161

VIII

“BUT the physicians! It seems I am really
unable to bring you to the main point
of our conversation. You are continually evad-
ing me. After all, the question before us is
whether physicians should be given the exclu-
sive right to employ psychoanalysis, that is,
after they have fulfilled certain conditions, if
you should insist upon such. According to
your own statement, the majority of ‘quacks,’
dabbling with psychoanalysis, does not con-
sist of physicians. You also admit that the
greatest number of your disciples and follow-
ers are physicians. I have heard that these do
not share your point of view, in regard to lay-
analyses.

“Of course, it is to be expected that your
disciples agree with you in the question of
sufficient training. Just the same, they hold
the laymen should be excluded from the
practice of psychoanalysis. Is that really the
case? And if so, how do you account for it?”

The Problem of Lay-Analyses

You are correctly informed. Not all, but a
great number of my medically trained col-
laborators do not side with me in this matter,
but insist that psychoanalytical treatment of
neurotics be exclusively reserved for physi-
cians. From this, you may gather that even
within the limits of our own camps, there pre-
vails a difference of opinion. Although my
point of view is very well known, the diver-
gence of opinion in matters of lay-analyses, in
no way interferes with an otherwise splendid
harmony.

How to explain this position of some of
my disciples?

I am not so sure, but I assume that profes-
sional pride is behind it. You see, their process
of development has been different from mine.
That they find themselves somewhat isolated
from their colleagues, is still annoying them.
They would like to be considered, by the pro-
fession as a whole, as members in good stand-
ing, so to say. Thus, in order to win the toler-
ance of their /Esculapian brothers, they are
willing to make a sacrifice, whose value is
apparently not clear to them,

[162]

[163]

The Problem of Lay-Analyses

Of course, I may be wrong here. To assume
that fear of competition is dictating their po-
sition, would not only amount to suspecting
them for a peculiar shortsightedness. After all, as
long as they are ready to initiate colleagues
into psychoanalysis, it can be of no importance
to them whether they will have to share pro-
spective patients with them, or with laymen.

Probably, there is something else to be con-
sidered. They may be impressed by certain
features which, in the practice of psycho-
analysis assure the physician of an unquestion-
able advantage over the layman.

“There you are:–‘Assure the advantage’! 
At last, you admit this advantage! I should
think this admission settles our argument.”

I admit this advantage. Perhaps by doing
so I shall prove to you that I am not as pas-
sionately deluded as you think. I postponed
mentioning these conditions, because in airing
them, additional theoretical discussion is
necessary.

“What are you driving at now?”

There is first the question of diagnosis. Be-
 

164

The Problem of Lay-Analyses

fore admitting a patient, suffering from nerv-
ous disturbances, to psychoanalytical treat-
ment, one naturally desires to have as much
assurance as possible that this therapy is suit-
able in that particular case, that is, that the
patient has a good chance of being benefited
by psychoanalysis. This can only be the case,
if he is actually suffering from neurosis.

“I should think that would be easily as-
certained, by the symptoms he complains
about.”

You are putting your finger just on the
point, where new complications may arise. It
is not always possible to be perfectly sure of
such a case. The patient, in spite of displaying
all the visible symptoms of neurosis, may ac-
tually be suffering from something else. The
incipient stage of a mental disease, for exam-
ple, or the beginning of a process destroying
his brain. To distinguish between such symp-
toms is not always easy or possible. Respon-
sibility for such a decision must naturally be
assumed by the physician alone. And as men-
tioned before, it is not so easy for him. For
the longest time, an ailment may appear ab-

165

solutely harmless, until finally manifesting its
malignant character. Nervous people, as a
rule, fear that they may be on the road to
some mental disease.

