Chapter 20 Lecture 19 Resistance and Repression

We need more material for our understanding of neuroses; two observations are readily available.They're all special, and start surprising.We did the preparatory work last year, so it must be easy to understand now. It is almost unbelievable that the patient will always resist us so strongly that we treat his symptoms.It is best not to mention this to the patient's relatives and friends, because they always think this is our excuse, trying to cover up the persistence or failure of treatment.The patient expresses this resistance without acknowledging it as a resistance; it would be a great therapeutic advance if we could make him realize this fact and admit it.You think that the patient, who has made himself and his relatives and friends so disturbed by the symptoms, has suffered such a great sacrifice of time, money and spirit for the treatment, and finally refuses all assistance because of the symptoms.Isn't this statement too unreasonable?But it is true, and if you reproach us for being unreasonable, we need only cite a similar incident to answer; a man goes to the dentist with a toothache, and when the dentist takes the pliers to his decayed tooth, he But managed to shirk again.

The forms of resistance expressed by the patient are so many and subtle that they are often difficult to recognize; the analyst has to be constantly on his guard.The method we use in psychoanalytic treatment is probably familiar to you from the interpretation of dreams: we try to put the patient in a state of quiet self-observation, without having to think about any event, and then put everything that is felt in the heart, such as feelings, Thoughts, memories, etc., are reported one by one in the order in which they arise in the mind.We expressly warn him against any choice or trade-off in associations of ideas, whether because those ideas are too "nasty" or "boring" to utter, or because they are too "unimportant," or too "irrelevant," or Too "meaningless" to be worth telling.We want to make him only pay attention to the ideas that surface on the surface of consciousness, and give up any form of protest; we also tell him that the success of the treatment, especially the length of the treatment, depends on whether he sticks to this basic rule.From the method of dream-interpretation we know that associations which force doubt or denial often contain material leading to the discovery of the unconscious.

The first thing that happens after this rule is established is that the patient makes it the first object of resistance.The patient tries in every possible way to escape its bondage.He first said that he had nothing in his heart, and then he said that he thought of too much, so that he had no choice.Secondly, we are surprised to find that he is now refuting one notion and another; this can be inferred from the timed pauses in his conversation.In the end, he declared that he really could not tell what he was ashamed of, and this emotion caused him to break his covenant.Or, he remembers an event, but it concerns others rather than himself, so he doesn't have to play by the rules.Or he had just thought of something so unimportant, meaningless, or absurd that I never expected him to report it.He procrastinated in this way, now using this method, now using that method, he kept answering to tell everything, and in the end he said nothing.

No matter which patient, he always tries to hide a certain part of his thinking from the analyst's attack.A patient who was usually very intelligent concealed his once most intimate love affairs for weeks in this way; when I said that he should not violate the rules of psychoanalysis, he justified that it was his private business.Naturally, the psychoanalytic method of treatment cannot allow the patient this right of asylum. If it were to be done, it would mean that we were trying to arrest criminals while at the same time allowing a special zone in the city of Vienna and prohibiting criminals near the market place or St. Stephen's Church. Catch people in the square.Naturally, the criminal could only hide in these safe places.I once resolved to allow this exception to a man; for he had to recover his powers, and he was a civil servant, bound by oath, to tell no one about certain events.He was indeed satisfied with the result, but I was not; henceforth I resolved not to practice under such conditions again.

Patients with obsessive-compulsive disorder are often prone to render the rules of our operation almost useless by distraction or doubt.Anxiety-hysterical patients sometimes render this rule absurd, for they only arouse misleading associations which make analysis impossible.But I don't want to tell you about these therapeutic difficulties.You only need to know that by determination and perseverance we were able at last to bring the patients into a little compliance with the rules of the operation; but their resistance took another direction altogether.At this time, it is manifested as rational criticism, using logic as a tool, and using the difficulties and unreliable points pointed out by ordinary people about psychoanalysis for their own use.Therefore, we have to hear from every patient's mouth all the criticisms and protests that the scientific community has imposed on us.There is nothing new in the accusations against us by outside critics.This is indeed a storm in a small teacup.But the patient can still reason; he likes us to teach him, to refute him, and to point him to certain reference books so that he can get a better understanding; Advocate.But even in this desire for knowledge, we can also see his resistance; it turns out that he wants to use this to avoid the special work in front of him, and of course we cannot allow it.In the case of obsessive-compulsive neuroses, the resistance also employs a special strategy, which is not to be expected.The analysis proceeded smoothly and unhindered, so that gradually all the problems in the case became clear, until at last we began to wonder why the explanations had no practical effect on improving the symptoms considerably.It turns out that the resistance of the obsessive-compulsive neurosis reverts back to being characterized by suspicion, which leaves us helpless.The patient seems to be saying to himself something of the following sort: "This is all very interesting. I would like to continue to be analyzed. If it were all true, it would of course do me a lot of good. But I don't believe it at all, neither , my illness will never be affected." After such a long time, I finally ran out of patience, so I expressed my resolute resistance.

