Experience has taught me to keep away from therapeutic methods as much as from diagnoses. The enormous variation among individuals and their neuroses has set before me the ideal of approaching each case with a minimum of prior assumptions. The ideal would naturally be to have no assumptions at all. But this is impossible even if one exercises the most rigorous self-criticism, for one is oneself the biggest of all one's assumptions, and the one with the gravest consequences. Try as we may to have no assumptions and to use no ready-made methods, the assumption that I myself am will determine my method: as I am, so will I proceed.
An ancient adept has said: "If the wrong man uses the right means, the right means work in the wrong way." This Chinese saying, unfortunately only too true, stands in sharp contrast to our belief in the "right" method irrespective of the man who applies it. In reality, everything depends on the man and little or nothing on the method.
Nobody should play with analysis as with an easy tool. Those who write superficial and cheap
books about the subject are either unconscious of the far-reaching effects of analytical treatment or
else ignorant of the real nature of the human soul.
We would do well to abandon from the start any attempt to apply ready-made solutions and warmed-up generalities of which the patient knows just as much as the doctor. Long experience has taught me not to know anything in advance and not to know better, but to let the unconscious take precedence. Our instincts have ridden so infinitely many times, unharmed, over the problems that arise [in later] life that we may be sure the transformation processes which make the transition possible have long been prepared in the unconscious and are only waiting to be released.
The remarkable potency of unconscious contents always indicates a corresponding weakness in the conscious mind and its functions. It is as though the latter were threatened with impotence. For primitive man this danger is one of the most terrifying instances of "magic." So we can understand why this secret fear is also to be found among civilized people. In serious cases it is the secret fear of going mad; in less serious, the fear of the unconscious-a fear which even the normal person exhibits in his resistance to psychological views and explanations. This resistance borders on the grotesque when it comes to scouting all psychological explanations of art, philosophy, and religion, as though the human psyche had, or should have, absolutely nothing to do with these things. The doctor knows these well-defended zones from his consulting hours: they are reminiscent of island fortresses from which the neurotic tries to ward off the octopus. ("Happy neurosis island," as one of my patients called his conscious state!) The doctor is well aware that the patient needs an island and would be lost without it. It serves as a refuge for his consciousness and as the last stronghold against the threatening embrace of the unconscious. The same is true of the normal person's taboo regions which psychology must not touch. But since no war was ever won on the defensive, one must, in order to terminate hostilities, open negotiations with the enemy and see what his terms really are. Such is the intention of the doctor who volunteers to act as a mediator. He is far from wishing to disturb the somewhat precarious island idyll or pull down the fortifications. On the contrary, he is thankful that somewhere a firm foothold exists that does not first have to be fished up out of the chaos, always a desperately difficult task. He knows that the island is a bit cramped and that life on it is pretty meager and plagued with all sorts of imaginary wants because too much life has been left outside, and that as a result a terrifying monster is created, or rather is roused out of its slumbers. He also knows that this seemingly alarming animal stands in a secret compensatory relationship to the island and could supply everything that the island lacks.
Practical medicine is and has always been an art, and the same is true of practical analysis. True art is creation, and creation is beyond all theories. That is why I say to any beginner: Learn your theories as well as you can, but put them aside when you touch the miracle of the living soul. Not theories but your own creative individuality alone must decide.
The patient is there to be treated and not to verify a theory. For that matter, there is no single theory in the whole field of practical psychology that cannot on occasion be proved to be basically wrong. In particular, the view that the patient's resistances are in no circumstances )justified is completely fallacious. The resistance might very well prove that the treatment rests on false assumptions.
One has to remind oneself again and again that in therapy it is more important for the patient to understand than for the analyst's theoretical expectations to be satisfied. The patient's resistance to the analyst is not necessarily wrong; it is rather a sign that something does not "click." Either the patient is not yet at a point where he would be able to understand, or the interpretation does not fit.
