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Psychoanalysis and suggestion
Psychoanalysis and Suggestion An Historical and Logical Analysis By
THOSIAS S. SZASZ
H E N F R E U D F I R S T tried to define psychoanalysis, he did so by contrasting it with suggestion. ~' For a long time it was not at all clear just w h a t psychoanalytic t r e a t m e n t was; it was only clear that it was not suggestion. This dichotomy has been widely accepted. Indeed, even today most opinions on psychoanalysis fall into two groups, one emphasizing the differences between the two procedures, the other the similarities. Implicitly, t h e a d h e r e n t s of both-of these views accept the premise that the two methods are comparable. In this essay, I propose to show that the connections b e t w e e n psychoanalysis and suggestion (including hypnosis) are naainly historical; the two procedures are logically distinct and hence incommensurable.
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TI-IE HISTOlqlCAL
BACKGROUND
W h e n Freud's interest first turned from neurology t o psychiatry, the terms p s y c h o t h e r a p y and s u g g e s t i o n were synonymous. E v e r y t-ype ot: psychot h e r a p y then practiced w a s suggestivei hypnotic suggestion being the para, digm case. The r e a s o n s for this are not h a r d to find. At:ter all, p s y c h o t h e r a p y was simply t.he exercise of the physician's Fersonal influence u p o n the patient. The nature of the influence depended, then as now, on t h e kind of relationship that existed betxveen them. Hence, the i m p o r t a n t question is: W h a t sort of physician-patient relationship was considered correct in late n i n e t e e n t h cen't-ury Vienna? "M~e answer is: O n e t h a t was benevolently a u t o c r a t i c and patriarchal. The model of the physician-patient relationship was the relationship b e t w e e n f a t h e r and child (or king and subject). Obviously, a n y t h i n g that transpires in this kind of social situation is b o u n d to be more or less suggestive. Given this sort of setting, F r e u d could not help b u t compare psychoanalysis with suggestion. This strategy m a y have been unavoidable; nevertheless, it proved to have a c~qppling effect on subsequent attempts to clarify ¢3~e nature of the psychoanalytic procedure. X,Vhy was this so? Because b y ,comparing psychoanalysis with suggestion, we become committed to certain logical consequences inherent in making comparisons. First, there is the implication that the two procedures belong in the s a m e logical class; if riley did not, no comparison would be possible. Both psychoanalysis and suggestion are thus considered treatments for mental illnesses (the former especiallv for hysteria); both belong in the class called "therapy for mental disease." There is tile additional implication that these "'treatments" are similar to theral)eutic procedures in various branches of medicine. In sum, the comparison between psychoanalysis and sl~ggestion forces analysis into a :271 C().MVm~1n.:NstvE I'SY(:mAT~Y, \rOt- 4, No. 4 ( A u c u s T ) , 1963
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T I I O ~ , I A S S. S Z A S Z
m e d i c a l = t h e r a p e u t i c c o n c e p t u a l f r a m e w o r k into w h i c h it does n o t fit. Instead of e m p h a s i z i n g the differences b e t w e e n file concepts of t r e a t m e n t a n d p sy c h o a n a lysis, analysis was de f ine d as a f or m of treatment. I n d e e d , it was c l a i m e d to be a m o r e effective t h e r a p y - - e s p e c i a l l y a ga inst some types of m e n t a l illness --than any thus far discovered. It is not surprising, then, that s u b s e q u e n t efforts to establish p s y c h o a n a l y s i s as an essentially n o n - m e d i c a l e d u c a t i o n a l enterprise h a v e e n c o u n t e r e d grave difficulties. ACTIVITY A N D AXJTHOmTY I N
