Ladies and gentlemen: I cannot tell how much knowledge about psychoanalysis each one of you has already acquired from what you have read or from hearsay. But the wording of my prospectus—“Elementary Introduction to Psycho-analysis”—obliges me to treat you as though you knew nothing and stood in need of some preliminary information.
Psychoanalysis is a procedure for the medical treatment of neurotic patients. And here I can at once give you an instance of how in this field a number of things take place in a different way—often indeed in an opposite way—from what they do elsewhere in medical practice. When elsewhere we introduce a patient to a medical technique which is new to him, we usually minimize its inconveniences and give him confident assurance of the success of the treatment. I think we are justified in this, since by doing so we are increasing the probability of success. But when we take a neurotic patient into psychoanalytic treatment, we act differently. We point out the difficulties of the method to him, its long duration, the efforts and sacrifices it calls for; as regards its success, we tell him we cannot promise it with certainty, that it depends on his own conduct, his understanding, his adaptability, and his perseverance.
The whole trend of your previous education and all your habits of thought are inevitably bound to make you opponents of psychoanalysis. In medical training you are accustomed to see things. You see an anatomical preparation, the precipitate of a chemical reaction, the shortening of a muscle as a result of the stimulation of its nerves. Later on, patients are demonstrated before your senses—the symptoms of their illness, the products of the pathological process, and even in many cases the agent of the disease in isolation. In the surgical departments you are witnesses of the active measurements taken to bring help to patients, and you may yourselves attempt to put them into effect. Even in psychiatry the demonstration of patients with their altered facial expressions, their mode of speech and their behavior, affords you plenty of observations which leave a deep impression on you. Thus a medical teacher plays in the main the part of a leader and interpreter who accompanies you through a museum, while you gain a direct contact with the objects exhibited and feel yourselves convinced of the existence of the new facts through your own perception.
In psychoanalysis, alas, everything is different. Nothing takes place in a psychoanalytic treatment but an interchange of words between the patient and the analyst. The patient talks, tells of his past experiences and present impressions, complains, confesses to his wishes and his emotional impulses. The doctor listens, tries to direct the patient’s processes of thought, exhorts, forces his attention in certain directions, gives him explanations and observes the reactions of understanding or rejection which he in this way provokes in him. The uninstructed relatives of our patients, who are only impressed by visible and tangible things—preferably by actions of the sort that are to be witnessed at the cinema—never fail to express their doubts whether “anything can be done about the illness by mere talking.” That, of course, is both a shortsighted and an inconsistent line of thought. These are the same people who are so certain that patients are “simply imagining” their symptoms. Words were originally magic, and to this day words have retained much of their ancient magical power. By words one person can make another blissfully happy or drive him to despair, by words the teacher conveys his knowledge to his pupils, by words the orator carries his audience with him and determines their judgments and decisions. Words provoke affects and are in general the means of mutual influence among men. Thus we shall not depreciate the use of words in psychotherapy, and we shall be pleased if we can listen to the words that pass between the analyst and his patient.
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