Chapter 17 Lecture 16 Psychoanalysis and Psychiatry

After a year, I am very happy to see you come to continue to listen to the lecture.The subject of last year's lecture was the psychoanalytic interpretation of slips and dreams; this year I want to give you a glimpse of the phenomenon of neurosis, which has much in common with dreams and slips, which you will soon understand.But before the lecture, I have to declare that the attitude of this year's speech must be different from last year's.Every time I took a step forward last year, I always sought your consent first; I deliberately debated with you more and allowed you to criticize me. In short, I used your "healthy common sense" as the deciding factor.This is no longer the case, for a simple reason.Mistakes and dreams are familiar phenomena; you have as much experience with them as I have, or even without such experience, it is not difficult to obtain.As for the phenomena of neurosis, they are not familiar to you; you are not doctors, and you have no opportunity of contact with them except from my reports; What's the use?

However, because of this statement, do not assume that I am speaking with authority, which you must accept unconditionally.If you have this misunderstanding, it would be too unfair to me.I don't want you to be superstitious—my purpose is to arouse research interest and dispel prejudice.If you don't have the ability to judge because you don't know anything about neurosis, then you don't have to believe it for the time being, and you don't have to defend it.You just have to listen and let my words gradually take effect in your hearts.Faith is not easy to obtain, otherwise it will lose its value very quickly.You don't have novel discoveries about neurosis like I have for many years of research, so you don't have the right to express your beliefs about these issues.However, we don't have to be easy to believe, light to judge, and unreasonable to disagree in learning.Don't you know that "love at first sight" love has its origin in the psychology of a very different kind of emotion?Nor do we need patients to believe in psychoanalysis in order to embrace it.Because excessive belief makes us doubt.What we love most is your reasonable skepticism.I hope, therefore, that you also let the concept of psychoanalysis quietly develop in your minds, looking for opportunities to interact with general or psychiatric views to form a firm opinion.

Conversely, you must not assume that the psychoanalytic views I have presented are a set of merely speculative ideas.In fact, this point of view is the crystallization of experience, or based on direct observation, or based on the conclusions drawn from observation.As to whether these conclusions are appropriate and reliable, it depends on the future development of this discipline; I have gone through twenty-five years of research, and now I am old, so I can say bluntly that these observations are Especially difficult, difficult, and dedicated.I often feel that our critics are reluctant to discuss the basis of our theory, as if this theory is only subjective, so everyone can criticize it.I cannot forgive this critical attitude.This may be due to the fact that doctors do not pay attention to neurotic patients and do not listen carefully to their complaints, so they cannot make careful observations and discover something.I would like to take this opportunity to tell you that in these speeches I will not mention personal criticism.It has been said that "debate is the source of truth", and I cannot take that for granted.I think this remark comes from the philosophy of the Greek Sophists, who erred in exaggerating the value of polemics.I don't think so-called scientific debates are likely to be very fruitful, not to mention that debates are almost always purely biased.I also had a formal scientific debate in my life, and my opponent was Lowenfeld of the University of Munich. As a result, we became good friends until today.Over the years, I dare not try this again, because who can guarantee that the debate will have the same outcome?

You must think that I am too stubborn to be modest when I so openly refuse to discuss it.If you have this opinion, I can reply as follows: If you have acquired a belief by painstaking research, you must also have a right to assert it.I can also say that, since I began my research, I have repeatedly revised the main points of my opinion, deleted or added, and published them according to the truth.What is the result of this frank attitude?Some people, no matter whether I have corrected myself or not, are still aiming at nothing based on my past views today.Others have ridiculed me for being changeable and calling me unreliable.Is it not the case that a man who has repeatedly changed his views is not to be trusted, because his last amended doctrine may still be free from errors; but is it not the case that a man who insists on his own views and refuses to budge will inevitably be regarded as stubborn and not humble?In the face of such contradictory criticisms, there is no other way but to be at ease.This is the attitude I have decided on; I have decided to constantly revise my theory in the light of later experience.But my basic point of view, I don't think there is a need to change it now, and I hope it will be the same in the future.

