Investigating The Unknown In A Patient

There are four methods of investigating the unknown in a patient:

ASSOCIATION METHOD

The first and simplest method is the Association Method. I do not think I need go into details here, as this method has been known for the last fifty years. Its principle is to discover the main complexes through disturbances in the association experiment. As an introduction to analytical psychology and to the symptomatology of complexes, this method is recommended for every beginner CW17 ¶ 175

SYMPTOMANALYSIS METHOD

The second method, Symptom-Analysis, has a merely historical value and was given up by Freud, its originator, long ago. By means of hypnotic suggestion it was attempted to get the patient to reproduce the memories underlying certain pathological symptoms. The method works very well in all cases where a shock, a psychic injury, or a trauma is the chief cause of the neurosis. It was on this method that Freud based his earlier trauma theory of hysteria. But since most cases of hysteria are not of traumatic origin, this theory was soon discarded along with its method of investigation. In a case of shock the method can have a therapeutic effect through “abreaction” of the traumatic content. During and after the first world war it was useful in treating shell-shock and similar disorders CW17 ¶ 176

ANAMNESTIC ANALYSIS METHOD

The third method, Anamnestic Analysis, is of greater importance as a method both of investigation and of therapy. In practice it consists in a careful anamnesis or reconstruction of the historical development of the neurosis. The material elicited in this way is a more or less coherent sequence of facts told to the doctor by the patient, so far as he can remember them. He naturally omits many details which either seem unimportant to him or which he has forgotten. The experienced analyst who knows the usual course of neurotic development will put questions which help the patient to fill in some of the gaps. Very often this procedure by itself is of great therapeutic value, as it enables the patient to understand the chief factors of his neurosis and may eventually bring him to a decisive change of attitude. It is of course as unavoidable as it is necessary for the doctor not only to ask questions, but to give hints and explanations in order to point out important connections of which the patient is unconscious CW17 ¶ 177

19-YEAR OLD RECRUIT REPORTED SICK

While serving as an officer in the Swiss Army Medical Corps, I often had occasion to use this anamnestic method. For instance, there was a nineteen-year-old recruit who reported sick. When I saw the young man he told me straight out that he was suffering from inflammation of the kidneys and that it was the cause of his pains. I wondered how he knew his diagnosis so definitely, whereupon he said that an uncle of his had the same trouble and the same pains in the back. The examination, however, revealed no trace of organic disease. It was obviously a neurosis. I asked for his previous history. The main fact was that the young man had lost both parents rather early and now lived with the uncle he had just mentioned. This uncle was his foster-father, of whom he was very fond. The day before he reported sick he received a letter from his uncle, telling him that he was laid up again with nephritis. The letter affected him unpleasantly and he threw it away at once, without realizing the true cause of the emotion he was trying to repress. Actually, he was very much afraid lest his foster-father should die, and this put him in mind again of his grief at the loss of his parents. As soon as he realized this he had a violent fit of weeping, with the result that he joined the ranks again next morning. It was a case of identification with the uncle, which was uncovered by the anamnesis. The realization of his suppressed emotions had a therapeutic effect CW17 ¶ 177

RECRUIT WITH STOMACH TROUBLE

A similar case was that of another recruit, who for weeks before I saw him had been having medical treatment for stomach trouble. I suspected that he was neurotic. The anamnesis revealed that the trouble began when he heard the news that his aunt, who was like a mother to him, had to undergo an operation for cancer of the stomach. Here again the uncovering of the hidden connection had curative results. Simple cases of this kind are quite common, and are accessible to anamnestic analysis. In addition to the favourable effect produced by the realization of previously unconscious connections, it is usual for the doctor to give some good advice, or encouragement, or even a reproof CW17 ¶ 178