PSYCFIOTI-IEItAP2t"
T h e central fallacy b e h i n d the f r e q u e n t a r g u m e n t s p u r p o r t i n g to s h o w t h a t p s y c h o a n a l y s i s a n d sugges tion are " b a s i c a l l y similar" o r " b a s i c a l l y d i g ferent'" lies in c o n f u s i n g two i m p o r t a n t concepts; n a m e l y , i n f l u e n c i n g a person a n d h a v i n g u n l i m i t e d Control over him. An a n a l o g y d r a w n from political affairs sh o uld prove i l l u m i n a t i n g . Let us i m a g i n e a person w h o is a c q u a i n t e d with only one type of political system, say h_ereditary f e u d a l m o n a r c h y , Such an i n d i v i d u a l m a y b e l i e v e that the only k i n d of g o v e r n m e n t a l control pos s ib le is t h a t w h i c h he knows, a n d h e m a y thus try to c o n t r a s t social order u n d e r a sovereign m o n m ' e h w i t h social chaos u n d e r political a na r c hy. This is the d i c h o t o m y of c o m p l e t e control versus no control. H o w w o u l d such a person j u d g e a r e p u b l i c a n t y p e of political syste m in w h i c h elective officials g o v e r n ? On the one h a n d , lle m i g h t say t h a t the r e p u b l i c a n a n d m o n a r c h i c a l systems are b a s i c a l l y similar: in b o t h , p e o p l e are seriously h a m p e r e d from d o i n g w h a t t h e y please. H e m i g h t even m a i n tain that the two s y s t e m s are e q u a l l y d e s p o t i c a n d that there are no s i g n i f cant dilt:erences b e t w e e n them. O n the o t h e r h a n d , h e m i g h t also a r g u e that the two systems are polar opposites: in absolute m o n a r c h i e s p e o p l e are p o t e n t i a l slaves, w h e r e a s in constitutional r e p u b l i c s the y enjoy g u a r a n t e e d freedoms. T h i s a n a l o g y is i n t e n d e d to show w h a t h a p p e n s w h e n we conceive of control as an all-or-none p h e n o m e n o n , a n d m a k e no provision for situations of p a r t i a l control. F r e u d and m a n y others, we m a y recall, we r e p r o n e to a r g u e that the p s y c h o a n a l y s t exerts no control over his p a t i e n t at all: he merely h e l p s the p a t i e n t b e c o m e conscious of certain desires or ideas o f w h i c h h e h a d p r e v i o u s l y b e e n u n a w a r e . This is false. T h e p s y c h o a n a l y s t does influence his patient. O u r task is to find out h o w h e does so, a n d p e r h a p s also h o w a n a l y t i c influence differs fro m other kinds. W e m a y n o w turn to our political analogy, and s u b s t i t u t e suggestion ( h y p nosis) for sovereign power, a n d p s y c h o a n a l y s i s for the more l i m i t e d p o w e r of a constitutional form of g o v e r n m e n t . T h e ' v i e w that p s y c h o a n a l y s i s is m e r e l y a form of suggestion or p e r s u a s i o n is like the anarchist's a r g u m e n t a b o u t d e m o c a r c y : since d e m o c r a t i c states also d e p r i v e persons of certain freedoms, there is no "'real" difference 1)etween d e m o c r a t i c a nd totalitarian governments. On the other h a n d , the opinion that p s y c h o a n a l y s i s is just the opposite of suggestion, that the one is e v e r y t h i n g that the other is not, is r a t h e r like the n a i v e a r g u m e n t a b o u t f r e e d o m in a d e m o c r a c y : since there is no personal despot to harass people, e v e r y o n e is free. Such freedom, however, is far from complete; it is l i m i t e d b y w h a t the la w permits. Laws, of
