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CHAPTER XI.

CONCERNING “WILD” PSYCHOANALYSIS.

During my consultation hours some days ago an elderly woman
called on me accompanied by a protecting friend and complained
of a state of anxiety. She was in the latter half of her fortieth
year, quite well preserved and seemingly had not yet reached her
menopause. The separation from her last husband was supposed
to have been the cause of her disease, but according to her state
ment the anxiety had considerably increased since she had con-
sulted a young physician in her suburban town. He explained to
her that the cause of her anxiety lay in her sexual demands; that
she could not dispense with sexual relations and that for that
reason she had only three roads to health–either to return to
her husband, to take a lover or to gratify herself. Since that time
she became convinced that she was incurable as she did not wish
to return to her husband and her moral and religious feelings
were against the other two measures. She came to me because
the physician had told her that this was a new viewpoint for
which I was responsible and urged her to come to me for cor-
roboration of the definite assertions. Her friend, a still older,
embittered and unhealthy looking woman, then adjured me to
assure the patient that this physician had been mistaken. She
insisted that his statement could not be true for she herself had
been a widow for many years and remained respectable without
suffering from states of anxiety.

I shall not dwell upon the delicate situation into which I was
placed by this visit but I shall explain the conduct of the col-
league who had sent me this patient. First, I wish to advise cau-
tion which is perhaps–or let us hope–not superfluous. Expe-
rience of many years has taught me–as it could teach everyone
else–not to accept readily as true that which patients, particu-
larly nervous ones, relate in regard to their physician. No matter
what the treatment is the neurologist not only becomes the target
for the manifold hostile feelings of the patient, but through a

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form of projection he must also occasionally be willing to assume
responsibility for the patient’s secret repressed wishes and it is a
hard but significant fact that such thrusts find nowhere more
ready credence than among other physicians.

I have, therefore, the right to hope that during the consulta-
tion the woman had given me a purposive distorted report of her
physician’s utterances and that I would be doing an injustice to
one who was unknown to me if I based my observation concern-
ing “wild” psychoanalysis on this particular case. However, in
doing this I may be able to restrain others from doing injustice
to their patients.

Let us therefore assume that the physician advised exactly
what the patient reported. Everyone will then justly criticize
that when a physician finds it necessary to discuss the theme of
sexuality with a woman he should do it with tact and delicacy.
However, these requirements are only a part of certain technical
rules of psychoanalysis. Besides the physician has misconstrued
or misunderstood a number of scientific theories of psychoanal-
ysis and thereby proven how little he has advanced towards the
understanding of its essentials and objects.

Let us begin with the latter—the scientific errors. The phy-
sician’s advice clearly shows in what sense he grasps the “sexual
life.” He grasps it in the popular sense—namely, that under
sexual demands nothing else is understood except the need for
coitus or its analogy, the processes causing the orgasm or the
ejaculation of the sexual product. But it could not have re-
mained unknown to the physician that psychoanalysis was wont
to be reproached for extending the idea of the sexual far beyond
its usual limits. The fact is correct, though whether it is just to
apply it as a reproach will not be discussed here. In psycho-
analysis the idea of the sexual has a much greater compass; both
above and below it far exceeds the popular sense. This exten-
sion justifies itself genetically; we also ascribe to the “sexual
life” all manifestations of tender feelings which originated from
the source of primitive sexual emotions, even if those emotions
experience inhibition in their original sexual aim or have sub-
stituted this aim by another no longer sexual. We, therefore, also
prefer to speak of psychosexuality, thus laying stress on the fact
that the psychic factor of the sexual life should neither be over-

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looked nor underestimated. We use the word “sexuality” in the
same broad sense as the word “love” in the English language.
We have also known for a long time that lack of psychic grati-
fication with all its consequences may exist where there is no lack
of normal sexual intercourse, and as therapeutists we always
remember that only a small proportion of the ungratified sexual
strivings whose substitutive gratification in the form of nervous
symptoms we are trying to combat, can be done away with
through coitus and other sexual acts.

Whoever does not share this conception of psychosexuality
has no right to refer to the doctrines of psychoanalysis in which
the etiological meaning of sexuality is dealt with. To be sure,
he has simplified the problem for himself by the exclusive em-
phasis of the somatic factor of sexuality, but he alone should be
responsible for his action.

Still a second and equally serious misunderstanding is obvious
from the advice of the physician.

It is true that psychoanalysis specifies that the lack of sexual
gratification is the cause of nervous affliction, but does it not
say more? Should one leave aside as too complicated the fact
that it teaches that nervous symptoms result from a conflict be-
tween two forces, a libido (mostly of excessive growth), and an
all too strong sexual rejection or repression? Whoever does not
forget the second factor, which was not actually assigned to
second rank, can never believe that sexual gratification as such
is a universally reliable remedy for the complaints of the neurotic.
A great many of these persons are incapable of obtaining grati-
fication under the given conditions or under any conditions. If
they were capable of it and had they not their inner resistances
the force of the impulse would point out the way to gratification,
even without the advice of the physician. What, then, is the use
of such advice as the physician ostensibly gave this woman?

Even if it were justified scientifically it would nevertheless be
unfeasible for her. If she had no inner resistances against
onanism or against an intrigue she would long since have grasped
one of these means. Or does the physician think that a woman
of over forty years knows nothing of the possibility of taking a
paramour, or does he so greatly overestimate his influence as to

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believe that without medical approval she could never decide on
such a step.

