find. The physician forms a very favorable opinion of the patient and praises the happy chance that permitted him to render assistance to so admirable a personality. If the physician has the opportunity of speaking to the relatives of the patient he hears with pleasure that this esteem is returned. At home the patient never tires of praising the physician, of prizing advantages which he constantly discovers. “He adores you, he trusts you blindly, everything you say is a revelation to him,” the relatives say. Here and there one of the chorus observes more keenly and remarks, “It is a positive bore to hear him talk, he speaks only of you; you are his only subject of conversation.”
Let us hope that the physician is modest enough to ascribe the patient’s estimation of his personality to the encouragement that has been offered him and to the widening of his intellectual horizon through the astounding and liberating revelations which the cure entails. Under these conditions analysis progressed splendidly. The patient understands every suggestion, he concentrates on the problems that the treatment requires him to solve, reminiscences and ideas flood his mind. The physician is surprised by the certainty and depth of these interpretations and notices with satisfaction how willingly the sick man