I must now, therefore, dwell on the psychoanalytic theory of neurotic symptoms.For this purpose, and for the sake of analogy and comparison, it is easiest to take the example of a phenomenon similar to slips and dreams.There is a kind of action in neuropathy that can be called "symptomatic action", which is often seen in my consulting-room.After the patient complained of his years of suffering in the interview room, the analyst routinely remained silent.Others may express their opinions, thinking that those people are not sick at all, it is better to use a little hydrotherapy; as for analysts, they are more knowledgeable and cannot express this kind of expression.When a colleague of mine was asked what to do with the visiting patients, he shrugged and said, "They're going to be fined a lot of money for lost time."No wonder, therefore, that you hear that even the busiest psychoanalysts have very few patients for exclusive visits.I put a door between the waiting room and the interview room, and the interview room has another door, and the interior is carpeted.So the reason for this arrangement is obvious.When I allow patients to come in through the waiting room, they often forget to close the door and sometimes leave both doors open.If I see such a situation, I will be honest and ask him or her to go back and close the door, no matter what kind of gentleman he is or what kind of fashionable woman she is.Of course I acted arrogantly; sometimes I knew it was a misunderstanding.But for the most part, I'm all right, because a man who keeps the door between the doctor's visiting room and the waiting room open is an inferior man, and should be despised by us.Please don't get me wrong until you have heard what I have to say.A patient enters the interview room and forgets to close the door only when there is no one else waiting in the waiting room; if a visitor is also waiting, he will never be so negligent.For at that time he knew well that it was in his own interest that the conversation with the doctor should not be heard by a third party; therefore he always took care to close both doors.

Therefore, the patient's forgetting to close the door is not accidental, nor is it meaningless, nor is it insignificant, because it reveals the visitor's attitude towards the doctor.He is like some people in the world who go to see someone of higher status, want to admire his momentum; he may first use the phone to ask when he can be seen, and at the same time long for the crowd of visitors, as seen in the grocery store during the European War .Unexpectedly, he came in and found an empty room, so plainly furnished, that he was deeply disappointed.He thought that the doctor had to be punished for being so disrespectful; therefore he left open the two doors between the waiting room and the visiting room.What he meant was: "Bah! There's no one else here now, and no matter how long I sit here, I dare say no one else comes." If he didn't get discouraged at first, he probably would when he was talking. Expresses an arrogant and disrespectful attitude.

For the analysis of this small symptomatic movement, there are only the following points: 1. This kind of movement is not accidental, and each has its own motivation, meaning and purpose; 2. The psychological background to which this kind of movement belongs can be pointed out one by one. 3. Starting from this small action, we can infer a more important psychological process.But there is another point, that the person who made the gesture was not aware of it; for those who left the doors open will never admit that they intended to insult me ​​by this.Many people may remember feeling disappointed that the waiting room was empty, but the relation between this impression and the subsequent symptomatic movements is indeed beyond their consciousness.

We shall now make a comparative study of this little analysis of symptomatic movements and observations of a certain patient.I would like to give a recent example, which I have chosen for its simplicity and ease of description.In this narrative, however, many details are indispensable. A young officer came home on short leave and asked me to treat his mother-in-law.This old lady was very happy in terms of family environment, but because of a boring concept, she and her family were very distressed.I saw her, fifty-three years of age, in good health, and of a kind and honest disposition.Without hesitation, she described her symptoms as follows: She was happily married and lived in the country with her husband, who was the manager of a large factory.She said that her husband loved her so much that she couldn't describe it enough. They had been married for thirty years, and there had never been an undercurrent, a quarrel, or a moment of jealousy.She has two sons who are well married, but her husband, who is obsessive, continues to work.A year ago, something happened suddenly that she could not believe or understand.She received an anonymous letter saying her husband was having an affair with a young girl, which she believed on the spot—and her happiness was ruined ever since.The details are roughly as follows: She has a maid who is very trusted by her.There was another woman, who was of the same birth as the young maid, but luckier in life.She had received a kind of commercial training and was employed in a factory. Since the male staff had gone to serve in the army, she was promoted to a position with better pay.She lived in the factory, and all the male employees knew her and called her "Ma'am".Therefore, the frustrated maid loathed her very much, and was ready to accuse her of all possible crimes whenever she had the opportunity.One day the old lady and the maid were commenting on a visiting old gentleman.It is said that he did not live with his wife, but had a concubine.The old lady said, "Why doesn't his wife know?" Suddenly she continued, "If I hear that my husband also has a concubine, that would be terrible." The next day, she received a An anonymous letter, the handwriting was forged, and what the letter told was exactly what she was most afraid of.She decided—perhaps rightly—that the letter was in the handwriting of a malicious maid, because the woman her husband described as being confided in the letter was the woman the maid hated.Although the old lady immediately knew the deceit and did not believe it, she finally became ill because of her belief.She was so irritated that she immediately called her husband to reproach her.Her husband laughed, denied it, and handled it well.He invited his family doctor, who was also a doctor in the factory, to see him, and tried his best to comfort his wife.Their second thing is also very reasonable.It was the maid who was dismissed, not the supposed concubine.Since then, the old lady thought she had considered the matter again and again, and no longer believed in the content of the letter; but it was still inevitable.Just hearing the young woman's name, or meeting the young woman on the road, aroused suspicion, anxiety, and resentment.

