I
From Dr. Loÿ.
12th January, 1913.
What you said at our last conversation was extraordinarily stimulating. I was expecting you to throw light upon the interpretation of my own and my patients' dreams from the standpoint of Freud's "Interpretation of Dreams." Instead, you put before me an entirely new conception: the dream as a means of re-establishing the moral equipoise, fashioned in the realm below the threshold of consciousness. That indeed is a fruitful conception. But still more fruitful appears to me your other suggestion. You regard the problems of psychoanalysis as much deeper than I had ever thought: it is no longer merely a question of getting rid of troublesome pathological symptoms; the analysed person gets to understand not his anxiety-experiences alone, but his whole self most completely, and by means of this understanding he can build up and fashion his whole life anew. But he himself must be the builder, the Analyst only furnishes him with the necessary tools.
To begin with, I would ask you to consider what justification there is for the original procedure of Breuer and Freud, now entirely given up both by Freud himself and by you, but practised by Frank, for instance, as his only method: I mean "the abreaction of the inhibited effects under light hypnosis." Why have you given up the cathartic method? More particularly, has light hypnosis in psychocatharsis a different value from suggestion during sleep, long customary in treatment by suggestion? that is, has it only the value which the suggestionist contributes, or does it claim to possess only the value which the patient's belief bestows upon it? Or, again, is suggestion in the waking-state equivalent to suggestion in hypnoidal states? This Bernheim now asserts to be the case, after having used suggestion for many years exclusively in hypnosis. You will tell me we must talk of psychoanalysis, not of suggestion. But I really mean this: is not the suggestion, by means of which the psychocatharsis in the hypnoidal state produces therapeutic effects, (modified naturally, by the patients' age, etc.) the main factor in the therapeutic success of the psychocatharsis? Frank, in his "Affektstörungen," says: "these partial adjustments of effect, suggestibility and suggestion, are almost altogether omitted in the psychocathartic treatment in light sleep, in so far as the content of the reproduced presentations is concerned." Is that really true? Frank himself adds: "How can meditation upon the dreams of youth in itself lead to the discharge of the stored-up anxiety, whether in hypnoidal states or under any other conditions? Must one not suppose, with much greater probability, that the anxiety-states would become more pronounced through such concentration upon them?" [I have noticed that myself, and much more than I at all liked.] One does indeed say to the patient: "First we must stir up, then afterwards comes peace." And it does come. But does it not come in spite of the stirring-up process, because gradually, by means of frequent talks under light hypnosis, the patient gets such confidence in the doctor that he becomes susceptible to direct suggestion, and that produces at first improvement and finally, cure? I go still further: in an analysis in the waking-state, is not the patient's belief that the method employed will cure him, coupled with his ever-growing trust in the doctor, a main cause of his cure? And I ask even further: in every systematically carried-out therapeutic treatment, is not faith in it, trust in the doctor, a main factor in its success? I will not indeed say the only factor, for one cannot deny that the physical, dietetic and chemical procedures, when properly selected, have a real effect in securing a cure, over and above the obvious effect of their indirect suggestion.