The problem of lay-analyses

Ii

Whether this modification shall be enacted as a law will depend mostly on people who may not be expected to know the peculiarities of analytical treatment. It will be our task, therefore, to instruct these impartial referees, these typical laymen whom we will assume, for the time being, are completely uninformed. It is regrettable that we cannot arrange for them to attend an analytical treatment in the rôle of an observer. It is one of the peculiarities of the “analytical situation” that it will not suffer the presence of a third party.

Moreover, individual sessions are liable to be very unequal, as regards the information they may yield. Mr. Referee happening in at an analytical session, would probably not profit to any great extent. As a matter of fact, he might altogether misinterpret that which is discussed between the analyst and the patient. He may even become downright bored with the proceedings. Therefore Mr. Referee must needs be satisfied with the information we shall presently impart to him, endeavoring to set it forth as lucidly as possible.

Let us assume that the patient is suffering from attacks of moodiness, which he is unable to control, or else is the victim of a despondency so depressing as to paralyse his energy, causing him to lose all confidence in himself, manifesting extreme self-consciousness when among strangers. Without grasping the underlying elements of his case, the patient may observe that not only the discharge of his daily duties becomes more and more arduous for him, but also that he experiences difficulties when called upon to make a decision or embark upon some enterprise.

One day—utterly ignorant of the exact cause—he succumbs to an attack of fear. From then on, he is unable to cross a street alone, or board a train, without fighting off a certain inarticulate fear. This condition, as a matter of fact, may even become so pronounced as to render it absolutely impossible for him to cross a street, or board a train, unaccompanied.

Or—what appears very peculiar to him—his thoughts “wander”; they are no longer subject to his will. They attach themselves to problems which, in reality, do not interest him at all but which he is, nevertheless, unable to dismiss from his mind. He imposes perfectly ludicrous tasks upon himself, such as counting the windows along the street. When attending to simple functions, such as mailing a letter or turning off the gas, doubts harass him a few moments later, as to whether he has really dropped the letter into the mail box and whether he actually turned off the gas.

Perhaps such a condition is merely annoying at first, but it becomes intolerable when, in advanced stages, it proves impossible to shake off such preposterous ideas as having flung a child under the wheels of a car, or thrown somebody from a bridge into the river, or being haunted by the terrifying doubt of whether he is not in reality the murderer the police are trying to apprehend for the latest spectacular crime.

All these delusions are utter nonsense, as he himself very well knows. He has never done any harm to anybody, but if he really were a fugitive from justice, this obsession, this feeling of contrition could not be stronger.

To take another case:—this time of a female patient, who is suffering in an entirely different way, presenting entirely different symptoms. We will assume that she is a pianiste, who suddenly experiences cramps in her fingers and discovers herself unable to play. As soon as she thinks of attending a social affair, she immediately feels the necessity of obeying a recurrent natural need, making it impossible for her to leave her own house. Thus, she has been forced to give up mingling with her friends, or attend dances, the theatre, or concerts.

At the most inopportune moments, she becomes the victim of headaches or other painful sensations. Eventually, after meals, she feels impelled to yield to nausea, a condition which, if prolonged, may become dangerous. Finally, she becomes absolutely unable to stand any of those little excitements which cannot be eliminated from daily life. Upon such occasions, she readily faints. As these spells are frequently complicated with muscular spasms, such attacks assume the aspect of dreadful afflictions.

Still other patients become subject to disturbances in a sphere where bodily functions coördinate with manifestations of sentiment. If men, they find themselves unable to give physiological expression to those tender urges that induce them to gravitate towards the other sex. On the other hand, all these physiological reactions may be at their command when not aimed at the person they cherish most. Then, there are still other cases, when bonds of sensuality will tie them to persons whom they actually despise and of whom they have the most earnest desire to free themselves. Or their sensuality imposes urges upon them whose fulfillment causes them to shudder.

If they be women, such patients, on account of fear or disgust, or from some other restraint of unknown origin, become unable to perform those functions which their sex imposes upon them. In cases where they have yielded to the prompting of passion, they discover that that gratification is withheld from them which nature normally offers as a reward for such complacency.

Sooner or later, all such persons come to consider themselves as sick and appeal to physicians, expecting to be cured of their nervous ailments. Physicians have classified these manifestations, diagnosing them differently, according to their own personal point of view. These ailments are listed under such terms as neurasthenia, psychasthenia, phobias and neuroses of different kinds, and with that sweeping term hysterics. The parts of the body inducing such disturbances are examined: the heart, the stomach, the intestines, the sex organs, and all are found to be in the best of condition. The physician then advises the patient to change his mode of living, to take a vacation, to exercise. Thus, with perhaps the aid of mild stimulants, the patient’s condition may, or may not, be temporarily relieved.

Eventually, the patient is informed that there are certain practitioners who specialize in the treatment of just such ailments, and thus they come to be psychoanalysed.

Mr. Referee, whom we will assume is present, has impatiently listened, while we have given an account of the nervous disturbances with which one may be afflicted. Mr. Referee suddenly becomes attentive, expressing his growing interest in these words: “Well, now at last we shall see what the psychoanalyst will do with the patient, whom physicians could not help.”