Assumed that a physician has not correctly
diagnosed a case, or has been unable to dis-
cover its true nature, nothing has been lost, no
damage has been done. Analytical treatment,
although not doing any harm to the patient,
would have been superfluous in such a case.
It might have given any number of people
a chance to lay the blame for the unfortunate
development of the case at the door of psycho-
analysis. Unjustly so, to be sure, but such a
likelihood should be avoided nevertheless.

“That sounds hopeless. It apparently tears
out, by the very roots, everything you told
me about the nature and development of a
neurosis.”

Not at all. It only strengthens the fact that
neurotics are a nuisance and a dilemma for
all parties concerned, including the psycho-
analysts. I may be able to alleviate your new
apprehensions if I make myself clearer. Prob-
ably it would be more correct to say of such

166

cases, as we now have under discussion, that
they actually present neuroses. However, these
neuroses are not psychic but rather somatic,
that is, they do not originate from the soul,
but rather from the body. Do you understand
me?

“I do. But I am at a loss to connect all this
with the psychological aspect.”

That can easily be done, if only complica-
tions of the living substance are sufficiently
taken into consideration. What was the in-
herent feature of a neurosis? That the “I,”
constituting the very essence of the soul, so to
speak, developed and improved by the influ-
ence of the outer world, proved unable to
fulfill its mediating functions between the
“It” and reality; that the “I,” on account of
its weakness, shirked its duties in regard to the
“It,” thus incurring repressions from which
it suffers. It is because such weakness of the
“I” regularly takes place in all of us in child-
hood that events of our tender years exert
such great importance in later life.

In the few years of our childhood, we have
to cover the enormous distance of develop-
 

167

ment from primitive man of the Stone Age to
civilized man of today. In addition to this
tremendous burden, the child has to ward off
the urges of an early sexuality. Small wonder,
then, that our “I” takes recourse to repres-
sions, thus exposing itself to childhood neu-
roses, the effects of which in turn furnish the
disposition for nervou˙ disturbances in more
mature years.

Everything now depends upon how the
growing up individual will be treated by fate.
If life is too hard, the divergence between
urges and the opposition of reality too great,
the “I” may remain unsuccessful in its en-
deavors to mediate between the two. This is
the more probable, the more the “I” is en-
croached upon by such infantile dispositions
as it may have acquired in tender years. Thus,
the process of repression is repeated; urges
tear themselves free from the sovereignty of
the “I” to gain, by way of regression, a sub-
stitute for the gratification they crave, while
the poor “I” has become helplessly neurotic.

Let us hold on firmly to this: that the most
important, the pivotal point in the whole sit-
 

168

The Problem of Lay-Analyses

uation, so to speak, is the relative strength of
the “I” in all its phases. It is easy, then, to
complete our whole etiological survey, that is
our endeavor to assign causes to the phenom-
ena observed. We already know the normal
causes for nervousness to be the infantile weak-
ness of the “I,” the checking of early sexual
urges, and the influence of chance episodes in
our childhood.

But is there no possibility that there are also
some other contributory factors, antedating
childhood? For example, an inborn strength
and unruliness of those urges which constitute
the “It,” presenting right from the very start
a task much too difficult for the “I”? Or could
a certain weakness, existing for reasons un-
known, in the development of the “I” be held
responsible? Of course, all these possibilities
will exert an etiological importance, in some
cases of surpassing value.

The specific driving power of the “It” must
always be taken into consideration, and where-
ever it is developed to an excessive degree,
there are only meagre chances for a successful
application of our therapy. Of the reasons

169

that block the development of the “I,” we
still know too little to account for such cases
of neurosis which arise on a constitutional
basis. It may be assumed that neurosis hardly
ever develops unless there are constitutional
or congenital factors increasing the possibility
for such a condition. However, if it is correct
that the relative weakness of the “I” is the
deciding factor for the development of neu-
roses, then it would also appear possible that
later, physical disturbances may result in a
neurosis provided it also results in a weaken-
ing of the “I.”