Anamnestic analysis is the best practical method for the treatment of neurotic children. With children you cannot very well apply the method of dream-analysis, as it penetrates deep into the unconscious. In the majority of cases you have simply to clear away certain obstacles, and this can be done without much technical knowledge. Generally speaking, a child's neurosis would be a very simple matter were it not that there is an invariable connection between it and the wrong attitude of the parents. This complication buttresses the child's neurosis against all therapeutic intervention CW17 ¶ 179

ANALYSIS OF THE UNCONSCIOUS METHOD

The fourth method is the Analysis of the Unconscious. Despite the fact that anamnestic analysis can reveal certain facts of which the patient is unconscious, it is not what Freud would have called “psychoanalysis.” In reality there is a remarkable difference between the two methods. The anamnestic method, as I pointed out, deals with conscious contents, or with contents ready for reproduction, while the analysis of the unconscious only begins when the conscious material is exhausted. I beg to point out that I do not call this fourth method “psychoanalysis,” as I wish to leave that term entirely to the Freudians. What they understand by psychoanalysis is no mere technique, but a method which is dogmatically bound up with and based upon Freud's sexual theory. When Freud publicly declared that psychoanalysis and his sexual theory were indissolubly wedded, I was obliged to strike out on a different path, as I was unable to endorse his one-sided views. That is also the reason why I prefer to call this fourth method the analysis of the unconscious CW17 ¶ 180

CAREFUL EXAMINATION OF THE

PATIENT'S CONSCIOUS MIND

The anamnestic method often serves as an introduction to the fourth method, [analysis of the unconscious]. By careful examination of his conscious mind you get to know your patient; you establish what the old hypnotists used to call “rapport.” This personal contact is of prime importance, because it forms the only safe basis from which to tackle the unconscious. This is a factor that is frequently overlooked, and when it is neglected it may easily lead to all sorts of blunders. Even the most experienced judge of human psychology cannot possibly know the psyche of another individual, so he must depend upon goodwill, i.e., good contact with the patient, and trust him to tell the analyst when anything goes wrong CW17 ¶ 181

OFTEN MISUNDERSTANDINGS OCCUR

AT THE BEGINNING THE TREATMENT

Very often misunderstandings occur right at the beginning of the treatment, sometimes through no fault of the doctor. Owing to the very nature of his neurosis, the patient will harbour all kinds of prejudices which are often the direct cause of his neurosis and help to keep it alive. If these misunderstandings are not thoroughly cleared up, they can easily leave behind them a feeling of resentment which reduces all your subsequent efforts to nothing CW17 ¶ 181

DANGER OF RIDING ROUGHSHOD OVER THE

REAL PSYCHOLOGY OF THE PATIENT

Of course, if you begin the analysis with a fixed belief in some theory which purports to know all about the nature of neurosis, you apparently make your task very much easier; but you are nevertheless in danger of riding roughshod over the real psychology of your patient and of disregarding his individuality. I have seen any number of cases where the cure was hindered by theoretical considerations. Without exception the failure was due to lack of contact. It is only the most scrupulous observation of this rule that can prevent unforeseen catastrophes. So long as you feel the human contact, the atmosphere of mutual confidence, there is no danger; and even if you have to face the terrors of insanity, or the shadowy menace of suicide, there is still that area of human faith, that certainty of understanding and of being understood, no matter how black the night CW17 ¶ 181

MISTRUST ON EITHER SIDE

IS A BAD BEGINNING

It is by no means easy to establish such a contact, and you cannot achieve it at all except by a careful comparison of both points of view and by mutual freedom from prejudice. Mistrust on either side is a bad beginning, and so is the forcible breaking down of resistances through persuasion or other coercive measures. Even conscious suggestion as part of the analytical procedure is a mistake, because the patient's feeling of being free to make up his own mind must at all costs be preserved CW17 ¶ 181

