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Selected Contributions to Psycho-Analysis

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A welcome reissue of the collected papers of John Rickman, originally published in 1957, with a new preface by Pearl King. It spans 30 years of Rickman's rapidly-expanding psychoanalytic research in fields including crime, individual and group dynamics, psychopathology, hysteria, communication and general medicine. This work will be of interest to all those in the psychoanalytic community and those interested in the history of psychoanalysis, and is a first rate anthology into the pioneering early years of psychoanalysis. This book acts as a partner to Pearl King's other edited collection, No Ordinary Psychoanalyst: The Exceptional Contributions of John Rickman.

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1. An Unanalysed Case. Anal Erotism, Occupation and Illness (1921)

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THE old man whose case is here given came under observation in circumstances which rigidly excluded analytic investigation; the facts given below were poured forth by the patient and tell their own tale; this brief notice cannot convey the full impression his conversation left on the mind, his dramatic nods and grimaces illustrated his story when words failed him,

The patient is now aged sixty-five. He said he had bowel trouble for twenty-seven years, beginning with ’diarrhoea and corruption and prolapse following the conception of my only son’; he had cno control over his bowels at alF. Since that time (1893) he had not had a single solid motion. I asked whether he had had treatment and what relief he had received. He replied that when going to a doctor he always said, ’Now, doctor, don’t interfere with my bowels whatever you do!’ Nevertheless he went to a famous hospital and was treated for six months. He kept ’fit’ for twelve years and then became worse. At this point I asked how fit he was during that time. He said he was fit enough to work, he didn’t go more than four times before he left the house in the morning; once immediately on rising, the second time after lighting the kitchen fire, then again after shaving and last after breakfast just before leaving for his work. I asked if the diarrhoea continued throughout the day and if his illness inter’ fered with his work. He replied that usually he did not go more than eight times in the day and that he always knew how hard he was going to find the day’s work by the way he went before breakfast, ’more than four times and I know I am going to have a bad day.

 

2. A Psychological Factor in the Aetiology of Descensus Uteri, Laceration of the Perineum and Vaginismus (1926)

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GYNAECOLOGY is chiefly concerned with the physical condition and position of the genital organs. Sometimes psychoanalysis is able to contribute an interpretation of the phenomena in terms of libido and explain the present conditions in terms of the patient’s past love attachments and his capacity to renounce infantile sexuality for an exogamous genital gratification. The physiology of use must be supplemented by a ’physiology of pleasure’ (Ferenczi).

In the psycho-analytical literature we read of the genitaliz-ation of other organs and learn something of the changes so produced, but little has been said of the changes in the genitals themselves when not acting as the central erotic organ of the body’ Recent investigations have led me to think that weakness of the pelvic floor and of the suspending ligaments of the uterus may be evidence that the genital stage has not been reached or maintained, and that loss of ’tone’ in these tissues is a sign of ’degenitalization’. A case to illustrate this point.

 

3. Discussion on Lay-Analysis (1927)

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1. Terms of Reference

(i) To enquire what pre-analytical educational standard should be required: and

(ii) What administrative measures will be needed if lay-analysis is to become a recognized professional activity.

2. The Requirements of Analytic Work

Analysis is at bottom a technique by which the analyst is able to investigate the mind of another person (by means of a modified introspection) and the patient to perceive, and so to control forces operating in himself which were formerly inaccessible to his consciousness. The difference between the two people lies in the superior power of the former to set aside resistances and to operate with smaller quantities of cathexis:2 the aim of the analysis is to give to the patient in this respect the capacities of his analyst.

The aim in the education of the analyst is two-fold, first, to overcome his own resistances (this requires a personal analysis), and secondly, to develop his power to perceive the relations between objects existing in the outer and inner world respectively, i.e. first, to remove a libidinal inhibition, and secondly, to develop the capacity of an ego- (intellectual) instinct. In Ferenczi’s terminology, we might say that both ends of the psychical function need to be dealt with, the genital and the intellectual. It is not sufficient that either one alone be the object of the educationalist’s care; love forges bonds with the outer world and promotes action, whereas thought forges no bonds and promotes no action, but opens up endless new combinations of relationships without doing anything with them (Ferenczi’s ’unconscious reckoning-operations’—can auxiliary organ of the sense of reality’). A properly functioning mind oscillates between the libidinal and ego-cathexis, between an introjection of the outer-world guided by love followed by an unconscious process in which the introjected material is split up into its elements, these are joined by other memory presentations and recombined, the recombinations are sorted and finally delivered for preconscious and conscious reality testing. What is of importance here is that two quite different mental functions are involved. The analysis of the candidate effects removal of affective inhibition without adding to the intellectual function.3

