Psychoanalysis: The Impossible Profession

by Janet Malcolm

“we overcome the transference by pointing out to the patient that his feelings do not arise from the present situation and do not apply to the person of the doctor, but that they are repeating something that happened to him earlier. In this way we oblige him to transform his repetition into a memory.”

the concept of transference expanded beyond the situation of the patient’s falling in love with the analyst (or, in the case of a male patient, of bitterly hating him) to embrace every aspect of the patient’s relationship to the analyst.

For example, one of Anna O.’s most troublesome symptoms—a pathological aversion to drinking water, even though she was horribly thirsty—was dispelled by her recollection of once seeing a little dog belonging to her English lady companion drink water from a glass. The sight had filled her with disgust and anger, which she had politely suppressed; only now, in Breuer’s trance, could she express these feelings, and after doing so she asked for water, drank a great deal, and was never troubled by her water phobia again.

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., who was by now much better, and bade her good-by. But that evening he was fetched back to find her in a greatly excited state, apparently as ill as ever. The patient, who according to him had appeared to be an asexual being and had never made any allusion to such a forbidden topic throughout the treatment, was now in the throes of an hysterical childbirth (pseudocyesis), the logical termination of a phantom pregnancy that had been invisibly developing in response to Breuer’s ministrations. 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.

Freud’s discovery of transference was (apart from any question of its validity) a defensive measure—a kind of “prophylaxis” that depersonalized the relationship and interposed a “third person” between the patient and the doctor, like the duenna-nurse who peers over the gynecologist’s shoulder during examinations.

Weir Mitchell rest cure,

he tried Breuer’s cathartic method, and found, as he reported in the Clark lectures, that “my experiences agreed entirely with his.” However, it was not long before Freud became dissatisfied with this method, too. Inducing hypnosis was not easy for him—he didn’t seem to be good at it—and he could get only a fraction of his patients into the desired trance.

Bernheim demonstrated that a person awakened from a trance could be induced to remember what had happened during the trance if the hypnotist firmly insisted that he did remember,

Freud likens the feat of the patient who suspends his critical faculties and says everything and anything that comes into his mind, regardless of its triviality, irrelevance, or unpleasantness, to that of the poet during the act of creation.

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.

The difference between neurotics and normal people is a matter only of degree, Freud says in the last Clark lecture: we all “entertain a life of fantasy in which we like to make up for the insufficiencies of reality by the production of wish fulfillments.” In distinction from the successful man of action who is able to impose his wishes on reality, or the artist who transforms them into works of art, the neurotic escapes from reality through his symptoms.

In most cases, “repression is replaced by condemning judgment.” The ex-neurotic will now deliberately choose not to do what he has previously murkily not done; his “better” impulses,” rather than his unsuccessful (symptom-producing) repressions, will guide him to his renunciations. Or he may “sublimate” the infantile wishes; that is to say, convert their original sexual aim into a culturally and socially valuable end while retaining their basic energy. Or, finally, he may choose to claim some modicum of sexual happiness for himself.

“Transforming your hysterical misery into common unhappiness”

(Repression is always a failure.)

led him to the inescapable conclusion that women, to whom the worst had already happened, must be less moral than men. “I cannot evade the notion (though I hesitate to give it expression) that for women the level of what is ethically normal is different from what it is in men,” Freud wrote in “Some Psychical Consequences of the Anatomical Distinction Between the Sexes” (1925). “Their superego is never so inexorable, so impersonal, so independent of its emotional origins as we require it to be in men. Character traits which critics of every epoch have brought up against women—that they show less sense of justice than men, that they are less ready to submit to the great exigencies of life, that they are more often influenced in their judgments by feelings of affection or hostility—all these would be amply accounted for by the modification in the formation of their superego which we have inferred above.” He added, “We must not allow ourselves to be deflected from such conclusions by the denials of the feminists, who are anxious to force us to regard the two sexes as completely equal in position and worth; but we shall, of course, willingly agree that the majority of men are also far behind the masculine ideal, and that all human individuals, as a result of their bisexual disposition and of cross-inheritance, combine in themselves both masculine and feminine characteristics, so that pure masculinity and femininity remain theoretical constructions of uncertain content.”

While the boy is frightened out of his love affair with his mother by the threat of castration, the girl is impelled into hopeless love for her father by pique with her mother “for having sent her into the world so insufficiently equipped.”

It is in this state of “intimate separation,” or “deprivation in intimacy,” that analysis is conducted, deriving its mutative power from the tension between verbal closeness and emotional distance. Stone believes, however, that the earlier, gratifying mother must not be totally eclipsed by the later, frustrating one—that the analyst’s “physicianly vocation” must meld with his analytic one if the analytic process is to develop and flourish.

As an example, for his analyst to express sympathy for a patient who has just lost a close relative may make it more difficult than it would otherwise be for the patient to express pleasure or spite or exhibitionistic satisfaction over the loss. This is taking respect for individual experience and generosity of spirit toward human frailty very far indeed.

Freud’s recommendation that the analyst himself be analyzed has become an inflexible and central fact of analytic education.

