The following are extracts (for review purposes) from The First Psychoanalyst & The Nature of Clinical Evidence (chapters I and II) from Insight and Responsibility: Lectures on the Ethical Implications of Psychoanalytic Insight, Erik H. Erikson, 1964:
Chapter I: The First Psychoanalyst (lecture delivered 1956)
"It is a solemn and yet always a deeply incongruous occasion when we select an anniversary to honor a man who in lonely years struggled through a unique experience and won a new kind of knowledge for mankind." – p. 19
"For...comparison, let us consider the circumstances of another discovery of the nineteenth century, the discovery of a man who was also lonely and calumniated, and who was also eventually recognized as a changer of man's image: Charles Darwin. [H]e had failed in medicine...partially because of an intellectual selectivity which forbade him to learn passively[.]
"[C]utting across existing classifications which assumed a parallel, linear origin of all species from a common pool of creation, [Darwin] saw everywhere transitions, transmutations, variations, signs of a dynamic struggle for adaptation. The law of natural selection began to 'haunt him.' And he perceived that man must come under the same law[.]
"[Darwin] became physically incapacitated by insomnia, nausea, and chills[:] 'I could...collect facts bearing on the origin of species...when I could do nothing else from illness.'...
"'We physicists have known sin,' Oppenheimer has said; but it does not take the use of scientific data for mankind's material destruction to make a scientist feel or behave as if he had sinned. It is enough to have persisted, with the naïveté of genius, in the dissolution of one of the prejudices on which the security and the familiarity of the contemporary image of man is built. But a creative man has no choice. He may come across his supreme task almost accidently. But once the issue is joined, his task proves to be at the same time intimately related to his most personal conflicts, to his superior selective perception, and to the stubbornness of his one-way will: he must court sickness, failure, or insanity, in order to test the alternative whether the established world will crush him, or whether he will disestablish a sector of this world's outworn fundaments and make place for a new one." – pp. 21–3
"What geology was to Darwin, physiology was to Freud: a schooling in method. The ideology of the physicalistic physiologic method of the time was formulated in an oath by two of its outstanding teachers, [Emil] Du Bois[-]Reymond and [Ernst von] Brücke: 'to put in power this truth: No other forces than the common physical chemical ones are active within the organism....One has either to find the specific way or form of their action by means of the physical mathematical method, or to assume new forces equal in dignity to the chemical physical forces inherent in matter.' (note 1)...
"[Freud's coauthor] Dr. Jose[f] Breuer[, the developer of the cathartic method in which patients described ever-earlier instances of their symptoms – MB] had shown him that there was a laboratory hidden in the very practice of neurology.
"Freud's new laboratory, then, were patients, mostly women, who brought him symptoms which only an overly-serious and searching observer could accept as constituting a field activated by dignified forces. These ladies suffered from neuralgic pains and anesthesias, from partial paralyses and contractions, from tics and convulsions, from nausea and finickiness, from the inability to see and from visual hallucinations, from the inability to remember and from painful floods of memory....The dominant neuropathology of the day...assumed some of their disturbances to be a consequence of hereditary degenerative processes in the brain....
"As Freud listened to his hypnotized patients, he realized that they were urgently, desperately offering him series of memories which...were...variations in search of a theme...which was often found in a historical model event....
"It fits our image of those Victorian days—a time when children in all, and women in most circumstances were to be seen but not heard—that the majority of symptoms would prove to lead back to events when violently aroused affects (love, sex, rage, fear) had come into conflict with narrow standards of propriety and breeding. The symptoms, then, were delayed involuntary communications: using the whole body as spokesman, they were saying what common language permits common people to say directly[.] Freud the neurologist now became 'haunted' by the basic conviction that any neurotic symptom, traced along a path of associated experiences (not of neurological pathways), would lead to the revival in memory of earlier and earlier conflicts, and in doing so would yield a complete history of its origin.
"As Freud proceeded with his reconstruction of the pasts of his patients, a dangerous insight dawned on him; such conflicts as his patients revealed were, in principle, shared by all men....He became aware of the fact that man, in principle, does not remember or understand much of what is most significant in his childhood, and more, that he does not want to. Here, a mysterious individual prehistory seemed to loom up, as important for psychology as Darwin's biological prehistory was for biology....