The old lady's symptoms were slightly as above.We don't need much experience in psychiatry to know that—she described her symptoms too calmly, or with too much concealment, to be different from his kind of neurosis—and that she still believed the words of the anonymous letter. What is the attitude of a psychiatrist towards this disorder?It is not difficult to guess his opinion on the symptomatic gesture of the patient not closing the door of the waiting room.He explained that the incident was accidental and of no psychological interest, so it was unnecessary to study it.However, he could no longer maintain this attitude towards this jealous woman's disease.Symptomatic actions seem to be insignificant; symptoms require significant attention.Subjectively, the symptoms are accompanied by intense distress, objectively, and the danger of breaking up the family; so there is no doubt that the interest of the psychiatrist should be aroused.First, the psychiatrist will attribute several main attributes to the symptom.The notion that torments an old lady is not in itself meaningless; it is true that an old husband may have relations with a young woman.There are, however, a number of nonsense and inexplicable points about this idea.Apart from the anonymous letter, the patient has absolutely no reason to assume that his dear and faithful husband has also committed such a thing, although it is not a common thing.She knew that the news lacked evidence, and could fully explain its source; therefore, she should understand that this jealousy was groundless; she had said so, and yet she was still deeply distressed by the fact that it seemed real. .Such illogical and realistic concepts are commonly called "delusions" delusions.The old lady's distress, therefore, arose from a delusions of jealousy.This is obviously the main feature of the disease.

If this first point is true, our interest in psychiatry must increase accordingly.A delusion which is not annihilated by real facts must not originate in reality.So where is its origin?Delusions can have various contents; why should the delusions of this disease only have jealousy as their content?And what kind of person will have delusions, especially jealous delusions?We had hoped to consult psychiatrists, but the results of our consultations still did not enable us to understand.We had many issues and he only discussed one.He will study the old lady's family history, or will give us an answer, thinking that a person who has a similar or different insanity in his family history often has delusions himself.In other words, the old lady was delusional because she had a genetic predisposition to cause it.This sentence is certainly intriguing, but has it exhausted everything we want to know?Was this the only reason for her illness?Can we assume that the fact that the patient has one delusion and not another is insignificant, arbitrary, and unexplainable?Can the so-called genetic predisposition really rule everything?No matter what experiences and emotions she has had in her life, is there always a delusion at one time or another?You may want to know why scientific psychiatry cannot give us a further explanation.I can tell you: "A person can only give as much as he has; only liars deceive people with empty words." Psychiatrists do not know how to further explain this disease.Although you have a wealth of experience, you can only be satisfied with the diagnosis and the future changes of the disease.