Intellectual resistance is not the worst kind; we can often overcome it.The patient, however, knows how to force resistance within the analysis itself; so conquering these resistances is the most difficult work of analysis.The patient does not recall a certain emotion and state of mind in the past life, but expresses these feelings and state of mind again, revives them, and resists the doctor and treatment through the so-called "transference".If he were a man, he often resorted to his relationship with his father to make the physician his father's surrogate; he rebelled by striving for personal and intellectual independence, or by ambition, whose earliest object was to win Equal to or better than his father, or rebellious because he does not want to take on the responsibility of giving thanks again.Sometimes we feel that the patient seeks to find the analyst's fault, makes him feel incompetent, attempts to defeat him and completely annihilate his well-meaning wishes to treat the disease.The women, for the purpose of resistance, have the inclination to infatuate with the analyst; and when this inclination reaches a certain intensity, all interest in the actual treatment and all restraints in the treatment are extinguished.The jealousy that followed, and the resentment that followed any refusal, however tactful, had to destroy her personal relationship with the doctor, so that analysis lost one of its strongest impetuses.

We should not condemn this resistance.Because these resistances contain so much important material from the patient's past life, and this material comes out in such a convincing manner, that the analyst, with great skill, can turn this resistance directly to his own great help. .What we should pay attention to is that this kind of material is often used as a kind of resistance, a kind of camouflage, and hinders the treatment.We can also say that it is the character traits and personal attitudes of his ego that the patient resists the treatment.These traits of character manifest themselves in accordance with the conditions and demands of the neurotic, and we thus observe material which is not ordinarily readily apparent.Nor do you think that we regard the emergence of these resistances as an accidental danger threatening analytic treatment.In fact, we know that these resistances are inevitable; we are dissatisfied only when they cannot be evoked clearly enough for the patient to understand them as resistances.We know, therefore, that overcoming these resistances is the essential work of the analysis, the evidence that makes the treatment somewhat effective.

In addition to this, you must note that the patient tends to take advantage of all the accidents that occur during the analysis-such as distractions, or criticisms of psycho-analysis by his peers, or all organic disorders that increase the intensity of the neurosis. etc.—to frustrate analysis; even every improvement in symptoms can be cited as an incentive to resist treatment.From this you can probably see the force and manner of the resistances which must be met and overcome in analysis.The reason I have been at length on this point is that I want to tell you that our conception of the dynamics of neurosis is based on the experience of all our patients with resistance to treatment of their symptoms.Breuer and I originally used hypnosis as an instrument of psychotherapy.Breuer's first patient was completely treated in a state of hypnotic suggestion; I also used this method at first.I confess that my work then proceeded more smoothly and time was more economical; but the effects were often recurrent and not long-lasting; therefore I finally gave up hypnotism.I know that as long as hypnosis is applied, the dynamics of these disorders are impossible to understand.Because during hypnosis, the patient's resistance cannot be observed by the doctor.Hypnosis removes the power of resistance, and it is true that a part of the field can be opened for analytical research, but the resistance is thus accumulated on the boundary of this part and cannot be breached; it has the same effect as the suspicion of obsessive-compulsive neurosis.I can therefore say that psychoanalysis really begins only after hypnotism has been lost.