"For Freud's psychologic findings, there were, at first, only physiologic methods, his own speculations, and the sayings of writers and philosophers, who, in their way, it seemed, had known it all....He now investigated memories as representative cross sections of a patient's emotional condition. In successive memories, he traced trends which led, like pathways, to the traumatic past; there experiences of a disruptive nature loomed like lesions interfering with growth....
"Before Copernicus, vanity as well as knowledge insisted that the earth must be in the exact nodal center of God's universe. Well, we know now where we are. Before Darwin, man could claim a different origin from the rest of the animal world with whom he shares a slim margin of the earth's crust and atmosphere. Before Freud, man (that is, man of the male sex and of the better classes) was convinced that he was fully conscious of all there was to him, and sure of his divine values. Childhood was a mere training ground, in charge of that intermediary race, women.
"In such a world female hysteria was implicitly acknowledged by men and men doctors as a symptom of the natural inferiority, the easy degeneracy, of women. When Freud presented to the Vienna Medical Society a case of male hysteria, the reaction of his colleagues convinced him that years of isolation lay ahead of him....Yet, their reaction [was] only one small aspect of a memorable crisis [from] which a new science was almost stillborn, [including] because of disturbances in the instrument of observation, the observer's mind." – pp. 24–8
"Freud...realized that in hypnosis the patients had at their disposal a depth of understanding and a freedom of affect which they did not marshal in normal life. This he had not imposed by suggestion: it was their judgment and their affect, and if they had it in hypnosis, it was part of them. Perhaps, if he treated them like whole people, they would learn to realize the wholeness which was theirs. He now offered them a conscious and direct partnership: he made the patient's healthy, if submerged, part his partner in understanding the unhealthy part. Thus was established one basic principle of psychoanalysis, namely, that one can study the human mind only by engaging the fully motivated partnership of the observed individual, and by entering into a sincere contract with him....
"[Freud] realized that habit and convention had made him and his fellow physicians indulge in an autocratic pattern, with not much more circumspection or justification than the very paternal authorities who he now felt had made the patients sick in the first place. He began to divine the second principle of psychoanalysis, namely, that you will not see in another what you have not learned to recognize in yourself....
"Freud had to relinquish a most important ingredient of the doctor role of the times: the all-knowing father role, which was safely anchored in the whole contemporary cult of the paternal male as the master of every human endeavor except the nursery and the kitchen." (note 2) – pp. 28–9
"The second problem which isolated Freud in those years was the course taken by his search for the 'energy of equal dignity' which might be the quantity and the power in mental life; for the mental mechanisms which normally maintain such power in a state of constancy; and for those inner conditions which unleash its destructiveness....A long treatise recently found with some of Freud's letters reveals the whole extent of Freud's conflict between the creative urge to say in psychological terms what only literature had known before him, and on the other hand, his desperate obedience to physiology. (note 3)...
"Freud['s] patients, he had become convinced, were suffering primarily from...one irrepressible 'affect,' namely, sexual sensuality, the existence of which had been consistently denied by their overclothed parents, while engaged in only with furtive shame and degradation by many of their mothers. In the epidemiological fact of widespread female hysteria, Freud faced the specific symptoms of the Victorian age, the price paid, especially by women, for the hypocritical double standard of the sexes in the dominant classes, the masters of commerce and the would-be masters of industrial power....In introducing the energy concept of a sexual libido,...Freud found at once [a personally safe – MB] answer to the questions posed by his patients' memories, and [a] theory...consistent with his search for a 'dignified force.' But alas, it was also the most irrationally repugnant solution thinkable in his prudish times, and [still] a solution of emotional danger to the observer. For, indeed, where 'to draw the line'?...
"[Earlier, c]ertain of being on the right track [i]n search for a pathogenic Ur-event, he [had been] led to [view] as historically real the patients' accounts of passive sexual experiences in the first years of childhood, and to consider the fathers of the patients the perpetrators in such events. [Yet, he sensed a personal danger to himself in this perspective. – MB As h]e later confessed: 'At that time, I would gladly have dropped the whole thing.'...