 

4. On some of the Standpoints of Freud and Jung (1928)

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AT the ’Debate’2 on The Standpoints of Freud and Jung’ I employed my time in exposition of the discoveries of Freud and took occasion to remark that he had no viewpoint peculiar to himself but worked on that shared by scientists generally, namely, determinism. In science this same determinism they now say fails to explain some events in the atom, so we must now modify our dogmatism or rather dogmatic attitude—born of long success—and say that determinism is not now the one and only standard of science; but returning to the non-determined events in the atom, one wonders how they would have been discovered without a long application of determinist methods, so, for the sake of the future of science (to reduce the chances that people may erringly say a thing is not determined when it is) it behoves us all to work on with the determinist principle, counting it no loss but a gain if by our own efforts we are proved mistaken sometimes and thereby a philosopher is made happy 3

At the debate before mentioned the topics centred about sexuality. In his Elaboration Dr. Baynes has put his finger on the most important matter of transference on which I confess to have laid too little stress in my exposition. In this phenomenon the Freudian sees evidence of an automatic repetition of infantile attitudes expressing both a desire for sexual gratification and an inhibiting impulse (conscience—also acting automatically). What brings about the misery in the patient is that both these things (desire and inhibition) are acting at cross purposes and both are unconscious, the effect being to prevent the individual from obtaining complete discharge of instinct tension, I believe there is not a word of this description at which Dr. Baynes would cavil, though he and I might differ as to the emphasis to be laid on this or that point. But he would say it did not express enough, it did not for instance take account of a synthesizing element in the psyche. It does not, but of that later. In addition he notes in the relationship of physician and patient that ’new vibrations deeper than the personal are brought into play’ (vide p. 25). On this matter I am not prepared with evidence as I have myself not experienced anything ’beyond’ personal relationships (I count my relationships to myself—narcissism, self-love—as personal), but it would surprise me if these deeper than personal vibrations, if such exist, were not of the order of events in the atom, i.e. events of which we can have opinions but no knowledge till an analysis of mind has been carried into the region of the infinitesimal, which is the province of those analysts of matter, the mathematical physicists. Dr. Baynes should count the Freudians as his allies in bringing him a hope of definiteness in regard to these extra-personal relationships, just as he should regard the old school physicists as his helpers in establishing his non-determinism on an extra-philosophical basis. In the handling of the transference the Freudian and Jungian methods stand in the strongest contrast. Every action of the patient in the phase of transference represents to the Freudian a repetition in action of an impulse once experienced psychically. It is the analyst’s task to bring this to the patient’s attention and get him to recollect the earlier psychical experience, in other words, something in the past has to be found to match the present experience. It follows from this that the less the analyst shows himself or his personality, the more he is a blank screen on which the patient may project his phantasies, the more exact will be the reproduction of the old experience. It will also be noted that the analyst has to do no more than detect and match two things produced, a new mental experience (centring on himself) and an old one (centring on some person in the patients past). His self-effacement has to be as complete as possible in order that the patient’s own characteristics may be thrown out in the strongest light.

 

5. On Quotations (1929)

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1. Introduction

SOME years ago I entertained the hope of being able to make the analysis of quotations from poets and novelists, but particularly from poets, into a new instrument for literary criticism. Lines are quoted to us that have impressed themselves on the minds of our analysands and are brought forward in a setting of associations which is usually free from the peculiar self-conscious atmosphere which aesthetic criticism frequently both generates and wilts in. My hope was that a significant connection would be found between the quotations from the great poets and important features in the patients’ infantile experiences, but though I had a ’run of luck’ in this respect which nearly evoked a paper for the British Psycho-Analytical Society, my evidence over a longer period gave me no ground for thinking that we have in the correlation of quotations and recollections of early experiences an index of the poet’s merit as it is usually judged, Owing to over-determination in the selection of passages it has not been possible to separate the aesthetic merits, the personal associations to the content, the respect for the poet and the mood or tone of the poem of which a part is quoted from one another with sufficient distinctness to form the basis for a definite statement. While disappointed that my curiosity about the content of the quotation and its relation to the patient’s mind did not lead in the direction expected, I found more scope for inquiry when attention was turned to the occasions when a quotation is used.

