exploitation of the conception of ego-libido or narcistic libido, by the aid of which we have extended to narcistic neuroses those observations which were confirmed in the transference neuroses. But now you will ask, is it possible for us to succeed in subordinating all the disturbances of narcistic conditions and the psychoses to the libido theory in such a way that in every case we recognize the libidinous factor of psychic life as the cause of the malady, and never make an abnormality in the functioning of the instincts of self-preservation answerable? Ladies and gentlemen, this conclusion does not seem urgent to me, and above all not ripe for decision. We can best leave it calmly to the progress of the science. I should not be surprised to find that the power to exert a pathogenic influence is really an exclusive prerogative of the libidinous impulses, and that the libido theory will celebrate its triumphs along the whole line from the simplest true neurosis to the most difficult psychotic derangement of the individual. For we know it to be a characteristic of the libido that it is continually struggling against subordinating itself to the realities of the world. But I consider it most probable that the ego instincts are indirectly swept along by the pathogenic excitations of the libido and forced into a functional disturbance. Moreover, I cannot see any defeat for our trend of investigation when we are confronted with the admission that in difficult psychoses the ego impulses themselves are fundamentally led astray; the future will teach us — or at least it will teach you. Let me return for one moment more to fear, in order to eliminate one last ambiguity that we have left. We have said that the relation between fear and the libido, which in other respects seems clearly defined, does not fit in with the assumption that in the face of danger real fear should become the expression of the instinct of self-preservation. This, however, can hardly be doubted. But suppose the emotion of fear is not contested by the egoistic ego impulse, but rather by the ego-libido? The condition of fear is in all cases purposeless and its lack of purpose is obvious when it reaches a higher level. It then disturbs the action, be it flight or defense, which alone is purposeful, and which serves the ends of self-preservation. If we accredit the emotional component of actual fear to the ego-libido, and the accompanying activity to the egoistic instinct to self-preservation, we have overcome every theoretical difficulty. Furthermore, you do not really believe that we flee because we experience fear? On the contrary, we first are afraid and then take to flight from the same motive that is awakened by the realization of danger. Men who have survived the endangering of their lives tell us that they were not at all afraid, they only acted. They turned the weapon against the wild animal, and that was in fact the most purposeful thing to do.
TWENTY-SEVENTH LECTURE
GENERAL THEORY OF THE NEUROSES
TRANSFERENCE
We are nearing the close of our discussions, and you probably cherish certain expectations, which shall not be disappointed. You think, I suppose, that I have not guided you through thick and thin of psychoanalytic subject matter to dismiss you without a word about therapy, which furnishes the only possibility of carrying on psychoanalysis. I cannot possibly omit this subject, for the observation of some of its aspects will teach you a new fact, without which the understanding of the diseases we have examined would be most incomplete.
I know that you do not expect any guidance in the technique of practising analysis for therapeutic purposes. You wish to know only along what general lines psychoanalytic therapy works and approximately what it accomplishes. And you have an undeniable right to know this. I shall not actually tell you, however, but shall insist that you guess it yourselves.
Only think! You know everything essential, from the conditions which precipitate the illness to all the factors at work within. Where is there room for therapeutic influence? In the first place, there is hereditary disposition; we do not speak of it often because it is strongly emphasized from another quarter, and we have nothing new to say about it. But do not think that we underestimate it. Just because we are therapeutists, we feel its power distinctly. At any rate, we cannot change it; it is a given fact which erects a barrier to our efforts. In the second place, there is the influence of the early experiences of childhood, which are in the habit of becoming sharply emphasized under analysis; they belong to the past and we cannot undo them. And then everything that we include in the term “actual forbearance”— misfortunes of life out of which privations of love arise, poverty, family discord, unfortunate choice in marriage, unfavorable social conditions and the severity of moral claims. These would certainly offer a foothold for very effectual therapy. But it would have to be the kind of therapy which, according to the Viennese folk-tale, Emperor Joseph practiced: the beneficial interference of a potentate, before whose will men bow and difficulties vanish. But who are we, to include such charity in the methods of our therapy? Poor as we are, powerless in society, forced to earn our living by practicing medicine, we are not even in a position to treat free of charge those patients who are unable to pay, as physicians who employ other methods of treatment can do. Our therapy is too long drawn-out, too extended for that. But perhaps you are still holding to one of the factors already mentioned, and think that you have found a factor through which our influence may be effective. If the restrictions of morality which are imposed by society have a share in the privation forced upon the patient, treatment might give him the courage, or possibly even the prescription itself, to cross these barriers, might tell him how gratification and health can be secured in the renunciation of that ideal which society has held up to us but often disregards. One grows healthy then, by giving one’s sexuality full reign. Such analytic treatment, however, would be darkened by a shadow; it does not serve our recognized morality. The gain to the individual is a loss to society.
But, ladies and gentlemen, who has misinformed you to this degree? It is inconceivable that the advice to give one’s sexuality full reign can play a part in analytic therapy, if only from the circumstance we have ourselves described, that there is going on within the patient a bitter conflict between libidinous impulse and sexual suppression, between sensual and ascetic tendencies. This conflict is not abolished by giving one of these tendencies the victory over its opponent. We see that in the case of the nervous, asceticism has retained the upper hand. The consequence of this is that the suppressed sexual desire gains breathing space by the development of symptoms. If, on the other hand, we were to give the victory to sexuality, symptoms would have to replace the sexual suppression, which has been pushed aside. Neither of the two decisions can end the inner conflict, one part always remains unsatisfied. There are only a few cases wherein the conflict is so labile, that a factor such as the intervention of the physician could be decisive, and these cases really require no analytic treatment. Persons who can be so much influenced by a physician would have found some solution without him. You know that when an abstinent young man decides upon illegitimate sex-intercourse, or when an unsatisfied woman seeks compensation from another man, they have generally not waited for the permission of a physician, far less of an analyst, to do this.
In studying the situation, one essential point is generally overlooked, that the pathogenic conflict of the neurotic must not be confused with normal struggles between psychic impulses of which all have their root in the same psychological soil. The neurotic struggle is a strife of forces, one of which has attained the level of the fore-conscious and the conscious, while the other has been held back in the unconscious stage. That is why the conflict can have no outcome; the struggling parties approach each other as little as in the well-known instance of the polar-bear and the whale. A real decision can be reached only if both meet on the same ground. To accomplish this is, I believe, the sole task of therapy.
Moreover, I assure you that you are misinformed if you assume that advice and guidance in the affairs of life is an integral part of the analytic influence. On the contrary, we reject this role of the mentor as far as possible. Above all, we wish to attain independent decisions on the part of the patient. With this intention in mind, we require him to postpone all vital resolutions such as choice of a career, marriage or divorce, until the close of the treatment. You must confess that this