"[I]t was only too easy to do what had become civilization's 'second nature,' that is, in the face of the man's sexual and aggressive drives[,] to beat a hasty retreat into romanticism and religionism[.]
"[S]exual...seductions of children do occur, and are dangerous to them. But more important, the general provocation and exploitation of the child's immature emotions by parent and grandparent for the sake of their own petty emotional relief, of suppressed vengefulness, of sensual self-indulgence, and of sly righteousness must be recognized not only as evident in case histories, but as a universal potentiality often practiced and hypocritically rationalized by very 'moral' individuals, indeed....What today is decried as 'momism' in the United States existed in analogous form in the father's role in the Victorian world: it is only necessary to think of Hitler's official account of his father-hate, and the appeal of this account for millions of young Germans, to know that this is a smoldering theme of general explosiveness. In finding access to the altogether fateful domain of man's prolonged childhood, Freud discovered that infantile man, in addition to and often under the guise of being trained, is being ruefully exploited, only to become in adulthood nature's most systematic and sadistic exploiter. Freud's search thus added another perspective of as yet unforeseeable importance to the image of man." – pp. 30–4
"[I]n 1894, Freud consulted [his] friend...Dr. Wilhelm...Fliess in regard to his own symptoms and moods, which he condenses in [a] word [meaning] something like 'misery of the heart.'...At this time, Freud speaks of his discoveries with the anguish of one who has seen a promised land which he must not set his foot on: 'I have the distinct feeling,' he writes, 'that I have touched on one of the great secrets of nature.' This tedium of thought seems to have joined the 'heart misery' and was now joined by a mistrust of his friend. He wrote, 'Something from the deepest depths of my own neurosis has ranged itself against my taking a further step in understanding of the neuroses, and you have somehow been involved.'
"Freud, at this point, had developed toward Fliess what later, when he understood it, he called a transference[.]
"Freud thus discovered another principle in his new work, namely, that psychological discovery is accompanied by some irrational involvement of the observer, and that it cannot be communicated to another without a certain irrational involvement of both. [H]ere it is not enough to put on an armor of superiority or aloofness....Here, only the observer's improved insight into himself can right the instrument, protect the observer, and permit the communication of the observed....
"A dream, [Freud] now reported to Fliess, had clearly revealed to him the fact...that [a] wish to blame all fathers for their children's neuroses had dominated him....
"[In order to escape his personal danger, – MB] Freud...concluded that 'I can only analyze myself with objectively acquired knowledge.' This insight is the basis for what later became the training analysis, that is, the preventive and didactic psychoanalytic treatment of every prospective psychoanalyst....
"[A]round the turn of the century,...The Interpretation of Dreams (note 4)...appear[ed]. Freud then, as later, considered this book his most fundamental contribution[.] For months, for years, there were no book reviews, no sales to speak of. Where there was interest, it was mostly disbelief and calumniation. At this time, Freud seems temporarily to have despaired of his medical way of life. Fliess offered a meeting at Easter. But...Freud refused. 'It is more probable that I shall avoid you,' he writes. 'I have conquered my depression, and now...it is slowly healing....In your company...I should unburden my woes to you and come back dissatisfied[.]" [Freud probably feared what his subconscious might express on meeting Fliess—that it would escalate its blaming of children's neuroses on their fathers. – MB] – pp. 35–8
"These, then, were the dimensions of the crisis during which and through which psychoanalysis was born.
"Most striking...[i]n the letters...is a theme of European dimensions, namely, an intense, a 'deeply neurotic' urge to see Rome. At first, he wants to arrange to see his friend [Fliess] there. But he writes, 'We are not in Rome yet,' or, 'I am further away from Rome than at any time since we met[.]' Only when his fundamental work, The Interpretation of Dreams is published, does Freud decide to spend Easter in Rome: 'Not that there is any justification for it, I have achieved nothing yet...and in any case, circumstances will probably make it impossible.'