But can psychoanalysis do better?I dare say, yes, and I wish to tell you that, even in a disease so obscure as this, we can discover certain facts which make a deeper understanding possible.First, to draw your attention to this incomprehensible detail; the anonymous letter, the basis of the old lady's delusion, had been summoned by herself, because she had told the cunning maid the day before that if her husband and a Fornication of young women is the most terrible thing in the world.It was she, therefore, who first inspired the servant girl to send the letter.So the old lady's delusion did not exist because of the anonymous letter; the delusion first appeared in the mind and became a fear-or did it become a wish?In addition, the points discovered by the analysis of only two hours are also worthy of our attention.After she narrated her illness, I asked her to narrate her thoughts, concepts and memories, but she refused indifferently.She said that everything had been said, and she had no other thoughts; after two hours, she had to stop the analysis, because she claimed to be completely well, and the morbid delusion would definitely not happen again. Naturally, her words were due to resistance , One is because of the fear of being re-analyzed.During the course of these two hours, however, she made a few incidental remarks which not only made it possible, but compelled us to come up with an explanation which would account for the origin of her jealous delusions.It turned out that she had a crush on the son-in-law who urged her to call me in for a diagnosis.She knows nothing about this kind of infatuation, or her knowledge is very limited; because it is the relationship between mother and husband, her infatuation is easily hidden and manifested as harmless love.From what we already know, it is not difficult to deduce the psychology of this good wife and mother.This obsession, this impossible wonder, naturally couldn't invade her conscious mind; but it still existed, subconsciously exerting a heavy pressure on the old lady.Once the pressure has arisen, it has to be relieved; and the easiest way to relieve it is to rely on the mechanism of displacement that caused envy.Had not only her old woman been in love with a young man, but her old husband had been in love with a young woman, she would not have had a conscience to condemn her for being unfaithful.So fantasizing about your husband's infidelity is a balm for your own painful wounds.As for her own love, she never knew it; but because the delusion gave her all kinds of conveniences, the "reflection" of her private love in the delusion meant that she fabricated the fact that her husband had an affair with a young woman. Inevitable, delusional, and conscious.All accusations are of course futile and useless; because all accusations are directed at the "reflection", not at the "original" that is full of dynamics and buried deep in the subconscious. Made of love. Let us now summarize the results of psycho-analytic investigations into this disease.We naturally assume that the data we have gathered are infallible, and you need not doubt that.First, the so-called delusions are no longer meaningless and incomprehensible; they have meaning and rational motives, and are quite related to the patient's emotional experience.Second, a delusion is a necessary response to another psychic process which can be inferred from other expressions; , due to its special relation to this other psychic process.Delusions originate from desire and are used for masturbation.Thirdly, the fact that this delusion is a jealous delusion depends on the experience that caused the disease.You will also see two important similarities with the symptomatic actions we have analyzed: 1. the intention behind the symptom, and 2. the relationship between the symptom and the unconscious desire. Naturally, this cannot solve all the difficult points caused by this disease.In fact, there are still many problems, some of which have not been solved, and some cannot be solved at all due to special circumstances.Why, for example, did the happily married lady fall in love with her son-in-law?And even if there is a love affair, there are all kinds of excuses possible, why bother to forcefully push your own concerns on your husband in order to seek relief?Do not think that these questions need not be raised.We have collected a great deal of material that allows for various possible answers to these questions.The patient's age has reached a critical period, giving a woman an unwelcome hypersexuality.This may be enough to explain.Perhaps there is another reason: that is, the sexual ability of his faithful husband may not be enough to meet his wife's vigorous and old needs in recent years.From the results of observation, we know that only this kind of man in the world will be faithful, will especially caress his wife, and be very sympathetic to their mental uneasiness.It is also an important fact that his perverted obsession targets his daughter's husband.Mother and daughter have a close relationship, so sexual love for a daughter is often easily transferred to her mother.Perhaps I should tell you here that the relationship between mother-in-law and son-in-law has been regarded by mankind as a particularly sexual relationship since ancient times; Taboo, 1913.On the positive side or on the negative side, this relationship often exceeds the limits of what is desirable in a civilized society.Is the case we have just discussed caused by one of the above three factors, or by two, or by all three?I can't tell you; because we only had two hours of analysis and couldn't continue. I know that everything that has just been said is beyond your comprehension.My purpose in saying this is to compare psychiatry and psychoanalysis.Yet I would like to ask you one thing in this connection: Do you not see the contradiction between the two?Psychiatry does not use the technique of psychoanalysis, nor does it discuss the content of delusions. It only points out the matter of heredity, and gives us a common remote cause without first discovering its more specific proximate cause.But must there be a contradiction here?Can't the two complement each other?Is the hereditary factor incompatible with the importance of experience and cannot be combined?You will admit that there is indeed nothing in the research of psychiatry that contradicts the inquiry of psychoanalysis.Therefore, it is not psychiatry itself but psychiatrists who oppose psychoanalysis.Psychoanalysis is to psychiatry roughly what histology is to anatomy; the one studies the superficial morphology of an organ, the other its structure, such as tissues and other constituent elements.These two studies are the beginning and end of each other, and it is not easy to see any contradiction in the division between the two.You must know that anatomy is now the basis of medical research; but in the past, medical scientists were strictly forbidden to dissect corpses to study the internal structure of the body, just as society curses us to carry out psychoanalysis to study the internal process of human psychology.Perhaps one day soon we will know that psychiatry cannot be regarded as having a scientific basis without knowledge of the unconscious processes of psychic life. Although psycho-analysis has been refuted, some of you may be fond of it and hope that it will be justified in therapy.You know that psychiatry has never been able to break down delusions.Since psychoanalysis is well aware of the mechanism of delusions, it may be able to treat delusions.However, I also want to tell you: "No!" However, as far as it is concerned, it has no power to treat delusions, just like other treatments.Of course we understand what happened to the patient, but there is no way for him to understand himself.You already know that I can only make a preliminary analysis of the delusion just mentioned.Therefore, you may think that this kind of analysis is inappropriate, but it is fruitless anyway.And I don't mean it that way.It is our right as well as our duty to just study, regardless of whether it will be effective immediately.Perhaps one day all our bits and pieces of knowledge will turn into power, into healing power, but where and when that day will come is unknown.Furthermore, although psychoanalysis cannot cure delusions and other neurological and psychotic diseases, it is still an indispensable tool of scientific research.We have not achieved this technique yet, that is undeniable; what we use as research materials are human beings, and human beings have life and will, so to participate in this kind of research, one must have a motive; but he did not have this motive.Therefore, I would like to conclude today's lecture with the following sentence: As far as most neurotic diseases are concerned, our knowledge has indeed produced therapeutic powers; and these diseases are not easy to treat, but in certain cases, The results obtained by our technology are second to none in medicine.