If the measure of resistance is of such importance, it is better to proceed with caution than to assume its existence too hastily.Perhaps in some neuroses the associations are stalled for other reasons, and perhaps the refutations of our theory do deserve our serious attention, and perhaps we should not simply dismiss the protests of the patient's reason as signs of resistance.True, but I will tell you that our judgment in this matter is not taken hastily; we have the opportunity to observe these critical patients before their resistance arises and after it disappears.While he is being treated, his resistance varies in intensity; it often increases as we approach a new problem; it reaches its highest point when we study it; In time, its resistance also disappears.If we do not make errors of method, it will not immediately arouse the possible and sufficient resistance of the patient.Therefore, during the analysis, we can clearly see that the same person, in the process of analysis, repeatedly criticizes and refutes, and suddenly stops silently.If we let some subconscious material which is particularly painful to the patient invade his consciousness, he protests to the extreme; His behavior is similar to that of a mentally handicapped or "emotionally retarded" person.If he overcomes this new resistance with our help, he regains the ability to understand.His critical power cannot be exercised independently, so we need not pay attention to it; it is only the slave of emotions, subject to resistance.He deftly refuted everything he didn't like; he immediately believed everything that pleased his taste.Perhaps this is true of us all; the reason why the intellect of a man under analysis is clearly dominated by his emotional life is because he is so forcefully oppressed during analysis.

How do we explain this fact, the fact that the patient struggles against the resolution of the symptoms and the normalization of the psychic process?We say that what is encountered here is the aftermath of a force which opposes the progress of the cure; it must have been the same force which then caused the disease.There must have been a certain process when the symptoms took shape, the nature of which can be deduced from our experience in therapy.From Breuer's observations, we already know that for the existence of symptoms, some mental process must have been incomplete in the normal state, so that consciousness cannot be aroused; symptoms are the substitutes for this unfinished process.We now know exactly where the forces we guess are at work are.The patient must have made an effort to keep the psychic process concerned from intruding into consciousness, and it turned out to be unconscious; because it is unconscious, it has the capacity to form symptoms.In analytic therapy this same effort is at work in rebellion against the attempt to make the unconscious conscious.This is what we know as resistance.The pathogenic process conceivable by resistance is called repression.