TAKE MISTRUST OR RESISTANCE

WITH THE UTMOST SERIOUSNESS

Whenever I discover the slightest trace of mistrust or resistance I try to take it with the utmost seriousness so as to give the patient a chance to re-establish the contact. The patient should always have a firm foothold in his conscious relation to the doctor, who in his turn needs that contact if he is to be sufficiently informed about the actual state of the patient's consciousness. He needs this knowledge for very practical reasons. Without it, he would not be able to understand his patient's dreams correctly. Therefore, not only in the beginning, but during the whole course of an analysis the personal contact must be the main point of observation, because it alone can prevent extremely disagreeable and surprising discoveries, as well as fatal issues so far as is humanly possible. And not only that, it is above all else a means for correcting the false attitude of the patient, in such a way that he does not feel he is being persuaded against his will or actually outwitted CW17 ¶ 181

CASE OF A YOUNG MAN

OF ABOUT THIRTY

I should like to give you an illustration of this. A young man of about thirty, obviously very clever and highly intellectual, came to see me, not, he said, for treatment, but only in order to ask one question. He produced a voluminous manuscript, which, so he said, contained the history and analysis of his case. He called it a compulsion neurosisquite correctly, as I saw when I read the document. It was a sort of psychoanalytical autobiography, most intelligently worked out and showing really remarkable insight. It was a regular scientific treatise, based on wide reading and a thorough study of the literature. I congratulated him on his achievement and asked him what he had really come for. “Well,” he said, “you have read what I have written. Can you tell me why, with all my insight, I am still as neurotic as ever? In theory I should be cured, as I have recalled even my earliest memories. I have read of many people who, with infinitely less insight than I have, were nevertheless cured. Why should I be an exception? Please tell me what it is I have overlooked or am still repressing” CW17 ¶ 182

THE PATIENT HAD BEEN SUPPORTED

BY A WOMANA 36-YEAR OLD SCHOOL TEACHER

I told him I could not at the moment see any reason why his really astonishing insight had not touched his neurosis. “But,” I said, “allow me to ask you for a little more information about yourself personally.” “With pleasure,” he replied. So I went on: “You mention in your autobiography that you often spend the winter in Nice and the summer in St. Moritz. I take it that you are the son of wealthy parents?” “Oh, no,” he said, “they are not wealthy at all.” “Then no doubt you have made your money yourself?” “Oh, no,” he replied, smiling. “But how is it then?” I asked with some hesitation. “Oh, that does not matter,” he said, “I got the money from a woman, she is thirty-six, a teacher in a council school.” And he added, “It's a liaison, you know” CW17 ¶ 182

As a matter of fact this woman, who was a few years older than himself, lived in very modest circumstances on her meagre earnings as a teacher. She saved the money by stinting herself, naturally in the hope of a later marriage, which this delightful gentleman was not even remotely contemplating. “Don't you think,” I asked, “that the fact that you are financially supported by this poor woman might be one of the chief reasons why you are not yet cured?” But he laughed at what he called my absurd moral innuendo, which according him had nothing to do with the scientific structure of his neurosis. “Moreover,” he said, “I have discussed this point with her, and we are both agreed that it is of no importance.” “So you think that by the mere fact of having discussed this situation you have talked the other factthe fact of your being supported by a poor womanout of existence? Do you imagine you have any lawful right to the money jingling in your pockets?” Whereupon he rose and indignantly left the room, muttering something about moral prejudices. He was one of the many who believe that morals have nothing to do with neurosis and that sinning on purpose is not sinning at all, because it can be intellectualized out of existence CW17 ¶ 182

PATIENT THOUGHT HE COULD UNTHINK

A WRONG HE HAD COMMITTED

Obviously I had to tell this young gentleman what I thought of him. If we could have reached agreement on this point, treatment would have been possible. But if we had begun our work by ignoring the impossible basis of his life, it would have been useless. With views like his only a criminal can adapt to life. But this patient was not really a criminal, only a so-called intellectual who believed so much in the power of reason that he even thought he could unthink a wrong he had committed. I believe firmly in the power and dignity of the intellect, but only if it does not violate the feeling-values. These are not just infantile resistances. This example shows what a decisive factor the personal contact is CW17 ¶ 183