Neither our modern medical training nor academic psychology and philosophy can equip the doctor with the necessary education, or with the means, to deal effectively and understandingly with the often very urgent demands of his psychotherapeutic practice. It therefore behooves us, unembarrassed by our shortcomings as amateurs of history, to go to school once more with the medical philosophers of a distant past, when body and soul had not yet been wrenched asunder into different faculties. Although we are specialists par excellence, our specialized field, oddly enough, drives us to universalism and to the complete overcoming of the specialist attitude, if the totality of body and soul is not to be just a matter of words.
Even the so-called highly scientific suggestion therapy employs the wares of the medicine-man and the exorcizing shaman. And why not? The public is not much more advanced either and continues to expect miraculous cures from the doctor. And indeed, we must rate those doctors - wise in every sense - who know how to surround themselves with the aura of a medicine-man. They have not only the biggest practices but also get the best results. This is because, apart from the neuroses, countless physical illnesses are tainted and complicated with psychic material to an unsuspected degree. The medical exorcist betrays by his whole demeanour his full appreciation of that psychic component when he gives the patient the opportunity of fixing his faith firmly on the mysterious personality of the doctor. In this way he wins the sick man's mind, which from then on helps him to restore his body to health. The cure works best when the doctor himself believes in his own formulae, otherwise he may be overcome by scientific doubt and so lose the proper convincing tone.
As a doctor it is my task to help the patient to cope with life. I cannot presume to pass judgment on his final decisions, because I know from experience that all coercion-be it suggestion, insinuation, or any other method of persuasion-ultimately proves to be nothing but an obstacle to the highest and most decisive experience of all, which is to be alone with his own self, or whatever else one chooses to call the objectivity of the psyche. The patient must be alone if he is to find out what it is that supports him when he can no longer support himself. Only this experience can give him an indestructible foundation.
People whose own temperaments offer problems are often neurotic, but it would be a serious
misunderstanding to confuse the existence of problems with neurosis. There is a marked difference
between the two in that the neurotic is ill because he is unconscious of his problems, while the
person with a difficult temperament suffers from his conscious problems without being ill.
The greatest mistake an analyst can make is to assume that his patient has a psychology similar
to his own.
No psychotherapist should lack that natural reserve which prevents people from riding roughshod over mysteries they do not understand and trampling them flat. This reserve will enable him to pull back in good time when he encounters the mystery of the patient's difference from himself, and to avoid the danger - unfortunately only too real - of committing psychic murder in the name of therapy. For the ultimate cause of a neurosis is something positive which needs to be safeguarded for the patient; otherwise he suffers a psychic loss, and the result of the treatment is at best a defective cure.
Medicine in the hand of a fool was ever poison and death. just as we demand from a surgeon, besides his technical knowledge, a skilled hand, courage, presence of mind, and power of decision, so we must expect from an analyst a very serious and thorough psychoanalytic training of his own personality before we are willing to entrust a patient to him. I would even go so far as to say that the acquisition and practice of the psychoanalytic technique presuppose not only a specific psychological gift but in the very first place a serious concern with the moulding of one's own character.
Each new case that requires thorough treatment is pioneer work, and every trace of routine then proves to be a blind alley. Consequently the higher psychotherapy is a most exacting business, and sometimes it sets tasks which challenge not only our understanding or our sympathy but the whole man. The doctor is inclined to demand this total effort from his patients, yet he must realize that this same demand only works if he is aware that it also applies to himself.
There are analysts who believe that they can get along without self-analysis. This is Munchausen psychology, and they will certainly remain stuck. They forget that one of the most important therapeutically effective factors is subjecting yourself to the objective judgment of another. As regards ourselves we remain blind, despite everything and everybody.
The object of therapy is not the neurosis but the man who has the neurosis. We have long known, for instance, that a cardiac neurosis comes not from the heart, as the old medical mythology would have it, but from the mind of the sufferer. Nor does it come from some obscure corner of the unconscious, as many psychotherapists still struggle to believe; it comes from the totality of a man's life and from all the experiences that have accumulated over the years and decades, and finally, not merely from his life as an individual but from his psychic experience within the family or even the social group.