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com-se, m a y b e good o r b a d , f a v o r a b l e to o n e group b u t u n f a v o r a b l e to another. F r e e d o m , like control, is a m a t t e r of d e g r e e . T h e t w o o p p o s i n g Views .....t h a t the a n a l y s t is eitlaer a p e r s u a d e r o r a m i r r o r .... a r e e q u a l l y false. T h e : d i g ficulty lies, as I t r i e d to s h o w , in r e g a r d i n g c o n t r o l s or i n f l n e n c e s , w h e t h e r in politics or in p s y c h i a t r y , as e i t h e r t o t a l o r n o n e x i s t e n t . I n this v i e w , o n e is e i t h e r e n s l a v e d or f r e e ; e i t h e r b r a i n w . a s h e d b y a n i n h ' u s i v e t h e r a p i s t or c o m p l e t e l y u n i n f l u e n c e d b y a n o n d i r e c t i v e screen. In actual practice, we are usually confronted with relationships falling s o m e w h e r e b e t w e e n flmse e x t r e m e s . T h e conta-ols e x e r c i s e d : b y various g o v e r n m e n t s d i f f e r in k i n d a n d d e g r e e ; so do t h e controls e x e r t e d b y therapists. I f w e w i s h t o d e e p e n o u r u n d e r s t a n d i n g of v a r i o u s m e t h o d s of psyclaot h e r a p y , w e m u s t define, a c c u r a t e l y a n d h o n e s t l y , t h e n a t u r e of t h e r e l a t i o n ship b e t w e e n t h e r a p i s t a n d p a t i e n t . T h e c e n t r a l q u e s t i o n is: "What a r e t h e rules t h a t g o v e r n t h e g a m e of p s y c h o t h e r a p y ? E a c h s e t of rules defines a d i f f e r e n t g a m e ....t h a t is, a d i f f e r e n t t y p e of p s y c h o t h e r a p y . W h e t h e r one m e t h O d o f p s y c h o t h e r a p y c a n b e c o m p a r e d to a n o t h e r will d e p e n d o n h o w r a d i e a l l y t h e t w o differ; it ~is r e a s o n a b l e to c o m p a r e c o n t r a c t - b r i d g e to a u c tion b r i d g e , b u t n o t to c h e c k e r s . I d o n o t i n t e n d , in t h i s e s s a y , to d i s c u s s t h e r u l e s : of e i t h e r t h e l l y p n o t i c g a m e o r of t h e p s y c h o a n a l y t i c g a m e i : I t s h o u l d Suffice to n o t e tlaat t h e s u g g e s t i v e t h e r a p i s t : a s p i r e s to a n d w i e l d s m o r e p o w e r o v e r liis patient than does t h e a n a l y t i c therapist~ t h e m e t h o d s f l i n t e a c h e m p l o y s I differ a c c o r d i n g l y . I n sum,: I s u b m i t :flaat p s y c h o a n a l y s i s a n d s u g g e s t i o n a r e n o t i d e n t i c a l ; n o r is o n e t h e a n t i t h e s i s of t h e Other; :hOG e v e n , is: t h e r e m u c h s i m i l a r i t y b e t ~ v e e n them. ILLUSTRATIVE EXCEI~PTS FI~O~ TI~E LITERATURE F r e u d ' s first s y s t e m a t i c a t t e m p t to d e s c r i b e p s y c h o a n a l y s i s m ~ d to - dist i n g u i s h it f r o m o t h e r m e t h o d s of p s y d m t h e r a p y w a s m a d e in his p a p e r "'On p s y c h o t h e r a p y , ( 1 9 0 4 ) . A f t e r c o m m e n t i n g b r i e f l y on his [ w o r k w i t h B r e u e r , a n d on t h e i n e f f e c t i v e n e s s of p h y s i c a l m e t h o d s of t r e a t m e n t in t h e n e u r o s e s , F r e u d l a u n c h e d i n t o a d i s c u s s i o n of v a r i o u s m e t h o d s o f p s y c h o t l a e r a p y . P e r h a p s in o r d e r to c o n c i l i a t e his a u d i e n c e b e f o r e i n t r o d u c i n g his o w ~ i d e a s , h e w e n t so f a r a s to s a y t h a t : I despise none of these methods and would