This happens only too frequently. Such a
physical disturbance may aim at the “It,” in-
tensifying its urges to an extent where the “I”
is not able to cope with them any more. As an
example for such developments, the changes
induced in woman by the disturbances of men-
struation and menopause could perhaps be
drawn upon. Other reasons that may weaken
the “I” are general physical disturbances, or-
ganic diseases of the central nervous system.
All of these may result in interference with
those sources from which the soul apparatus

170

draws its strength, to lead, in turn, to an en-
croachment of its more delicate functions,
which are necessary to maintain unimpaired
the whole “I” organization. In all these cases,
neurosis presents about the same picture.
However, while manifesting the same psy-
chological mechanism, neuroses develop on
the basis of a multifarious, frequently highly
complicated etiology; that is, they arise from
a great number of various causes.

“That suits me better. At last you have
spoken like a physician. And now I am wait-
ing for you to admit that so complicated a
condition as a neurosis should only be treated
by a physician.”

I am afraid you are expecting too much.
What we have just discussed belonged in the
realm of pathology. Psychoanalysis, however,
is a therapeutical process. I admit, no, I even
insist, that a physician should first diagnose
each and every case where psychoanalysis
seems applicable. Fortunately, the greater
number of neuroses are of a psychical nature
and not pathologically induced. As soon as the
physician has ascertained this, he may safely

[171]

The Problem of Lay-Analyses

leave the treatment to the lay-analyst. We
have always followed this procedure within
our analytical societies. Thanks to this close
coöperation between the medically trained
and non-trained members, errors almost never
occur.

There is another emergency when the ana-
lyst has to invite the assistance of a physician.
It is possible that, in the course of psychoana-
lytical treatment, symptoms–mostly of physi-
cal nature–appear which may either be part
of the neurosis, or else manifestations of inde-
pendent, organic disturbances. Here, the de-
cision must once more be left to the physician.

“From all this, there follows that the ana-
lysts, even during the analysis, cannot dispense
with the physician. This is another argument
against lay-analyses.”

No, this possibility cannot be drawn upon as
an argument against lay-analyses, because in
an analogous case the medically trained ana-
lyst would not proceed any differently.

“I do not understand that.”

There is a rule that even a medically trained
analyst, running across such dubious symp--

172

The Problem of Lay-Analyses

toms in the course of the treatment, is not to
depend on his own judgment, but to consult
some colleague, preferably a specialist of in-
ternal diseases.

“Why this rule, apparently so superfluous?”
This rule is not superfluous at all. There are
several reasons for it. In the first place, it is
hard to combine organic and psychical treat-
ment. In the second place, the particular con-
dition of transference frequently prevailing in
analyses may make it inadvisable for the ana-
lyst to subject his patient to physical examina-
tion. In the third place, there are all the rea-
sons in the world for the analyst to doubt his
own opinion, inasmuch as he is so intensely in-
terested in the psychical aspects of the case.

“I now understand your position towards
lay-analyses. You insist that there must be lay-
analysts. However, as you have to admit their
insufficiency for the task, you compile every-
thing that could serve to excuse them, and
make things in general easier for them. To be
frank with you, I cannot understand why we
should have lay-analysts at all, inasmuch as
they would never be more than second-class

[173]

therapeutists. This need not include those few
laymen who have already received their train-
ing, but institutes for psychological training
should not accept laymen any more.”

I would assent to all this, if I could be
shown that such restrictions would benefit all
parties interested. You will admit that these
interests are tri-fold:–There is the interest of
the patient, the interest of the physicians, and
last but not least, the interest of science which,
in turn, includes the interest of all patients of
the future. Let us investigate these three
points.