It is now time to describe this conception of the repressive process more precisely.This process is the main antecedent condition for the development of symptoms, but unlike the others, it has no parallel phenomena.To illustrate, there is an impulse or a mental process which wants to be acted upon: we know that this can be resisted by the "rejection" or "blame" of the actor; can remain in memory.The entire decision-making process is fully known by the actor-self Ego.Had this same impulse been repressed, the result would have been very different.The power of the impulse remains, but it leaves no trace on the memory; the ego is ignorant, and the process of repression is complete.This comparison, therefore, is still insufficient to give us any insight into the nature of repression. The word repression may be given a more definite meaning by virtue of certain theoretical concepts, which I will now illustrate.To this end, we first proceed from the purely descriptive meaning of the word "unconscious" to its systematic meaning; that is to say, we resolve to regard the conscious or unconscious of a mental process as a mere attribute of that process. One, but not necessarily conclusive.Assuming that this process is unconscious, its inability to penetrate consciousness may be only a signal of the fate it has encountered, and not necessarily its final fate.In order to obtain a more concrete idea of ​​this fate, we may say that every psychic process - with one exception, to which we shall speak later - first exists in an unconscious state and then develops into a conscious state, just as photographs first A negative, which is then printed as a positive, becomes an image.But not every negative is necessarily printed as a positive, and by the same token, every subconscious spiritual process does not have to be conscious.This relation is best explained as follows: each individual process belongs first to the unconscious psychic system; then, under certain conditions, from this system it proceeds to the conscious system. The crudest and most convenient notion of these systems is that of space.The unconscious system may thus be compared to a large anterior chamber in which the various psychic energies are crowded together like many individuals.Adjacent to the front room, there is a smaller room, like a reception room, where the consciousness stays.But at the door between the two rooms, there is a man standing there, responsible for guarding the door, examining and examining all kinds of mental excitement, and denying those excitements that he does not approve of to enter the reception room.You will immediately know that it is of little importance whether the porter drives out any impulses at the door, or whether he waits for them to be driven out after they have invaded the anteroom; question.This metaphor can now be used to expand our noun.Excitations in the subconscious in the anterior chamber are not perceptible to the conscious in the other house, so they initially linger in the subconscious.If they come in at the door and are driven out by the gatekeeper, they cannot become conscious; then we call them repressed.But even those excitements which are allowed to enter do not necessarily become conscious;Therefore, this second room may be called the preconscious system.And thus, this process of becoming conscious may remain in a purely narrative sense.If we call any impulse repressed, we mean that it cannot break out of the unconscious because the gatekeepers prevent it from entering the foreconscious.As for the gatekeeper, it refers to the resistance we encounter when we try to liberate repressed thoughts during analysis and treatment. You may think that these concepts are too crude and outlandish to be permitted by a scientific account.I know they are short; I even know they are not true, but unless I am mistaken we have higher concepts to take their place; and whether you still think them queer then I do not know .In any case, they are, for the time being, useful aids to explanation, like Ampere's dwarfs swimming in the current, and should not be despised by us so long as they serve to illustrate.I still think, however, that these brief hypotheses, the two rooms and the gatekeeper at the door between them, the consciousness standing as observer at the end of the second room, are roughly similar to the actual situation.And I would like you to admit that our subconscious, preconscious, conscious, etc. terms are less biased than other scholars' proposed or applied terms such as sub-conscious, inter-conscious, and co-conscious, etc. And it's easier to justify yourself. If this is the case, then I think it is more important that you can also infer that the hypotheses of the psychic systems we use to explain neurotic symptoms can have general utility, thus making the normal functioning more apparent.This is certainly true.We cannot elaborate on this conclusion for the time being; however, if we can gain a better understanding of the functioning of the normal mind, which has always been mysterious, through the study of sick minds, our interest in the psychology of symptom formation will certainly be greatly improved. greatly improved. Besides, don't you see the basis for the concepts of these two systems and their relation to consciousness?The gate-keeper between the unconscious and the foreconscious is the censor who subjects manifest dream-forms to it.The daytime experience of the stimuli which aroused the dream is the material of the preconsciousness; this material is influenced by the subconscious mind and the repressed desires and agitations during sleep at night; hidden meaning.Under the control of the subconscious system, this material is manipulated by artisans, such as compression and displacement. Even the normal spiritual life, that is, the preconscious system, has no way of knowing and is difficult to admit.This difference in function is what distinguishes the two systems; the relation of the preconscious to the conscious is a permanent property; so that from its relation to the conscious it is determined which of the two systems any process belongs to.Dreams are not a morbid phenomenon; every healthy person dreams during sleep.Everything that has been said about dreams and neurotic symptoms applies also to normal psychic life. Now the word about repression has been said.It is only a necessary prerequisite for the formation of symptoms.We know that a symptom is a substitute for some other process repelled by repression; yet even if we were given repression, we would still have to study for a long time before we could understand how this substitute came to be.There are other aspects of the problem of repression, such as: which mental agitation is repressed?What is the power behind the repression?What is the motive?We know only a little about these matters.When we study resistance, we know that the forces of resistance emanate from the ego, from manifest or latent character traits: it is therefore these forces that cause the repression, or at least part of it.That's all we know now. A second observation which I wish to relate may help us now.By