Ladies and Gentlemen: With the discovery of infantile sexuality and the tracing back of the neurotic symptoms to erotic impulse-components we have arrived at several unexpected formulae for expressing the nature and tendencies of neurotic diseases. We see that the individual falls ill when in consequence of outer hindrances or inner lack of adaptability the satisfaction of the erotic needs in the sphere of reality is denied. We see that he then flees to sickness, in order to find with its help a surrogate satisfaction for that denied him. We recognize that the symptoms of illness contain fractions of the sexual activity of the individual, or his whole sexual life, and we find in the turning away from reality the chief tendency and also the chief injury of the sickness. We may guess that the resistance of our patients against the cure is not a simple one, but is composed of many motives. Not only does the ego of the patient strive against the giving up of the repressions by which it has changed itself from its original constitution into its present form, but also the sexual impulses may not renounce their surrogate satisfaction so long as it is not certain that they can be offered anything better in the sphere of reality.
The flight from the unsatisfying reality into what we call, on account of its biologically injurious nature, disease, but which is never without an individual gain in pleasure for the patient, takes place over the path of regression, the return to earlier phases of the sexual life, when satisfaction was not lacking. This regression is seemingly a twofold one, a temporal, in so far as the libido or erotic need falls back to a temporally earlier stage of development, and a formal, since the original and primitive psychic means of expression are applied to the expression of this need.
Both sorts of regression focus in childhood and have their common point in the production of an infantile condition of sexual life.
The deeper you penetrate into the pathogenesis of neurotic diseases, the more the connection of neuroses with other products of human mentality, even the most valuable, will be revealed to you. You will be reminded that we men, with the high claims of our civilization and under the pressure of our repressions, find reality generally quite unsatisfactory and so keep up a life of fancy in which we love to compensate for what is lacking in the sphere of reality by the production of wish-fulfillments. In these phantasies is often contained very much of the particular constitutional essence of personality and of its tendencies, repressed in real life. The energetic and successful man is he who succeeds by dint of labor in transforming his wish fancies into reality. Where this is not successful in consequence of the resistance of the outer world and the weakness of the individual, there begins the turning away from reality. The individual takes refuge in his satisfying world of fancy. Under certain favorable conditions it still remains possible for him to find another connecting link between these fancies and reality, instead of permanently becoming a stranger to it through the regression into the infantile. If the individual who is displeased with reality is in possession of that artistic talent which is still a psychological riddle, be can transform his fancies into artistic creations. So he escapes the fate of a neurosis and wins back his connection with reality by this round-about way.[20] Where this opposition to the real world exists, but this valuable talent fails or proves insufficient, it is unavoidable that the libido, following the origin of the fancies, succeeds by means of regression in revivifying the infantile wishes and so producing a neurosis. The neurosis takes, in our time, the place of the cloister, in which were accustomed to take refuge all those whom life had undeceived or who felt themselves too weak for life. Let me give at this point the main result at which we have arrived by the psychoanalytic investigation of neurotics, namely, that neuroses have no peculiar psychic content of their own, which is not also to be found in healthy states; or, as C. G. Jung has expressed it, neurotics fall ill of the same complexes with which we sound, people struggle. It depends on quantitative relationships, on the relations of the forces wrestling with each other, whether the struggle leads to health, to a neurosis, or to compensatory over-functioning ( Ueberleistung).
Ladies and gentlemen, I have still withheld from you the most remarkable experience which corroborates our assumptions of the sexual impulse-forces of neurotics. Every time that we treat a neurotic psychoanalytically, there occurs in him the so-called phenomenon of transfer (Uebertragung), that is, he applies to the person of the physician a great amount of tender emotion, often mixed with enmity, which has no foundation in any real relation, and must be derived in every respect from the old wish-fancies of the patient which have become unconscious. Every fragment of his emotive life, which can no longer be called back into memory, is accordingly lived over by the patient in his relations to the physician, and only by such a living of them over in the "transfer" is he convinced of the existence and the power of these unconscious sexual excitations. The symptoms, which, to use a simile from chemistry, are the precipitates of earlier love experiences (in the widest sense), can only be dissolved in the higher temperature of the experience of transfer and transformed into other psychic products. The physician plays in this reaction, to use an excellent expression of S. Ferenczi,[21] the rôle of a catalytic ferment, which temporarily attracts to itself the affect which has become free in the course of the process.
The study of transfer can also give you the key to the understanding of hypnotic suggestion, which we at first used with our patients as a technical means of investigation of the unconscious.
Hypnosis showed itself at that time to be a therapeutic help, but a hindrance to the scientific knowledge of the real nature of the case, since it cleared away the psychic resistances from a certain field, only to pile them up in an unscalable wall at the boundaries of this field. You must not think that the phenomenon of transfer, about which I can unfortunately say only too little here, is created by the influence of the psychoanalytic treatment. The transfer arises spontaneously in all human relations and in the relations of the patient to the physician; it is everywhere the especial bearer of therapeutic influences, and it works the stronger the less one knows of its presence. Accordingly psychoanalysis does not create it, it merely discloses it to consciousness, and avails itself of it, in order to direct the psychic processes to the wished for goal. But I cannot leave the theme of transfer without stressing the fact that this phenomenon is of decisive importance to convince not only the patient, but also the physician. I know that all my adherents were first convinced of the correctness of my views through their experience with transfer, and I can very well conceive that one may not win such a surety of judgment so long as he makes no psychoanalysis, and so has not himself observed the effects of transfer.
