I confess frankly were I doing your work I should often be in difficulties if I relied only on psychoanalysis. I can scarcely imagine a general practice, especially in a sanatorium, with no other means than psychoanalysis. At Dr. Bircher's sanatorium in Zürich the principle of psychoanalysis is adopted completely by several of the assistants, but a whole series of other important educative influences are also brought to bear upon the patients, without which matters would probably go very badly. In my own purely psychoanalytic practice I have often regretted that I could not avail myself of the other methods of re-education that are naturally at hand in an institution—this, of course, only in special cases where one is dealing with extremely uncontrolled, uneducated persons. Which of us has shown any disposition to assert that we have discovered a panacea? There are cases in which psychoanalysis operates less effectively than any other known method. But who has ever claimed psychoanalysis should be employed in every sort of case, and on every occasion? Only a fanatic could maintain such a view. Patients for whom psychoanalysis is suitable have to be selected. I unhesitatingly send cases I think unsuitable to other doctors. As a matter of fact this does not happen often, because patients have a way of sorting themselves out. Those who go to an analyst usually know quite well why they go to him and not to some one else. However, there are very many neurotics well suited for psychoanalysis. In these matters every scheme must be looked at in due perspective. It is never quite wise to try to batter down a stone wall with your head. Whether simple hypnotism, the cathartic treatment, or psychoanalysis shall be used, must be determined by the conditions of the case and the preference of the particular doctor. Every doctor will obtain the best results with the instrument he knows best.
But, barring exceptions, I must say definitely that for me, and for my patients also, psychoanalysis proves itself better than any other method. This is not merely a matter of feeling; from manifold experiences I know many cases can indeed be cured by psychoanalysis which are refractory to all other methods of treatment. I have many colleagues whose experience is the same, even men engaged exclusively in practice. It is scarcely to be supposed that a method altogether contemptible would meet with so much support.
When once psychoanalysis has been applied in a suitable case, it is imperative that rational solutions of the conflicts should be found. The objection is at once advanced that many conflicts are intrinsically incapable of solution. That view is sometimes taken because only an external solution is thought of—and that, at bottom, is no real solution at all. If a man cannot get on with his wife he naturally thinks the conflict would be solved if he were to marry some one else. If such marriages are examined they are seen to be no solution whatsoever. The old Adam enters upon the new marriage and bungles it just as badly as he did the earlier one. A real solution comes only from within, and only then because the patient has been brought to a new standpoint.
Where an external solution is possible no psychoanalysis is necessary; in seeking an internal solution we encounter the peculiar virtues of psychoanalysis. The conflict between "love and duty" must be solved upon that particular plane of character where "love and duty" are no longer in opposition, for indeed they really are not so. The familiar conflict between "instinct and conventional morality" must be solved in such a way that both factors are taken satisfactorily into account, and this is only possible through a change of character. This change psychoanalysis can bring about. In such cases external solutions are worse than none at all. Naturally the particular situation dictates which road the doctor must ultimately follow, and what is then his duty. I regard the conscience-searching question of the doctor's remaining true to his scientific convictions as rather unimportant in comparison with the incomparably weightier question as to how he can best help his patient. The doctor must, on occasion, be able to play the augur. Mundus vult decipi—but the cure is no deception. It is true that there is a conflict between ideal conviction and concrete possibility. But we should ill prepare the ground for the seed of the future, were we to forget the tasks of the present, and sought only to cultivate ideals. That is but idle dreaming. Do not forget that Kepler cast horoscopes for money, and that countless artists have been condemned to work for wages.
V.
From Dr. Loÿ.
9th February, 1913.
The selfsame passion for truth possesses us both when we think of pure research, and the same desire to cure when we are considering therapy. For the scientist, as for the doctor, we desire the fullest freedom in all directions, fullest freedom to select and use the methods which promise the best fulfilment of their ends at any moment. Here we are at one; but there remains a postulate we must establish to the satisfaction of others if we want recognition for our views.
First and foremost there is a question that must be answered, an old question asked already in the Gospels: What is Truth? I think clear definitions of fundamental ideas are most necessary. How shall we contrive a working definition of the conception "Truth"? Perhaps an allegory may help us.