 

6. The Psychology of Crime (1932)

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THE discussion has brought out three points which we commonly meet with when lawyers and other intelligent laymen consider crime: first their surprise that the criminal cannot give a reasonable explanation for his act, secondly the compulsive element in crime, and thirdly that criminals often do not in fact appear to be so aggressive as they are commonly regarded by the general public. On each of these points the psycho-pathologist is ready with an explanation, though from the nature of the case it is not very convincing to those who have not his special opportunity for investigation.

As to the first two points, they are shared with the neurotic, who also cannot explain his peculiar behaviour, which is often also compulsive; for our present purpose the centre of interest attaches to the third point; something peculiar has happened to the criminal in connection with his aggressive impulse.

If we view the criminal not in respect to his place in society but as a person with a peculiar way of dealing with his instinctual energies, he appears to us to be endeavouring by his acts to rid himself of an almost unbearable internal tension; his crimes, viewed in this way, are attempts at relief from the intolerable and because they serve this (to him) useful and apparently remedial purpose the criminal views with suspicion those who want to treat him for his criminality. The intolerable mental tension is not due to a simple increase of aggressiveness or de-structiveness, but to a weakening of the controlling part of the mind and an incapacity to temper this aggressiveness by admixture of the impulse of love. The love impulse is present in every case and this gives rise to the conflict from which they suffer. We can revise the previous formula and say that the criminal endeavours by his act to solve an intolerable internal conflict, adding that he is literally unaware of the true nature of that conflict.

 

7. On 'Unbearable' Ideas and Impulses (1937)

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IF at some future date, a student wished to survey the development of psychology in the last fifty years he would find much to guide him from a study of this Journal, which is remarkable not only for its scope but for the fact that it has given an early welcome to so many ideas which have exercised a lasting influence on our science,

Before about 1900, psychology was in the main concerned with the phenomena of consciousness, with introspection and cognition and with such experiments as would throw more light on these problems. The question of pain, when considered at all, was treated as a mode of sensation, it did not include ’mental suffering’. But suffering is to the ordinary man most closely associated with mental phenomena, physical pain is a rare and unwelcome visitor and the victim of it hastens for help or takes care to avoid the occasion of it In the case of mental suffering the victim does not call in aid till he must, indeed he often seems compelled to take the very path to meet it and even at times to welcome it. It would be hardly an exaggeration to say that to the ordinary man a study of the mind that did not in any great measure deal with the sufferings of the mind would be regarded as dealing with an abstraction. This view is not held as a reproach to the psychologist by the ordinary man, for experience shows that the moment that mental pain is the subject of study he takes up a contrary attitude, saying that the topic is being mishandled and emotion is given too great prominence to the belittlement of reason. Another factor which contributes to the difficulties of studying mental pain is indeed & strange one. Though willing enough to speak in general terms of misery as an inevitable part of our human lot or to call an individual ’shallow’ or ’inhuman’ who has no understanding of mental suffering, yet the moment that this suffering is an object of investigation its victims are regarded as abnormal, for ’psycho-pathology’ is thought of as a science of mental disease rather than the study of mental suffering and its deductions are regarded as in no way valid for the normal mind or the normal man, who of a sudden is pictured as guided by reason and predestined to a life of pleasure. Even psychologists have shared these contradictory views.

 

8. Sigmund Freud: A Personal Impression (1939)

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IN Professor Freud two characteristics were present in the highest degree: his friendly simplicity towards one as a human being and the prodigious power of his mind. The combination of these qualities made one feel to be in the company of a new kind of being—an ideal for human nature. Freud accepted his transcendent intellectual gifts as a phenomenon of nature, a thing neither to be personally proud of nor of course concealed; they belonged as much to the universe as to himself. Lesser men might have used such power for their own aggrandisement, but he was immune to the temptation because his protagonists were not his fellows but the obscurities in human nature. The confusion in man’s mind was an affront to him and he set about to get to terms with his enemy. Characteristically, and here he gave a lead to his followers and to the world, he turned first to the obscurity of his own mental processes, patiently exploring that seemingly chaotic and unprofitable region—the world of dreams. He always referred to the results of this ten years of labour as a piece of good fortune that was not likely to come twice in a lifetime and seemed to be grateful to the generosity of nature for disclosing to him such valuable secrets. He gave the rest of his life, from about forty onwards, to the detailed working out and consequences of the laws he had in fact himself discovered. That such discoveries were changing the outlook of psychiatry, anthropology and sociology, giving a new understanding of the forces in art and religion, and indeed likely to change the mental outlook of the human race, was but evidence of his good luck to be in at the beginning of a new world of thought. He knew full well the part he had played in bringing about the changes, but never forgot how small was his discovery compared to the infinity of detail and complexity into which some day order must be brought. His unshrinking modesty before the vastness of Nature led him to measure the praise of men by a scale that fitted both the framework of our knowledge and the universe of our ignorance. The application of this standard proved discomforting to flatterers—with whom he was not popular.