"What did Rome mean to Freud?...We recognize in it the fate of Hannibal, who had kindled the imagination of the Jewish boy: the Semitic warlord had never conquered Rome. [T]he final wish which Freud sent to Fliess [was]: 'Next Easter in Rome.'
"Freud is now forty-four years of age." – pp. 39–40
"I believe that an innovator's achievement can be seen most dramatically in that moment when he, alone against historical adversity and inner doubts, and armed only with the means of persuasion, gives a new direction to human awareness[.]" – p. 42
"That shift in self-awareness...implies a fundamentally new ethical orientation of adult man's relationship to childhood: to his own childhood, now behind and within him; to his own child before him; and to every man's children around him....
"[T]he collective life of mankind, in all its historical lawfulness, is fed by the energies and images of successive generations; and...each generation brings to human fate an inescapable conflict between its ethical and rational aims and its infantile fixations. This conflict...is a condition of man's humanity—and the prime cause of his bottomless inhumanity. For whenever and wherever man abandons his ethical position, he does so only at the cost of massive regressions endangering the very safeguards of his nature....
"In Freud, a genius turned a new instrument of observation back on his childhood, back on all childhood. He invented a specific method for the detection of that which universally spoils the genius of the child in every human being....Since then, the nature of growth in childhood has been studied by ingenious observers all over the world: never before has mankind known more about its own past—phylogenetic and ontogenetic. Thus, we may see Freud as a pioneer in a self-healing, balancing trend in human awareness." – pp. 44–6
"Freud, before he went into medicine, wanted to become...a lawmaker[.] When, in 1938,...Freud...was exiled from his country, he carried under his arm a manuscript on Moses, the supreme law-giver of the Jewish people...whose unique gifts Freud had accepted as his own. With grim pride he had chosen [this role, and] the role of one who opens perspectives on [new] fertile fields[.] Freud the physician[,] in finding a method of healing himself in the very practice of emotional cure[,] has given a new, a psychological rationale for man's laws. He has made [a] decisive step toward a true interpenetration of the psychological with...the political in the human order.
"If...others see in him primarily the destroyer of precious illusions, if not of essential values, I would remind you...that, in 1930, the Secretary of the Goethe Prize Committee informed Freud of his award[.] In his dedication the Secretary suggested that 'the Mephistophelic bend toward ruthless disillusion was the inseparable counterpart of the Faustian veneration of man's creative potentials.'" – pp. 45–6
Chapter II: The Nature of Clinical Evidence (lecture delivered 1957)
"[M]ore than any other clinician the psychotherapist must include in his field of observation a specific self-awareness in the very act of perceiving his patient's actions and reactions. [T]here is a core of disciplined subjectivity in clinical work[.]" – p. 53
"[T]he psychotherapist...will enter...the patient's...life history and join the grouping of individuals already significant in it....
"The analogy between the clinician and the historian...centers in the case-historian's function in the art of history-taking, of becoming part of a life history. Here the analogy breaks down; it could remain relevant only if the historian were also a kind of clinical statesman, correcting events as he records them, and recording changes as he directs them. Such a conscious clinician-historian-statesman may well emerge in the future.
"Let me restate the psychotherapeutic encounter, then, as an historical one. A person has declared an emergency and has surrendered his self-regulation to a treatment procedure....To some degree, he has had to interrupt his autonomous life-history as lived in the unself-conscious balances of his private and his public life in order, for a while, to 'favor' a part-aspect of himself and to observe it with the diagnostic help of a curative method. 'Under observation,' he becomes self-observant. As a patient he is inclined, and as a client often encouraged, to historicize his own position by thinking back to the onset of the disturbance, and to ponder what world order (magic[al], scientific, ethical) was violated and must be restored before his self-regulation can be reassumed. He participates in becoming a case, a fact which...may forever change his view of himself.
"The clinician...finds himself part of another man's most intimate life history. Luckily he also remains the functionary of a healing profession with a systematic orientation, based on a coherent world image—be it the theory that a sick man is beset by evil spirits or under the temptation of the devil, the victim of chemical poisons or of faulty heritage, racked by inner conflicts, or blinded by a dangerous ideology. In inviting his client to look at himself with the help of professional theories and techniques, the clinician makes himself part of the client's life history, even as the client becomes a case in the history of healing.