Freud’s dual-instinct theory—and

“But is it such a serious flaw? Is it even a symptom?” I asked. “Don’t we all have something we don’t do well or can’t do at all?” “My immediate reaction to that is to say, ‘Look, if I’m going to have a flaw, let it be in an area that doesn’t interfere with my professional ambition’—which, of course, is nonsensical.” “Since ambition is the problem?” “Right. There’s no question about it. Ambition is the problem. But I think you’d be surprised by what the ambition is about. It isn’t just getting out there and killing my father. That’s just part of it. There are other things, too. Well, I’ll be frank. It’s the desire to be a beautiful woman. You find all kinds of surprises in analysis.” “Somehow, that doesn’t surprise me about you,” I was interested to hear myself say. “Well, it surprised me! It bothered me, I can tell you.”

As time goes on, the wishes that the candidate has had to renounce and sublimate—but that are always there—are powerfully reactivated. He begins to dare hope that maybe he will, after all, be admitted into the parental bedroom, that he will be treated to the secrets of the parents, that he will find out what they ‘do’ in there, that he will be able to form alliances with one or another of them.

“I used to have a symptom. I used to have social anxiety before going to parties. Parties, you know, are highly instinctualized things. Well, the symptom fell away during my analysis, and now I go to parties, and they’re so mundane.” “The best parties are the ones you’re not invited to.”

The motives of student organizations are nothing if not transferential.” “The kids getting together against the parents.”

“But if the job were seen for what it is—for the poor thing it is—who would want to do it?” “That’s just it. What are the sources of motivation and pleasure? The sources of motivation and pleasure are infantile wishes.”

“The essence of being human is that one does not seek perfection, that one is sometimes willing to commit sins for the sake of loyalty, that one does not push asceticism to the point where it makes friendly intercourse impossible, and that one is prepared in the end to be defeated and broken up by life, which is the inevitable price of fastening one’s love upon other human individuals,”

Stone advocated spreading the wealth of psychoanalysis beyond the safe-bet hysterics and obsessionals to the dicey psychotics and “borderlines” (as patients have come to be called who are more severely afflicted than ordinary neurotics but are not mad.

“any analyst who out of the fullness of his heart, perhaps, and his readiness to help, extends to the patient all that one human being may hope to receive from another commits the same economic error as that of which our non-analytic institutions for nervous patients are guilty.” He went on: Their one aim is to make everything as pleasant as possible for the patient, so that he may feel well there and be glad to take refuge there again from the trials of life. In so doing, they make no attempt to give him more strength for facing life and more capacity for carrying out his actual tasks in it. In analytic treatment, all such spoiling must be avoided. As far as his relations with the physician are concerned, the patient must be left with unfulfilled wishes in abundance. It is expedient to deny him precisely those satisfactions which he desires most intensely and expresses most importunately.

But implicit in even the most avant-garde position is a belief in a basic experience called psychoanalysis—a belief in its unique efficacy with mental suffering and in the (homeopathic) idea of curing suffering with suffering. To do its profound and searing work on the soul, analysis must be an ordeal. (“Cruel though it may sound, we must see to it that the patient’s suffering, to a degree that is in some way or other effective, does not come to an end prematurely,” Freud wrote in “Lines of Advance in Psychoanalytic Therapy.”) And at

It cannot be too unusual for patients—I certainly remember it from the time I was a patient on the couch—to experience, at least at times, being in analysis as an illness, insofar as it is a regressive and unsettling experience, not dissimilar to the passions and conflicts stirred up anew in the state of being in love which, from the point of view of the ordinary order and emotional tenor and discipline of life, feels like an illness, with all its deliciousness and pain.

So, too, did Proust’s Narrator have to pass through the Slough of Despond before finding his way to the kingdom of art. Just before his radiant revelation in the library, he had come to the despairing realization that he would have to renounce his lifelong ambition of becoming a writer—that he had nothing to say!

breathtakingly unreadable The Analysis of the Self (1971)

He attributes the narcissistic disorders in which he specializes to a “primary defect in the self,” created in infancy by an “unempathic” mother (who in nine cases out of ten is also “shallow,” “unpredictable,” “bizarre,” or a “latent psychotic”).

The unenviable offspring of such mothers never experience the “empathic merger with the self-object’s mature psychic organization,” which would permit them to endure the “optimum (non-traumatic, phase-appropriate) failures of the self-object [that] lead, under normal circumstances, to structure building via transmuting internalization.” Like Winnicott’s “false-self” patients, these patients develop a shoddy armor (of a “defensive” or “compensatory” character) around their maimed inner core. During analysis, the rage and despair of the “archaic self” are reactivated and, ...

For Kohut, as for Winnicott and Balint, the Oedipus complex is an irrelevance in the treatment of severe pathology. Where the orthodox Freudian sees sex everywhere, the Kohutian...

But a great many versions of the truth, couched in great varieties of language and emotional gesture, are being offered in today’s analytic consultation rooms to patients who have little inkling of the implications (for themselves) of where their analyst stands on issues of which they have never heard.