All this seems very clear and still it must be admitted that there
is one factor which often hinders the passing of sentence. Some
of the nervous affections, the so-called actual neuroses, such as the
typical neurasthenia and the pure anxiety neuroses, apparently
depend on the somatic factor of the sexual life, while we have not
yet any definite conception concerning the rôle played in them by
the psychic factors and the repression. In such cases it is natural
for the physician to have in view, first of all, an actual therapy,
an alteration of the somatic sexual activity and he would be fully
justified in so doing were his diagnosis correct. The woman who
consulted this young physician complained above all of states of
anxiety. He thus probably concluded that she was suffering
from anxiety neurosis and felt justified in recommending her a
somatic therapy. Again a convenient misunderstanding! He
who suffers from anxiety does not necessarily have an anxiety
neurosis. This diagnosis is not to be derived from the name.
One must know what manifestations constitute anxiety neurosis
and how to differentiate them from other morbid states which are
also manifested through fear. According to my impression the
woman in question suffered from an anxiety hysteria and the
whole as well as the full value of such nosographic distinctions
lies in the fact that they point to a different etiology and a differ-
ent therapy. Whoever has in mind the possibility of such an
anxiety hysteria would not have failed to neglect the psychic fac-
tors as shown in the alternative advice of the physician.

Strangely enough in the therapeutic alternative of this supposed
psychoanalyst there is no place left for psychoanalysis. This
woman could be freed of her anxiety only were she to return to
her husband, or gratify herself by resorting to onanism, or to a
paramour. And where would the analytical treatment enter
which is the principal remedy in states of anxiety?

We thus come to the technical errors which we recognize in
the procedure of the physician in the admitted case. It is easy to
refer it to ignorance. It is a conception long since combated,
based on a most superficial judgment, that the patient suffers from
a lack of knowledge and when this ignorance is removed through
enlightenment (concerning the causative relation of his illness with

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his life, regarding his childhood experiences, etc.) he must become
well. It is not this lack of knowledge in itself that is the patho-
genic motive, but the determination of this ignorance by inner
resistances which first called forth this ignorance and still sup-
ports it. The task of the therapy lies in the combating of these
resistances. To impart that which the patient does not know be-
cause he has repressed it is only one of the necessary preparations
for the therapy. If the knowledge of the unconscious were as
important to the patient as the inexperienced psychoanalyst be-
lieves the cure would be effected if the patient attended lectures
or read books on the subject. But these measures have just as
much influence on the symptoms of nervous complaints as the dis-
tribution of menus has on hunger during a famine. The com-
parison is useful even beyond its original application, as the im-
parting of the unconscious to the patient regularly has the result
of sharpening his conflict and of exaggerating his complaints.

But as the psychoanalysis cannot dispense with such informa-
tion it dictates that it should be imparted only after the two fol-
lowing conditions have been fulfilled. First, after the patient has
through preparation, himself come into the surrounding of his
repression; and secondly, after he has become so attached to the
physician (transference) that his feeling toward the latter would
make the newer flight impossible.

Only through the fulfillment of these conditions does it become
possible to recognize and master the resistances which have led
to repression and ignorance. Hence a psychoanalytical procedure
assumes from the beginning a longer contact with the patient;
and attempts to surprise the patient by brusquely imparting to
him his secrets guessed by the physician during his first consulta-
tion hour are technical errors which usually avenge themselves
by the doctor’s incurring the cordial enmity of the patient which
thus cuts off every future influence.

We shall leave out of consideration the fact that one sometimes
advises wrongly and that one is never in a position to guess every-
thing. By the aid of these unequivocal technical rules psycho-
analysis replaces the demand of the vague “medical tact” in
which one looks for a special endowment.

It is therefore not enough that the physician should know some
of the results of psychoanalysis, but he must also be well versed

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in its technique if he wishes to guide his medical actions by psy-
choanalytic viewpoints. This technique can not yet be learned
from books and to acquire it through one’s self requires great
sacrifices of time, effort and success. Like other medical tech-
niques it is best learned from those who have already mastered
it. It is therefore certainly not a matter of indifference for the
criticism of the case on which I base my remarks, that I do not
know nor have I ever heard the name of the physician who is
supposed to have given such advice.

It is neither agreeable to me nor to my friends and coworkers
to monopolize in such manner the claim to the practice of a med-
ical technique. But in view of the dangers which may be antici-
pated from the practice of “wild” psychoanalysis for the patients
as well as for the subject of psychoanalysis, no other course was
left to us. In the spring of 1910 we founded an international
psychoanalytic society, in order to be able to disclaim responsi-
bility for the acts of all who do not belong to us and who call
their medical practice “psychoanalysis.” For as a matter of fact
such wild analysts do more harm to the subject than to the indi-
vidual patient. It has often been my experience that such an
awkward procedure, even if it at first caused an aggravation of
the symptoms, has nevertheless achieved a cure in the end. Not
always, but quite often. After the patient has railed against the
physician long enough and feels himself far enough removed from
his influence his symptoms abate, or he decides to take a step
which leads to the road of recovery. The final improvement is
then supposed to have come “of itself,” or is attributed to the
most indifferent treatment of the physician who treated the pa-
tient last. As for the case of the women who complained against
the physician we have heard, I should say that the wild psycho-
analyst had nevertheless done more for his patient than any emi-
nent authority who would have told her that she was suffering
from a “vasomotor neurosis.” He forced her attention to, or
near, the real cause of her illness, and in spite of the patient’s
opposition this intervention will not remain without favorable
results. He harmed himself, however, and helped to increase the
prejudices against the activity of the psychoanalysts, which arise
in the patients as a consequence of comprehensible affective re-
sistances. And this can be avoided.