It does not matter whether the patient be
analysed by a physician or a layman, as long
as any danger of mistaking his condition is ex-
cluded by being properly examined by a phy-
sician before the beginning of the treatment,
or re-examined as soon as developments, in the
course of the analysis, make this advisable. It
is much more important for the patient that
the analyst possesses those personal qualities
which invite full confidence, and that he has
that knowledge and experience which alone
qualify him to apply psychoanalysis. To some

174

people, it may seem that it might undermine
the authority of the analyst to have his patient
know that he is no physician and must obtain
the advice of a medically trained expert in
certain matters. However, although we have
never kept a patient in the dark, as to the qual-
ifications of an analyst, we have come to the
conclusion that the patients have no prejudice
against a non-medically trained analyst; they
are only to glad to accept the benefits of treat-
ment, wherever they offer themselves–a fact
resented by the medical profession for the
longest time.

It also must be considered that analysts,
practising today, are men and women with
academic training and degrees, pedagogues,
of great experience and impressive person-
ality. The analysis, to which all candidates of
psychoanalytical institutes are required to sub-
mit, is the best means of testing their personal
suitability for the performance of so exerting
an activity as an analysis presents.

In reference to the interest of the physicians,
I do not believe that medicine has anything to
gain by annexing psychoanalysis. Today, med-
 

175

ical training requires five years, with almost
a whole sixth year taken up with examina-
tions. Ever so often, new demands in regard to
training are made with which the young stu-
dent must comply, if his medical education is
to be considered adequate. Generally speaking,
while it is difficult today to enter the medical
profession, the practice of medicine is neither
very satisfactory nor very advantageous. And
as soon as the undoubtedly justified necessity
is realized that the physician be also informed
of the psychological aspects of diseases, thus
including in medical training a partial prep-
aration for psychoanalysis, there would fol-
low an extension of the medical curriculum
and a corresponding extension of the period of
training. I do not know how physicians would
like such a development, arising from the
monopoly they claim on psychoanalysis. But
these demands would then have to be fulfilled
and at a time when, in general, the material
aspects of those strata of society which con-
tribute the greatest contingent to the medical
profession, are such that young physicians
must establish a practice, as soon as possible.

176

The Problem of Lay-Analyses

However, the medical profession may not
intend to include preparation for psychoanaly-
sis into the medical curriculum proper. The
general opinion may be that it is much more
practical for the young physician to acquire
psychoanalytical knowledge only after having
completed his medical education. It may be
said that such a procedure would not involve
any actual loss of time, inasmuch as a young
man under thirty never gains that confidence
of patients which is an indispensable condition
for benefiting a patient psychoanalytically.
Of course, it could be said that a young physi-
cian, too, who has just won his diploma, can-
not command too much respect, as regards his
opinion of the physical ailments of his pa-
tients, and that the young analyst could very
well utilize his time, by working in a psycho-
logical clinic, under the supervision of an ex-
perienced practitioner.

It seems to me that the aforementioned de-
mand amounts to a waste of energy which, in
view of economic conditions, does not seem
justified. Although analytical training invades
the field of medical training, it neither in-

177

cludes this training, nor is included by it. If a
psychoanalytical college were to be organized,
which today may strike one as being a fan-
tastic idea, the curriculum of this institution
would have to include much of what is taught
in medical schools. Aside from the Psychology
of the Depths, which would naturally always
be the main subject taught, Biology would
have to be included in the course, and Science
of Sex would also be one of the major subjects.
In addition, adequate instruction would have
to be given on such disturbances which belong
in the realm of Psychiatry. Psychoanalytical
training would have to include a number of
subjects which have no connection with medi-
cine, and never enter the physician’s prac-
tice, such as History of Civilization, Mythol-
ogy, Psychology of Religion, and Literature.
Without being well acquainted with these sub-
jects, the analyst will be unable to grasp the
problems that will face him in the course of
his practice.

