III
From Dr. Loÿ.
2nd February, 1913.
You answer several of my questions in a decidedly affirmative sense. You take it as proved that in the cures by the cathartic method the main rôle is played by faith in the doctor and in his method, and not by the "abreaction" of real or imaginary traumata. I also. Equally I am at one with your view that the cures of the old materia medica of filth, as well as the Lourdes cures, or those of the Mental Healers, Christian Scientists and Persuasionists, are to be attributed to faith in the miracle-worker, rather than to any of the methods employed.
Now comes the ticklish point: the augur can remain an augur so long as he himself believes the will of the gods is made manifest by the entrails of the sacrificial beast. When he no longer believes, he has to ask himself: Shall I continue to use my augur's authority to further the welfare of the State, or shall I make use of my newer, and (I hope) truer convictions of to-day? Both ways are possible. The first is called opportunism; the second the pursuit of truth, and scientific honour. For a doctor, the first way brings perhaps therapeutic success and fame; the second, reproach: such a man is not taken seriously. What I esteem most highly in Freud and his school is just this passionate desire for truth. But again, it is precisely here that people pronounce a different verdict: "It is impossible for the busy practitioner to keep pace with the development of the views of this investigator and his initiates." (Frank, "Affektstörungen Einleitung.")
One can easily disregard this little quip, but one must take more seriously one's self-criticism. We may have to ask ourselves whether, since science is an undivided, ever-flowing stream, we are justified in relinquishing on conscientious grounds any method or combination of methods by means of which we know cures can be achieved?
Looking more closely at the fundamental grounds of your aversion to the use of hypnosis (or semi-hypnosis, the degree matters nothing) in treatment by suggestion, (which as a matter of fact every doctor and every therapeutic method makes use of willy-nilly, no matter what it is called), it is clear that what has disgusted you in hypnotism is at bottom nothing but the so-called "transference" to the doctor, which you, with your unalloyed psychoanalytic treatment, can get rid of as little as any one else, for indeed it plays a chief part in the success of the treatment. Your insistence that the psychoanalyst must be answerable for the cleanness of his own hands—(here I agree with you unreservedly)——is an inevitable conclusion. But, after all, does anything more "augurish" really cling to the use made of hypnosis in psychotherapeutic treatment, than to the quite inevitable use made of the "transference to the doctor" for therapeutic ends? In either case we must perforce "take shares" in faith as a healing agent. As for the feeling which the patient—whether man or woman—entertains for the doctor, is there never anything in the background save conscious or unconscious sexual desire? In many cases your view is most certainly correct; more than one woman has been frank enough to confess that the beginning of hypnosis was accompanied by voluptuous pleasure. But this is not true in all instances—or how would you explain the underlying feeling in the hypnotising of one animal by another, e.g. snake and bird? Surely you can say that there the feeling of fear reigns, fear which is an inversion of the libido, such as comes upon the bride in that hypnoidal state before she yields to her husband wherein pure sexual desire rules, though possibly it contains an element of fear. However this may be, from your three cases I cannot draw any ethical distinction between the "unconscious readiness towards the hypnotist" and the "transference to the doctor" which should avail to condemn a combination of hypnotism and psychoanalysis as a method of treatment. You will ask why I cling to the use of hypnotism; or rather of hypnoidal states. Because I think there are cases that can be much more rapidly cured thereby, than through a purely psychoanalytic treatment. For example, in no more than five or six interviews I cured a fifteen-year-old girl who had suffered from enuresis nocturna from infancy, but was otherwise thoroughly healthy, gifted, and pre-eminent at school: she had previously tried all sorts of treatment without any result.
Perhaps I ought to have sought out the psychoanalytic connexion between the enuresis and her psychosexual attitude and explained it to her, etc., but I could not, she had only the short Easter holidays for treatment: so I just hypnotised her and the tiresome trouble vanished. It was a lasting cure.
In psychoanalysis I use hypnosis to help the patient to overcome "resistances."
Further, I use light hypnosis in association with psychoanalysis, to hasten the advance when the "re-education" stage comes.
For example, a patient afflicted with washing-mania was sent to me after a year's psychocathartic treatment by Dr. X. The symbolic meaning of her washing-ceremonial was first made plain to her; she became more and more agitated during the "abreaction" of alleged traumata in childhood, because she had persuaded herself by auto-suggestion that she was too old to be cured, that she saw no "images," etc. So I used hypnosis to help her to diminish the number of her washings, "so that the anxiety-feeling would be banished"; and to train her to throw things on the ground and pick them up again without washing her hands afterwards, etc.
In view of these considerations, if you feel disposed to go further into the matter, I should be grateful if you would furnish me with more convincing reasons why hypnotic treatment must be dispensed with; and explain how to do without it, or with what to replace it in such cases. Were I convinced, I would give it up as you have done, but what convinced you has, so far, not convinced me. Si duo faciunt idem, non est idem.
Now I want to consider another important matter to which you alluded, but only cursorily, and to put one question: behind the neurotic phantasies there stands, you say, almost always (or always) a moral conflict which belongs to the present moment. That is perfectly clear to me. Research and therapy coincide; their task is to search out the foundations and the rational solution of the conflict. Good. But can the rational solution always be found? "Reasons of expediency" so often bar the way, varying with the type of patient, for instance children, young girls and women from "pious" catholic or protestant families. Again that accursed opportunism! A colleague of mine was perfectly right when he began to give sexual enlightenment to a young French patient, a boy who was indulging in masturbation. Whereupon, like one possessed, in rushed a bigoted grandmother, and a disagreeable sequel ensued. How to act in these and similar cases? What to do in cases where there arises a moral conflict between love and duty (a conflict in married life)?—or in general between instinct and moral duty? What to do in the case of a girl afflicted with hysterical or anxiety symptoms, needing love and having no chance to marry, either because she cannot find a suitable man or because, being "well-connected," she wants to remain chaste? Simply try to get rid of the symptoms by suggestion? But that is wrong as soon as one knows of a better way. How to reconcile these two consciences: that of the man who does not want to confine his fidelity to truth within his own four walls; and that of the doctor who must cure, or if he dare not cure according to his real convictions (owing to opportunist-motives), must at least procure some alleviation? We live in the present, but with the ideas and ideals of the future. That is our conflict. How resolve it?