analysis we can often discover the purpose behind neurotic symptoms.This is, of course, not a new fact for you: I have already indicated it in the two neuroses I have described above.But what can the two neurotic cases point to?You certainly have the right to ask for two hundred or an infinite number of examples to illustrate.But I can't agree.Therefore, you have to rely on your own experience or belief, which can be based on evidence recognized by various psycho-analysts. You will recall that in the case of the first two cases we were led, as a result of the symptomatic analysis, into the secret sexual life of the patient.The purpose or tendency of the symptom in the first case was particularly pronounced; the second was perhaps somewhat obscured by another factor; this other factor is left for later.From these two examples it follows that the same is true of all the other examples analyzed.Whenever we infer from the analysis the patient's sexual experiences and desires, we have to affirm that the symptoms serve the same purpose.This end is sexual gratification; the patient wants to use the symptoms for the purpose of sexual gratification; the symptoms are therefore really substitutes for unattainable gratification. Consider again the compulsions of the first patient.The woman had to separate from the husband she loved; she could not live with him because of his handicap.She had to be faithful to him; therefore, she could not replace her husband with another.Her obsessive-compulsive syndrome just gratifies her own desires; she can thereby exalt her husband, deny and justify his shortcomings, especially his impotence.This symptom is essentially a desire-fulfillment, just like the dream; it is especially the fulfillment of an erotic desire, which is not always the case in dreams.As far as the second patient is concerned, you know that the purpose of her ritual is to prevent the parents from having intercourse or to reproduce a child; you may think that she basically intends to use this ritual to substitute herself for the mother.Therefore, the purpose of this symptom is also to eliminate obstacles to the satisfaction of sexual desire in order to satisfy the patient's sexual desire.The complication of the second example will be elaborated shortly. These words are not of general application hereafter; I draw your attention to the fact that what I have said about repression, symptom formation, and symptom interpretation has been derived from studies of three neuroses, and is now applicable only to these three neuroses— That is, anxiety hysteria, conversion hysteria and obsessive-compulsive neuropathy.These three diseases, we often collectively call them transference neurosis, can all be treated by psychoanalysis.Other neuroses have not been so closely analyzed psychoanalytically; and the fact that one class of these has not been studied is evidently due to the impossibility of being affected by treatment.You must not forget that psychoanalysis is still a very young science, that its study still needs a lot of time and trouble, and that not so long ago only one person practiced it; Symptoms have a deeper understanding.I hope to be able to tell you in the future how our hypotheses and conclusions have been progressively developed by adapting this new material, and also to show that these further studies do not create contradictions in our knowledge, but rather add to the unity of our knowledge.All that has been said, therefore, applies only to these three transference neuroses, and I would now like to add a sentence which will make the meaning of the symptoms still clearer.A comparative study of disease-causing situations yields the following result, which can be reduced to a formula—namely, that these people get sick because reality does not allow them to satisfy their sexual desires and makes them feel a certain lack. .You will see how these two conclusions perfectly complement each other.Symptoms can then be interpreted as vicarious gratifications of unsatisfied desires in life. I say that neurotic symptoms are substitutes for sexual gratification; a statement which certainly provokes protests.Today I am only going to discuss two of them.If any of you have ever analyzed a large number of neurotics, you may shake your head and say: "This sentence does not apply to some symptoms; for these symptoms seem to have an opposite purpose, to exclude or prevent sexual gratification. .” I don’t want to argue with your opinion.As far as psychoanalysis is concerned, things are much more complicated than imagined, otherwise there is no need for psychoanalysis to explain.Indeed, there are many gestures in the ritual of presenting the second patient that may be considered ascetic; the movement of the clock to prevent nocturnal erections of the clitoris, and the preservation of her virginity as protection against broken vessels.This ascetic undertone is even more pronounced in the case of the other rites of bed-bedding which have been analysed; the whole of which seems to work only as a defense against rebellious memory and temptation.Yet we already know from psychoanalysis that the opposite does not constitute a contradiction.We may extend this statement to say that the aim of the symptoms is either sexual gratification or sexual cessation; hysterias focus on the positive gratification of desires, and obsessional neuroses on negative ascetic undertones.Symptoms can be used to achieve the purpose of sexual desire gratification, and also can be used to achieve the purpose of abstinence, because this polarity has an extremely appropriate basis in a certain factor of the symptom mechanism, but we have not had the opportunity to mention this mechanism.A symptom is, in fact, the result of a reconciliation between two opposite and conflicting tendencies; they represent on the one hand the repressed tendencies, and on the other hand the active tendencies which suppress the other tendencies to cause the symptom.One of these two factors must be more dominant in the symptom, but the other need not lose its place entirely.In hysteria these two tendencies are often combined in one and the same symptom, in obsessional neuroses the two parts are often distinct; then the symptom is double, containing two mutually counteracting actions. As for the second kind of protest, it is more difficult to deal with.If you discuss all the explanations of the symptoms, you will first think that the concept of sexual substitute satisfaction must be greatly expanded to include these explanations; you will also point out that these symptoms do not provide real satisfaction. A fantasy caused by a sexual complex.Moreover, you would think that this apparent sexual gratification is often childish and worthless, perhaps akin to an act of masturbation, or reminding one of ugly habits long aborted in childhood.And you'll express your wonder why anyone would consider the gratification of sadistic or frightening or unnatural desires to be sexual gratification.In fact, we will not have a consensus on these issues, unless the scope of the word "sexual" is defined by a thorough study of human sexual life.