"The disciplined psychotherapist of today finds himself heir to medical methods and concepts, although he may decide to counteract these with a determined turn to existential or social views concerning his person-to-person encounter in the therapeutic setting." – pp. 53–6
"[W]e consider a patient's 'associations' our best leads to the meaning of an as yet obscure item brought up in a clinical encounter[.] By associated evidence we mean everything which comes to the patient's mind during and after the report of that item. [W]e can assume that what we call the synthesizing function of the ego will tend to associate what 'belongs together,' be the associated items ever so remote in history, separate in space, and contradictory in logical terms. Once the therapist has convinced himself of a certain combination in the patient of character, intelligence, and a wish to get well, he can rely on the patient's capacity to produce during a series of therapeutic encounters a sequence of themes, thoughts, and affects which seek their own concordance and provide their own cross-references." – p. 58
"Does it...contradict Freudian symbolism if I emphasize in [a given dream image] a representation of...lack of identity? In the context of the 'classical' interpretation, the dream image would be primarily symbolic of a sexual idea which is to be warded off, in ours a representation of a danger to the continuous existence of individual identity." – p. 70
"It is a mark of the good clinician that much can go on in him without clogging his communication at the moment of therapeutic intervention, when only the central theme may come to his awareness. Since a clinician's identity as a worker is based...on decisive learning experiences during the formative years of his first acquaintance with the field[,] he cannot avoid carrying with him some traditional formulations which may range in their effect...to burdening dogmatisms. [T]here is a systematic relationship between clinical observation on the one hand and, on the other, such conceptual points of view as Freud has introduced into psychiatry: a structural point of view denoting a kind of anatomy of the mind, a dynamic point of view denoting a kind of physiology of mental forces, a genetic point of view reconstructing the growth of the mind and the stages marking its strengths and its dangers, and finally, an adaptive point of view. (note 5) But...it stands to reason that clinical evidence is characterized by an immediacy which transcends formulations ultimately derived from mechanistic patterns of thought.
"The 'points of view' introduced into psychiatry and psychology by Freud are, at this time, subject to a strange fate. [T]hey were the bridges by which generations of medical clinicians could apply their anatomical, physiological, and pathological modes of thinking to the workings of the mind....A transfer of concepts from one field to another has in other fields led...to a necessary transcendence of the borrowed concepts by newer and more adequate ones. In psychoanalysis, the fate of the 'points of view' was pre-ordained:...in the study of the mind they sooner or later served improper reifications, as though libido or the death-instinct or the ego really existed. Freud was sovereignly aware of this danger, but always willing to learn by giving a mode of thought free reign to see to what useful model it might lead. He also had the courage, the authority, and the inner consistency to reverse such a direction when it became useless or absurd. Generations of clinical practitioners cannot be expected to be equally detached or authoritative. Thus it cannot be denied that in much clinical literature the clinical evidence secured with the help of inferences based on Freud's theories has been increasingly used and slanted to verify the original theories. This, in turn, could only lead to a gradual estrangement between theory and clinical observation." – pp. 76–7
1 – Ernest Jones, The Life and Work of Sigmund Freud, New York: Basic Books, 1953.
2 – Sigmund Freud, "Fragment of an Analysis of a Case of Hysteria" [1905], Standard Edition, 7:3–122, London: Hogarth Press, 1953.
3 – Sigmund Freud, The Origins of Psychoanalysis: Letters to Wilhelm Fliess, Drafts and Notes: 1887–1902, edited by Marie Bonaparte, Anna Freud and Ernst Kris, New York: Basic Books, 1954.
4 – Sigmund Freud, The Interpretation of Dreams [1900], Standard Edition, 4, London: Hogarth Press, 1953.
5 – David Rapaport and M. Gill, "The Points of View and Assumptions of Metapsychology," International Journal of Psycho-analysis, 40:1–10, 1959.
Copyright (c) 2021 Mark D. Blackwell.
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