 

9. The General Practitioner and Psycho-Analysis (1939)

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IN two recent issues of The Practitioner 2 some problems connected with psychology in general practice were dealt with. As this is often connected—in the minds of patients, at least—with psycho-analysis, it may be well also to give some account of this subject. The term ’psycho-analysis’ was first introduced (Freud, 1896) to indicate a particular kind of treatment of neurotic patients which, although hypnosis was dispensed with, relied on mental means for curing emotional disturbances of the mind. As this was done by a detailed examination of the patient’s symptoms, the name came to be applied to the special method employed in the making of this examination; and since these studies resulted in the discovery of a set of data concerning those parts of the mind which are unconscious, the term was employed also for the branch of science which deals with those data. The term ’psycho-analysis’ therefore denotes (according to context) a method of treatment, a research technique, or a branch of psychology which deals with a part of the mind more or less inaccessible apart from the special technique. When a patient says, ’I think I need some psycho-analysis’, he may be interpreted as saying, ’There is something bothering my mind, I do not know exactly what it is, but I want it dealt with!’ and the practitioner, even though he may not be trained in the technique, should know from this that his patient is referring to, and is worried by, something definite but as yet unplaced, and therefore probably not capable of full solution by ordinary introspection or interrogation.

 

10. On the Nature of Ugliness and the Creative Impulse (1940)

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1. Introduction

The study of Æsthetics presents difficult problems and the solution of them is made more arduous if the field of observation is unduly constricted. So long as Æsthetics is confined to an examination of Beauty research is likely to prove as sterile as is a study of Behaviour which confines itself to the single factor of pleasure. Human psychology made greater progress when it gave recognition to the factors of mental pain, anxiety and guilt; it would therefore seem prudent to accord more significance than is commonly done in the literature to these disturbing but powerful forces in our aesthetic inclinations, and to see whether the underlying impulses of destructiveness, which give rise to these painful feelings, do not provide a substratum to Art as they do to everyday life. It is even possible that by representing in a neutral medium the interplay of creative and destructive instincts the artist can help us to comprehend a better solution of the conflicts that press within us than we could do for ourselves unaided, with nothing interposed between us and our passions but the medium of our unstable flesh. The artist provides more than a momentary consolation for our miseries; he goes behind the veil which serpens the source of our dejection and brings back evidence for the triumph of the creative impulse over the forces of destruction; he can do this not by the denial of pain but by facing it with a determination to master it. If we are to learn anything about Æsthetics we must be ready to follow the path he takes,

 

11. A Case of Hysteria: Theory and Practice in the Two Wars (1941)

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GOOD fortune sometimes sends us a case which aptly illustrates some view of illness we are interested in; occasionally we find one which enables us to make a brief historical review of our theories. Such is the case of a soldier of 28 who received superficial gunshot wounds of the right arm and leg on active service and thus incommoded made his way to the coast during the retreat wandering about for five days unable to get treatment. After a few weeks in hospital he recovered from his wounds and went ,6n sick-leave. On returning to his depot he developed a glove anaesthesia in the arm below the wound and hysterical paralysis. This condition continued for many months during which he was morose and dejected. When seen he had an evasive manner and spoke in clipped speech with ’Yes, sir.— No, sir.—I’ll answer any question you put, sir/ volunteering no information.

