Elucidating issues of profound importance, 'Analysis terminable and interminable' stimulated the advance of psychoanalytic thought while in some respects paradoxically reactivating antiquated ideas. Soberly realistic about analytic outcome, Freud indicated that conflict could not be permanently resolved or the ego definitively strengthened. He emphasized some important aspects of constitution, such as strength of the instincts, libidinal adhesiveness, free aggression, and psychic fluidity or rigidity. Considering the influence of experience, he regarded the more accidental traumatic neurosis as having an unusually favourable prognosis. While concurrently advancing dual drive theory and ego psychology, Freud also paradoxically returned to concepts of ego instincts.
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The other two, which have been known much longer, are education and government. As psychoanalysts, we are only too aware that our profession is not only impossible but also extremely difficult. Aaron Green as I shall call him is a forty-six-year-old psychoanalyst who practices in Manhattan, in the East Nineties. He has seven patients in analysis, who come four or five times a week and lie on the couch, and eight patients who come for psychotherapy once or twice or three times a week and sit in a chair.
He charges between thirty and seventy dollars per fifty-minute hour. He is on the faculty of a local medical school, where he teaches and supervises medical students and psychiatric residents. He came to New York to study at the Institute after getting his medical degree and serving his interneship and residency in a New England city. He is a slight man, with a vivid, impatient, unsmiling face.
He has thin dark hair and wears professorial clothes. A herringbone jacket, light-blue oxford shirt, subdued tie, and gray flannel trousers are his customary apparel. He looks Jewish. He lives with his wife and son in a brownstone apartment off Madison, four blocks from his office.
The living room of his apartment is furnished with black modern sofas and armchairs, beige carpets, reproductions of modern art, photographs, folk art and archeological objects, and books; it is spare, extremely neat, pleasant, perhaps a hair studied.
His consultation room is a kind of poor relation of his living room. The couch is fifties Scandinavian modern rather than seventies high-tech Italian; the pictures are old MOMA reproductions rather than Fondation Maeght exhibition posters; there are floor lamps instead of track lighting. The lights in the consultation room are kept dim, purposely.
The psychoanalysis that Aaron Green practices is of the most unswervingly classical Freudian sort. Brenner is known for his advocacy of a fanatically meticulous, aseptic analytic technique and for his hard-line theoretical position, which goes from Freud through the ego-psychology triumvirate of Heinz Hartmann, Ernst Kris, and Rudolph Loewenstein to the culminating quartet of himself, Jacob Arlow, Martin Wangh, and David Beres. Green is contemptuous of most recent developments in psychoanalysis, dismissing them as fads.
He is unimpressed by the French structuralist psychoanalyst Jacques Lacan, whose impenetrably obscure writings have been gaining increasingly earnest attention here, but whose innovation of reducing the fifty-minute analytic hour to an austere seven or eight minutes or sometimes even to a single oracular parole murmured in the waiting room has yet to be adopted.
He is similarly skeptical of the new theories of Heinz Kohut and Otto Kernberg, derived from work with narcissistic and borderline disorders; the stir that Kohut who works in Chicago and Kernberg who works here have been making within and outside the field fills him with disgust. The English object-relations people D. Winnicott, W. Fairbairn, Michael Balint, Harry Guntrip, and others , who predate and foreshadow the Kohut and the Kernberg groups, are equally wrong-minded, he feels.
Green is critical of his own work. He feels it is good, but not as good as it will be when he has had more experience. He looks back on past cases with misery and guilt over blunders he has made. He has been doing analysis—counting the years of work he did under supervision during his training at the New York Psychoanalytic Institute—for more than a decade.
He was in analysis himself, with two analysts, for a total of fifteen years. The first analysis began while he was in medical school and lasted for six years; the second was his training analysis at the Institute, which lasted for nine years. I met Aaron Green for the first time on a freezing winter day about a year ago, when I went to his office to interview him; I was preparing a report on contemporary psychoanalysis, and his name was on a list of sources that a psychoanalyst friend had given me.
I remember that the day was freezing because I remember the agreeable warmth of the low-ceilinged, dimly lit room in which he received me; I felt as if I had come out of a bleak, harsh woods into a cozy lair.
This feeling of comfort and relaxation, I now suspect, derived from something besides abundant steam heat. With Aaron Green, however, things were different from the start. He subtly deferred to me, he tried to impress me. He was the patient and I was the doctor; he was the student and I was the teacher. To put it in psychoanalytic language, the transference valence of the journalist was here greater than that of the analyst. The idea of infant sexuality and of the Oedipus complex can be accepted with a good deal more equanimity than the idea that the most precious and inviolate of entities—personal relations—is actually a messy jangle of misapprehensions, at best an uneasy truce between powerful solitary fantasy systems.
Even or especially romantic love is fundamentally solitary, and has at its core a profound impersonality. The concept of transference at once destroys faith in personal relations and explains why they are tragic: We cannot know each other.
We must grope around for each other through a dense thicket of absent others. We cannot see each other plain. A horrible kind of predestination hovers over each new attachment we form. Forster proposed. As she woke up on one occasion, [she] threw her arms round my neck. The unexpected entrance of a servant relieved us from a painful discussion, but from that time onwards there was a tacit understanding between us that the hypnotic treatment should be discontinued.
I was modest enough not to attribute the event to my own irresistible personal attraction, and I felt that I had now grasped the nature of the mysterious element that was at work behind hypnotism. In order to exclude it, or at all events to isolate it, it was necessary to abandon hypnosis. This new fact, which we recognize so unwillingly, is known by us as transference.