Most of the subjects, however, belonging
to medical training, will not be of any use to
him and although all this knowledge is highly

178

valuable for those who need it, it would not
assist the analyst to understand a neurotic con-
dition nor to alleviate it. In case the objection
is made here that specialists in other fields of
medical endeavor, also do not need all the de-
tails they acquire in the course of their train-
ing, it must be said that such a case could not
be considered analogous. For many branches
of medicine, such facts as, for example, Pa-
thology presents, are of great importance. The
analyst, however, reaches out for a variety of
experiences, with different phenomena, un-
derlying different laws. Although philosophy
may succeed in bridging the chasm between
body and soul, as far as our own experience
is concerned, this chasm, nevertheless, exists,
presenting itself in an especially striking light,
as regards our practical endeavors.

It seems unjust and impractical to force a
person to take a roundabout route via medical
training, if this person be bent upon relieving
another individual from the agonies of a pho-
bia or a fixed idea. Moreover, such a proce-
dure would be ineffective, as long as psycho-
analysis in general is not suppressed.

[179]

The Problem of Lay-Analyses

Just imagine that somewhere in the country,
there is a certain mountain top that can be
reached by two different roads, the one being
short and straight, and the other long and
winding. An attempt is made to block the
short road by a “no-trespass” sign. There is
some chance of this sign being respected, if the
short road is steep and difficult to climb,
whereas the long road is easy to travel. How-
ever, if the detour should be the more difficult
road, you can easily surmise how little the
trespassing sign would be respected.

I am very much afraid it will be just as
difficult to force the laymen to study medi-
cine, as it is for me to induce physicians to
study psychoanalysis. Human nature is like
that.

“If you are correct in your assumption that
analytical treatment cannot be administered
without a special training, but that on the
other hand the medical curriculum could not
bear the burden of psychoanalytical training,
and that medical knowledge, to the greatest
extent, is superfluous for the analyst, how will
we ever achieve the ideal medical personality,

180

The Problem of Lay-Analyses

the physician who can cope with all the de-
mands of his profession?”

I am unable to foresee how to solve these
difficulties, and I do not feel called upon to
make any suggestions. I only perceive two
things clearly: firstly, that the analysis seems
to constitute a dilemma, but certainly the neu-
rotic is also a dilemma; secondly, that for
the time being, all interests would be served
if physicians resolve to tolerate a class of ther-
apeutists who will relieve them of the arduous
treatment of those tremendously frequent psy-
chical neuroses, in addition benefiting the pa-
tients by remaining in constant contact with
them.

“Is that your last word in reference to the
problem of lay-analyses, or is there something
else?”

There is a third interest to be considered:–
that of science. Although what I have to say
in that respect may not mean much to you, it
nevertheless means a good deal to me.

We do not consider it advisable that psy-
choanalysis be swallowed up by medicine,
finally to be shelved in a text-book of psychia-
 

181

The Problem of Lay-Analyses

try, under the chapter heading of Therapy,
together with such other treatments as Hyp-
notic Suggestion, Auto Suggestion, Persuasion
which, due to lack of knowledge, were in-
debted for their short lives to the indolence
and ignorance of the broad masses. Psycho-
analysis deserves a better fate, which, let us
hope, it will really attain.

As the Psychology of the Depths, the teach-
ing of the Unconscious, psychoanalysis may
prove indispensable to all sciences which deal
with the development of human culture, and
such of its great achievements as art, religion,
and civilized society. Psychoanalysis has al-
ready appreciably assisted these sciences in
the solution of their problems. But all this
is insignificant, compared to what may be
achieved through psychoanalysis in the future,
when students of History, Psychology of Re-
ligion, and Etymology, will avail themselves
to the fullest extent of the assistance psycho-
analysis will be able to render them.

The employment of psychoanalysis for the
treatment of neuroses is only one of its pos-
sibilities, and time may yet prove that this is

182

not even the most important of them. At any
rate, it would be unfair to sacrifice all other
advantages of psychoanalysis, simply because
there is just one phase where the application
of psychoanalysis encroaches upon the pre-
serves of medicine.