Viewed in terms of the last war’s psycho-pathology we would say that there was a break in the representation of the limb as an active thing in the mind, because, in the struggle between the impulse to duty and that of self-preservation (the fear of injury or of extinction in active service) self-preservation had won: he had no occasion to experience the fear while protected by his hysterical paralysis. Though it came on after leave and on return to duty, he was unaware of the relevance of this factor in its causation because—the symptom having solved it—he was now unconscious of the conflict in his mind. That he was an unstable fellow lends support to the view that the dissociative mechanism of escape from conflict is often found in those with some hereditary degeneration; his evasive manner might be ascribed to a psychopathic disposition due to the same cause. The fact that he had seen active service in the Far East and only broke under the strain of the battle in Flanders also shows that even trained regulars can be pounded into dissociation if the threat to life be severe enough. Treatment would have followed within the framework of reference of the psycho-pathology. Since rest, massage and electricity had failed, his esprit de corps would have been stimulated, his sense of shame touched on, under hypnosis he might have been shown the limb in movement so that that break in the representation in the higher centres would have been bridged. It would be possible to extend the theoretical exposition with other views and evidence, This man of marriageable years roved through life single, refusing promotion so as to keep the equal camaraderie of his friends, unspoiled by differences of rank. But self-love, heightened by danger and stimulated by the injury, awakened fears of other injuries and threats from the infantile past and pulled him away even from loyal companionship. Regression, once begun, ended in the focusing of all attention on the flaccid limb. ’It is all I can think about’, he said. It would not be discordant to common knowledge among psycho-pathologists to see in the helpless right arm both a symbol and a visitation of punishment. He is impotent to defend himself; guilt now contributes to the maintenance of the symptom since with it he must leave his companions, just as a sense of guilt must have contributed to its origin when he failed them on return to duty. And further by being thus incapacitated he stays in England. The regressive pull to home and security would tend to keep him ill Tor the duration’.

 

12. Sigmund Freud, 1856-1939: An Appreciation (1941)

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FREUD ’S death marks the close of an epoch, and his life’s work was the foundation of a new one. He was the last of the great nineteenth-century scientists, he inherited their tradition and their methods, and on their foundation he built a new edifice.

Born in anno Darwinii, he gave a new dimension to biological thought; The Origin of Species showed man’s physical relation to the brute creation; within fifty years Freud’s corresponding work on The Interpretation of Dreams showed the way in which impulses of instinctual origin (in the mental sphere the part of us nearest to the animals) find representation in our imagination and are transformed into the bonds which unite us in our cultural life.

To every thinking man and woman now living the death of Freud was a personal event. The ideas which he formulated have become a part of our everyday thought, and though the number who read his works is comparatively small, the recognition that they touched the inner life of man gave him a position in our regard which we can accord only to the great leaders in history. However little was known of his personal life, mankind has recognized and respected a fellow-being who endured calumny and lived to receive honour. And all men admire the energy and creativeness of a pioneer. His death in exile, and after many years of great physical suffering patiently borne, brought: him within the horizons of our own imagination and experience, for the kinship in pain and affliction is more easily felt by our common clay than the sweeping movement of spirit and creative imagination which carries us away from our accustomed thoughts to new visions of the universe and to rediscoveries of familiar things. So all men drew breath and paused at Freud’s death: the moment witnessed another and irrevocable move made by the Fates on the field of human destiny.

 

13. Psychology in Medical Education (1947)

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AN important event in the professional life of every medical man, if not the most important event, is his dealing with patients in the first months of general practice. It is the first test of the young practitioner; it is also of course a test of his professional education. This article will discuss some of the difficulties, and the reasons for the difficulties, in the transition from student to practitioner, with special reference to the acquisition of professional skill in and understanding of the relation of a sick person to his medical adviser.

Changes in Medical Education

There are two ways in which a doctor can get instruction. He can be taken by his teacher into the patient’s environment and be told there what factors have led to the ailment, what difficulties lie in the way of the remedy, and what chances there are, all things taken into consideration, of recovery. The teacher and his pupil make an entry into the patient’s life, they enter his region of’social space’ and do what they can to bring some easement within it. The apprenticeship was an example of this kind of medical education. The second, the more modern way, is different: the patient is drawn into a region where he is isolated from usual social contacts and interests, and is examined by a number of hospital departments which have specialized on one or other aspect of the mechanism of his body or mind. The criterion on which the laboratory departments report is basically a statistical one: the findings lie within the normal limits for the age group of the patient examined.

 

14. The Application of Psycho-Analytical Principles to Hospital In-Patients (1948)

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WE are met to consider the application of psycho-analytical principles to hospital in-patients. Before we consider the applications it would be well to consider briefly, and have some agreement on, what those principles are.

First, the whole fifty years of psycho-analytical experience shows that one cannot separate research from therapy in this field of work. The technical aim of the therapy is to enable the patient to disclose as fully and as freely as possible the history of his development, including not least that of which he has been unconscious. This disclosure the doctor must meet with sincerity of purpose and dispassionateness, and he must not lose patience in the face of failure. These qualities are among those which are prerequisites in the research worker. The discovery of the causes and the solving of the problems of mental pain are not possible unless the patient experiences relief of that, suffering in the course of his treatment; then he will co-operate in the research and in the therapy. This can be briefly summarized by saying ’No research without therapy; no therapy without research’, i.e., the patient’s personal and particular difficulty has to be the subject of a special and personal investigation, personal both to the patient and to the doctor treating him.

