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Instead of many cases, I shall tell you of just one in which, because of professional precautions, I was destined to play a sad role. Many years ago I treated a young girl who for a long time was afraid to go on the street, or to remain at home alone. The patient hesitatingly admitted that her phantasy had been caused by accidentally observing affectionate relations between her mother and a well-to-do friend of the family. But she was so clumsy – or perhaps so sly – as to give her mother a hint of what had been discussed during the analysis, and changed her behavior toward her mother, insisting that no one but her mother should protect her against the fear of being alone, and anxiously barring the way when her mother wished to leave the house. The mother had previously been very nervous herself, but had been cured years before in a hydropathic sanatorium. Let us say, in that institution she made the acquaintance of the man with whom she was to enter upon the relationship which was able to satisfy her in every respect. Becoming suspicious of the stormy demands of the girl, the mother suddenly realized the meaning of her daughter's fear. She must have made herself sick to imprison her mother and to rob her of the freedom she needed to maintain relations with her lover. Immediately the mother made an end to the harmful treatment. The girl was put into a sanatorium for the nervous and exhibited for many years as "a poor victim of psychoanalysis." For just as long a period I was pursued by evil slander, due to the unfavorable outcome of this case. I maintained silence because I thought myself bound by the rules of professional discretion. Years later I learned from a colleague who had visited the institution, and had seen the agoraphobic girl there, that the relationship between the mother and the wealthy friend of the family was known all over town, and apparently connived at by the husband and father. It was to this "secret" that our treatment had been sacrificed.
In the years before the war, when the influx of patients from all parts made me independent of the favor or disfavor of my native city, I followed the rule of not treating anyone who was not sui juris, was not independent of all other persons in his essential relations of life. Every psychoanalyst cannot do this. You may conclude from my warning against the relatives of patients that for purposes of psychoanalysis we should take the patients away from their families, and should limit this therapy to the inmates of sanatoriums. I should not agree with you in this; it is much more beneficial for the patients, if they are not in a stage of great exhaustion, to continue in the same circumstances under which they must master the tasks set for them during the treatment. But the relatives ought not to counteract this advantage by their behavior, and above all, they should not antagonize and oppose the endeavors of the physician. But how are we to contend against these influences which are so inaccessible to us! You see how much the prospects of a treatment are determined by the social surroundings and the cultural conditions of a family.
This offers a sad outlook indeed for the effectiveness of psychoanalysis as a therapy, even if we can explain the great majority of our failures by putting the blame on such disturbing external factors! Friends of analysis have advised us to counterbalance such a collection of failures by means of a statistical compilation on our part of our successful cases. Yet I could not try myself to do this. I tried to explain that statistics would be worthless if the collected cases were not comparable, and in fact, the various neuroses which we have undertaken to treat could, as a matter of fact, hardly be compared on the same basis, since they differed in many fundamental respects. Besides, the period of time over which we could report was too short to permit us to judge the permanency of our cures, and concerning certain cases we could not have given any information whatever. They related to persons who had kept their ailments, as well as their treatment, secret, and whose cure must necessarily be kept secret as well. The strongest hindrance, however, lay in the knowledge that men behave most irrationally in matters of therapy, and that we have no prospect of attaining anything by an appeal to reason. A therapeutic novelty is received either with frenzied enthusiasm, as was the case when Koch first made public his tuberculin against tuberculosis, or it is treated with abysmal distrust, as was the really blessed vaccination of Jenner, which even today retains implacable opponents. There was a very obvious prejudice against psychoanalysis. When we had cured a very difficult case we would hear it said: "That is no proof, he would have become well by himself in all this time." Yet when a patient who had already gone through four cycles of depression and mania came into my care during a temporary cessation in the melancholia, and three weeks later found herself in the beginnings of a new attack, all the members of the family as well as the high medical authorities called into consultation, were convinced that the new attack could only be the result of the attempted analysis. Against prejudice we are powerless; you see it again in the prejudices that one group of warring nations has developed against the other. The most sensible thing for us to do is to wait and allow time to wear it away. Some day the same persons think quite differently about the same things than before. Why they formerly thought otherwise remains the dark secret.
It may be possible that the prejudice against psychoanalysis is already on the wane. The continual spread of psychoanalytic doctrine, the increase of the number of physicians in many lands who treat analytically, seems to vouch for it. When I was a young physician I was caught in just such a storm of outraged feeling of the medical profession toward hypnosis, treatment by suggestion, which today is contrasted with psychoanalysis by "sober" men. Hypnotism did not, however, as a therapeutic agent, live up to its promises; we psychoanalysts may call ourselves its rightful heirs, and we have not forgotten the large amount of encouragement and theoretical explanation we owe to it. The injuries blamed upon psychoanalysis are limited essentially to temporary aggravation of the conflict when the analysis is clumsily handled, or when it is broken off unfinished. You have heard our justification for our form of treatment, and you can form your own opinion as to whether or not our endeavors are likely to lead to lasting injury. Misuse of psychoanalysis is possible in various ways; above all, transference is a dangerous remedy in the hands of an unconscientious physician. But no professional method of procedure is protected from misuse; a knife that is not sharp is of no use in effecting a cure.
I have thus reached the end, ladies and gentlemen. It is more than the customary formal speech when I admit that I am myself keenly depressed over the many faults in the lectures I have just delivered. First of all, I am sorry that I have so often promised to return to a subject only slightly touched upon at the time, and then found that the context has not made it possible to keep my word. I have undertaken to inform you concerning an unfinished thing, still in the process of development, and my brief exposition itself was an incomplete thing. Often I presented the evidence and then did not myself draw the conclusion. But I could not endeavor to make you masters of the subject. I tried only to give you some explanation and stimulation.