Ladies and gentlemen, I am of the opinion that there are, on the intellectual side, two hindrances to acknowledging the value of the psychoanalytic view-point: first, the fact that we are not accustomed to reckon with a strict determination of mental life, which holds without exception, and second, the lack of knowledge of the peculiarities through which unconscious mental processes differ from those conscious ones with which we are familiar. One of the most widespread resistances against the work of psychoanalysis with patients as with persons in health reduces to the latter of the two moments. One is afraid of doing harm by psychoanalysis, one is anxious about calling up into consciousness the repressed sexual impulses of the patient, as though there were danger that they could overpower the higher ethical strivings and rob him of his cultural acquisitions. One can see that the patient has sore places in his soul life, but one is afraid to touch them, lest his suffering be increased. We may use this analogy. It is, of course, better not to touch diseased places when one can only cause pain. But we know that the surgeon does not refrain from the investigation and reinvestigation of the seat of illness, if his invasion has as its aim the restoration of lasting health. Nobody thinks of blaming him for the unavoidable difficulties of the investigation or the phenomena of reaction from the operation, if these only accomplish their purpose, and gain for the patient a final cure by temporarily making his condition worse. The case is similar in psychoanalysis; it can lay claim to the same things as surgery; the increase of pain which takes place in the patient during the treatment is very much less than that which the surgeon imposes upon him, and especially negligible in comparison with the pains of serious illness. But the consequence which is feared, that of a disturbance of the cultural character by the impulse which has been freed from repression, is wholly impossible. In relation to this anxiety we must consider what our experiences have taught us with certainty, that the somatic and mental power of a wish, if once its repression has not succeeded, is incomparably stronger when it is unconscious than when it is conscious, so that by being made conscious it can only be weakened. The unconscious wish cannot be influenced, is free from all strivings in the contrary direction, while the conscious is inhibited by those wishes which are also conscious and which strive against it. The work of psychoanalysis accordingly presents a better substitute, in the service of the highest and most valuable cultural strivings, for the repression which has failed.
Now what is the fate of the wishes which have become free by psychoanalysis, by what means shall they be made harmless for the life of the individual? There are several ways. The general consequence is, that the wish is consumed during the work by the correct mental activity of those better tendencies which are opposed to it. The repression is supplanted by a condemnation carried through with the best means at one's disposal. This is possible, since for the most part we have to abolish only the effects of earlier developmental stages of the ego. The individual for his part only repressed the useless impulse, because at that time he was himself still incompletely organized and weak; in his present maturity and strength he can, perhaps, conquer without injury to himself that which is inimical to him. A second issue of the work of psychoanalysis may be that the revealed unconscious impulses can now arrive at those useful applications which, in the case of undisturbed development, they would have found earlier. The extirpation of the infantile wishes is not at all the ideal aim of development. The neurotic has lost, by his repressions, many sources of mental energy whose contingents would have been very valuable for his character building and his life activities. We know a far more purposive process of development, the so-called sublimation ( Sublimirung), by which the energy of infantile wish-excitations is not secluded, but remains capable of application, while for the particular excitations, instead of becoming useless, a higher, eventually no longer sexual, goal is set up. The components of the sexual instinct are especially distinguished by such a capacity for the sublimation and exchange of their sexual goal for one more remote and socially more valuable. To the contributions of the energy won in such a way for the functions of our mental life we probably owe the highest cultural consequences. A repression taking place at an early period excludes the sublimation of the repressed impulse; after the removal of the repression the way to sublimation is again free.
We must not neglect, also, to glance at the third of the possible issues. A certain part of the suppressed libidinous excitation has a right to direct satisfaction and ought to find it in life. The claims of our civilization make life too hard for the greater part of humanity, and so further the aversion to reality and the origin of neuroses, without producing an excess of cultural gain by this excess of sexual repression. We ought not to go so far as to fully neglect the original animal part of our nature, we ought not to forget that the happiness of individuals cannot be dispensed with as one of the aims of our culture. The plasticity of the sexual-components, manifest in their capacity for sublimation, may cause a great temptation to accomplish greater culture-effects by a more and more far reaching sublimation. But just as little as with our machines we expect to change more than a certain fraction of the applied heat into useful mechanical work, just as little ought we to strive to separate the sexual impulse in its whole extent of energy from its peculiar goal. This cannot succeed, and if the narrowing of sexuality is pushed too far it will have all the evil effects of a robbery.
I do not know whether you will regard the exhortation with which I close as a presumptuous one.
I only venture the indirect presentation of my conviction, if I relate an old tale, whose application you may make yourselves. German literature knows a town called Schilda, to whose inhabitants were attributed all sorts of clever pranks. The wiseacres, so the story goes, had a horse, with whose powers of work they were well satisfied, and against whom they had only one grudge, that he consumed so much expensive oats. They concluded that by good management they would break him of this bad habit, by cutting down his rations by several stalks each day, until he had learned to do without them altogether. Things went finely for a while, the horse was weaned to one stalk a day, and on the next day he would at last work without fodder. On the morning of this day the malicious horse was found dead; the citizens of Schilda could not understand why he had died. We should be inclined to believe that the horse had starved, and that without a certain ration of oats no work could be expected from an animal.
I thank you for calling me here to speak, and for the attention which you have given me.