 

15. Guilt and the Dynamics of Psychological Disorder in the Individual (1948)

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I N this session of the Conference we shall hear the topic assigned to us discussed from several aspects, medical, legal, ecclesiastical and philosophical. Within each of these disciplines there is, as is well known, diversity of opinion, which is a healthy sign; between these disciplines there is even greater diversity, probably because the method of profess-narapproach to persons suffering from guilt is different in each of these learned disciplines. What I shall say from the viewpoint of a psycho-pathologist will be an attempt at a combination of not altogether incompatible opinions.

In addition to the doctor’s general responsibility for the physical and mental welfare of his patient, the psycho- pathologists have, since the early pioneering days of Freud, a common method of work which is shared, so far as I know, by no other profession: they listen to whatever the patient may say in free association about his pains, griefs, dreams, aspirations or joys; they regard no two ideas as irrelevant to one another if the patient has brought them—however unwittingly or however unwillingly—into the same stream of associations. Thus the psycho-pathologist sees guilt in a wide context of personal experiences: not in relation to religious beliefs and ethical codes as the clergy inevitably do, not in relation to abstractions as the philosophers choose to do, but as the patients find and feel it within themselves.

 

16. On the Criteria for the Termination of an Analysis (1950)

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THE lack of a systematic follow-up of our cases several years after treatment is ended makes difficult an accurate assessment of the criteria for termination. We know something of the cases which come back for more analysis and the reasons for the incompleteness of the first therapy, but we do not usually know enough about those who do not come back, though we sometimes get favourable accounts of those whose analysis was terminated before we, at the time, thought advisable.

There is a second reason for hesitation in defining the criteria. The class of case now treated, speaking generally, is more of the character analysis type than the simpler hysteria and obsessional with which psycho-analytical work in the main began. Both our frontiers and our method of work are changing, and also our criteria.

In an analysis two parties have to be satisfied, the patient and the therapist. The patient is often satisfied too early with the results obtained in the procedure, while the therapist has his own and less subjective criteria. One of these can be given a sort of code name, ’Irreversibility;’ i.e. the process of improvement in personality-integration and adaptability, which has been reached thus far, should be of such a degree and kind that, even without further analytical aid, there will be no reverse process or regression on the cessation of treatment—granted of course that no enormous stress is put upon the patient after treatment ends. The matter can be viewed in another way, viz, has the treatment removed the major obstacles to the action of the integrative processes which operate within every living organism, so that these integrative processes will in the end get the upper hand without further analytical aid?

 

17. The Role and Future of Psycho-Therapy within Psychiatry (1950)

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1. IT may be well to begin by delimiting the term psychotherapy; to me it has two aspects :

(a) It is a procedure of verbal interchange between patient and doctor in which the phenomena presented by the patient to the doctor during interview are interpreted by the doctor to the patient—to the end that the patient’s mental pain shall be relieved (by the interpretation) and he shall have an increased understanding and mastery of the impulse-laden, unresolved, emotional conflicts in his own personal past experience, and a better insight into his own personality.

(b) Psycho-therapy is also a procedure in which transference phenomena are manipulated by the doctor, whether or no he is conscious of the nature of those phenomena within the patient or in himself.

This double-channelled definition is positive, i.e. it states what happens, but it does not exclude the simultaneous or alternating use of non-psycho-therapeutic procedures such as induced hypoglycaemia or narcosis or fits (which are sometimes given the lordly title of biological treatments). This definition also covers most of the procedures of Group Psycho-therapy, which I shall discuss in more detail later.

 

18. The Development of Psychological Medicine (1950)

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THE half-century which this series of essays is designed to cover also spans the history of modern psychological medicine, which is also the history of a new skill. Every advance in medical science can be related to the development of skills—in clinical observation, in the design and use of apparatus of research, in the interpretation of data obtained by the use of the apparatus, and above all in conceptualizing the problem that is being faced. To this general rule the development of psychological medicine is no exception; but since the data differ so greatly from those of the physiologist and pathologist the means by which the facts are collected also are different. Both kinds of research are concerned with answers to the fundamental question, ’What goes with what?’ If the data of the pathologist cannot be immediately linked with the data of the psycho-pathologist and psychiatrist, and vice versa, it simply means that ’total medicine’ has not yet found a theory which combines the two.

 

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