Here another aspect manifests itself which
cannot be interfered with, without causing
damage. If the representatives of the differ-
ent sciences should really take up the study of
psychoanalysis, to apply it in their own spheres
of interest, it would not suffice for them to
merely avail themselves of such results as have
been recorded in psychoanalytical literature.
They will have to come to an understanding of
psychoanalysis in the only way possible, that
is, by submitting themselves to analysis.

Thus, to the neurotics in need of analysis, a
second class of persons would be added: those
who undergo analysis for intellectual reasons
and who would welcome that intensification of
their efficiency which would result inciden-
tally from analysis. To undertake these analy-
ses, a number of analysts would be necessary
for whom medical knowledge would be of

183

The Problem of Lay-Analyses

specially limited importance. However, these
instructor-analysts–as they ought to be called
–are in need of an especially thorough train-
ing, which they can only obtain if they are
given opportunities to study interesting and
convincing cases. Inasmuch as healthy persons
do not feel the necessity and curiosity to be an-
alysed, neurotics would have to be the objects
of study for the instructor-analysts. Their
study would be guided by expert analysts, with
a special eye to their future, non-medical
work. Of course, all this necessitates a certain
amount of freedom of action, and would not
brook petty interference.

Perhaps you do not believe in these strictly
theoretical endeavors of psychoanalysis, and
are not ready to admit their importance, in
connection with the practical side of the
problem of lay-analyses. In that case, let me
remind you that there is another field for the
application of psychoanalysis, outside the
hunting ground of the “quack”–a field which
physicians will hardly claim as their own.
I allude to the application of psychoanalysis to
pedagogy.

[184]

The Problem of Lay-Analyses

As soon as a child manifests the first signs of
an undesirable development, by being moody,
stubborn and inattentive, neither the child spe-
cialist nor the school physician will be able
to do anything for him; not even when a
child shows such clear signs of nervous dis-
turbances as timidity, lack of appetite, vomit-
ing, and sleeplessness. A treatment which com-
bines analytical influence with pedagogic mea-
sures and is applied by persons who are not
above delving into the child’s own world and
who understand how to penetrate the soul life
of the child, will succeed not only in dissolv-
ing nervous disturbances, but also in reversing
incipient traits of character.

The importance which we were forced to
attach to apparently unimportant neurotic
conditions of children, in view of the fact that
they very often serve as a disposition for dis-
turbances in later life, would prove that the
analyses of children constitute a splendid
means of prophylaxis. Although psychoanaly-
sis still has its enemies, I do not know what
means are at their disposal to hinder the ac-
tivity of a pedagogic analyst, or analytical

185

pedagogue, and I doubt whether this could be
done so easily.

To return once more to the problem of the
analytical treatment of adults, suffering from
nervous disturbances, we have not yet ex-
hausted all points of view. Civilized life of
today exerts an almost unbearable pressure,
which necessitates corrective measures. Does
it seem too fantastic to expect that psycho-
analysis, in spite of the many difficulties it en-
counters, should be called upon to furnish this
corrective agent? Maybe some American mil-
lionaire will one day donate enough money
for the psychoanalytical training of the so-
cial workers of his country, thus creating an
emergency corps, to fight neurotic conditions
brought about by present-day life.

“You mean some sort of a new Salvation
Army?”

Why not? After all, our fancy always fol-
lows existing patterns. The stream of eager
students that will then flood towards Europe,
will, of course, have to pass Vienna, because
there the development of psychoanalysis may
have prematurely died, on account of gov-
 

[186]

ernmental interference. You smile? I’m not
saying this to sway your judgment. I know you
don’t believe me, and I surely cannot guaran-
tee that my predictions will come true. But
there is one thing I know: it is not at all im-
portant what the opinions of individuals and
of individual governments may be, in respect
to the problem of lay-analyses. All this can
only have limited effects. What is really im-
portant is that potentialities for the develop-
ment of psychoanalysis cannot be affected by
ordinances and prohibitions.