In this way we oblige him to transform his repetition into a memory. This was easier said than done. Sexual love is undoubtedly one of the chief things in life, and the union of mental and bodily satisfaction in the enjoyment of love is one of its culminating peaks. Apart from a few queer fanatics, all the world knows this and conducts its life accordingly; science alone is too delicate to admit it.
Again, when a woman sues for love, to reject and refuse is a distressing part for a man to play; and, in spite of neurosis and resistance, there is an incomparable fascination in a woman of high principles who confesses her passion. As psychoanalysis developed, the transference became at once more central and more complex.
In that period, the feverish rush of discoveries that Freud had made in the eighteen-nineties—about dreams, the unconscious, repression, infantile sexuality, the Oedipus complex, free association, transference—was settling into a design of orderly beauty.
All the pieces fit, and the whole thing shone. When Freud was invited to Clark University, in Worcester, Massachusetts, in , he gave a lecture series that was an excited celebration of the new science of psychoanalysis. A radiance and a buoyancy run through the Clark lectures Freud reconstructed them from memory—they had been given extemporaneously—and published them shortly after his return to Vienna , which were to fade from later accounts of the same events.
It is like comparing a Beethoven bagatelle with a late quartet. Freud begins by asserting that Breuer, and not he, was the father of psychoanalysis a statement he was to curtly retract a few years later. It would seem that Breuer had developed what we should nowadays call a strong countertransference to his interesting patient. At all events, he was so engrossed that his wife became bored at listening to no other topic, and before long she became jealous.
She did not display this openly, but became unhappy and morose. It was a long time before Breuer, with his thoughts elsewhere, divined the meaning of her state of mind. It provoked a violent reaction in him, perhaps compounded of love and guilt, and he decided to bring the treatment to an end.
He announced this to Anna O. But that evening he was fetched back to find her in a greatly excited state, apparently as ill as ever. Though profoundly shocked, he managed to calm her down by hypnotizing her, and then fled the house in a cold sweat.
The next day, he and his wife left for Venice to spend a second honeymoon, which resulted in the conception of a daughter; the girl born in these curious circumstances was nearly sixty years later to commit suicide in New York.
They could thenceforth feel reassured. Freud heard about the case of Anna O. In , on his return from study in Paris with the great neurologist Jean Martin Charcot, who had convinced him of the psychological etiology of hysteria, Freud set up practice in Vienna as a specialist in nervous diseases.
For twenty months, he treated his patients by means of electrotherapy according to directions in a textbook by W. Erb plus baths, massage, and something called the Weir Mitchell rest cure, but with a growing sense of futility. Then, for sixteen more months, he treated them with no less ineffectual hypnotic suggestion.
As you see, you are hypnotized, you can t open your eyes. Freud began to wonder whether he could achieve catharsis without hypnosis, and was emboldened to try by an inference he drew from an experiment he had recently witnessed in Nancy, performed by a physician named Hippolyte Bernheim, who was also using hypnotic suggestion to treat hysterics.
Freud tried similar coercion on his patients, and it worked. But it was a laborious procedure, and in the long run an exhausting one; and it was unsuited to serve as a permanent technique. However, the very difficulty and laboriousness of the process led Freud to a crucial insight.
For example, one of his patients Elisabeth von R. Eventually, by ceasing to badger the patient and allowing him to say anything he liked, Freud arrived at stumbled on the psychoanalytic method that has remained unchanged to this day. He quotes from a letter that Schiller wrote in in reply to a friend who had complained of meagre literary production:.
The ground for your complaint seems to me to lie in the constraint imposed by your reason upon your imagination. I will make my idea more concrete by a simile. It seems a bad thing and detrimental to the creative work of the mind if Reason makes too close an examination of the ideas as they come pouring in—at the very gateway, as it were. Looked at in isolation, a thought may seem very trivial or very fantastic; but it may be made important by another thought that comes after it, and, in conjunction with other thoughts that may seem equally absurd, it may turn out to form a most effective link.
Reason cannot form any opinion upon all this unless it retains the thought long enough to look at it in connection with the others. On the other hand, where there is a creative mind, Reason—so it seems to me—relaxes its watch upon the gates, and the ideas rush in pell-mell, and only then does it look them through and examine them in a mass.
You critics, or whatever else you may call yourselves, are ashamed or frightened of the momentary and transient extravagances which are to be found in all truly creative minds and whose longer or shorter duration distinguishes the thinking artist from the dreamer. You complain of your unfruitfulness because you reject too soon and discriminate too severely. Just as there are few people who can write poems like Schiller, there are few analytic patients who can free-associate easily, if at all.
I do not know of any outside influence which drew my interest to them or inspired me with any helpful expectations. At that period, I was completely isolated, and in the network of problems and accumulation of difficulties I often dreaded losing my bearings, and also my confidence.
It was only my success in this direction that enabled me to persevere. There will be brought home to you with irresistible force the many developments, repressions, sublimations, and reaction-formations by means of which a child with a quite other innate endowment grows into what we call a normal man—the bearer, and in part the victim, of the civilization that has been so painfully acquired.
Freud pauses here to take one of his habitual swipes at the opponents of psychoanalysis, comparing them to patients under the sway of resistance. This argument puts the reader into a quandary.
The Impossible Profession—I
Analysis Terminable and Interminable: A Half Century Retrospective