use them all in appropriate circumstances. If I have actually come to confine myself to one foma of treatmerit, to the method which Breuer called c a t h a r t i G but whid~ I myself prefer to call "analytic," it is because I have allowedmyself tO be influenced by purely subjective motives (p. 259). z H e t h e n w e n t on to d e p l o r e t h e c o n f u s i o n of t h e a n a l y t i c m e t h o d w i t h " ' h y p n o t i c t r e a t m e n t b y suggestion,'" a n d o f f e r e d t h e f o l l o w i n g e x p l a n a t i o n f o r their r e s p e c t i v e m o d e s of a c t i o n : There is, actually, the greatest possible antithesis betnveen snggestive and analytie teehniquemthe same antithesis which, ira regard to the fine arts, the great Leonardo da Vinci stnnmed np in the formulas: 7~er Lqa di porre and p e r vi a d i let~,re, Painting, Says
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L e o n a r d o , w o r k s p e r via. eli p o r r e , f o r it a p p l i e s a s u l ) s t a n e e - - p a r t i c l e s of c o l o u r - - w l a e r e t h e r e w a s n o t h i n g b e f o r e , on t h e e o l o u r l e s s c a n v a s ; s c u l p t u r e , h o w e v e r , p r o c e e d s p e r t~ia eli left:are, s in ce it t a k e s a w a y f r o m t h e b l o c k o f s t o n e all t h a t h i d e s t h e s u r f a c e o f t h e s t a t u e c o n t a i n e d in it+. In a s i m i l a r w a y , t h e t e c h n i q u e o f s u g g e s t i o n a i m s at p r o c e e d i n g p e r ~ i a d i porr~+; it is n o t c o n c e r n e d w i t h t h e ori gi n, s t r e n g t h a n d m e a n i n g o f t h e m o r b i d s y m p toms, b ~ t i n s t e a d , it s t q ) e r i n l p o s e s s o m e t h i n g - - a s u g g e s t i o n - - i n t h e e x p e c t a t i o n t h a t it will b e s t r o n g e n o u g h to r e s t r a i n t h e p a t h o g e n i c i d e a f r o m c o m i n g to e x p r e s s i o n . A n a l y t i c t h e r a p y , on t h e o t h e r h a n d , d o e s not s e e k to a d d or to i n t r o d u c e a n y t h i n g n e w , b u t to tak e a w a y s o m e t h i n g , to | ) r i n g o u t s o m e t h i n g ; a n d to this e n d c o n c e r n s itself w i t h fl~e g en es is o f t h e m o r b i d s y m p t o m s a n d t h e p s y c h i c a l c o n t e x t o f t h e p a t h o g e n i c i d e a w h i c h it seeks to r e m o v e ( p p . 2 6 0 - 2 6 1 ) .
This is a r a t h e r u n f o r t u n a t e analo~v...~. It h a s b e e n s e i z e d u p o n 1)v. philosophers a n d r i g h t l y so: to p o i n t u p the e p i s t e m o l o g i e a l l y u n c l e a r s t a t u s of t h e p s y c h o a n a l y t i c m e t h o d . I:.n an essay, e n t i t l e d " T h e logical s t a t u s of psychoanalysis," Toulmin wrote: A l t h o u g h it is fifty y e a r s s i n c e F r e u d ' s p i o n e e r w o r k , a n d a l t h o u g h p s y e h o - a n a l y t i e t e c h n i q u e s ar e in r e g u l a r t h e r a p e u t i c use, t h e p o s i t i o n of p s y c h o a n a l y s i s an an i n t e l l e c t u a l disc i p l i n e is still n o t c s t a l ) l i s h e d . It m a y t h e r e f o r e lye p r u d e n t f o r o n e to e n q u i r e h o w f a r t h e m y s t e r y s u r r o u n d i n g t h e s u b j e c t c.omes f r o m a d e s i r e to ask t h e w r o n g q~mstions a b o u t it, a n d h o w far a l~etter m ~ de, ; s t a ndi ng o f t h e n a t u r e a n d ]~gie o f p s y c h o a n a l y s i s will, b y itself, dispel t h e f o g ( p . 13:2). in
T h e c r u x of t h e m a t t e r , a c c o r d i n g to T o u h n i n , is this: \ V h y d o p s y c h o - a n a l y t i c c u r e s w o r k at all? A n d a r e t h e y b e t t e r in p r i n c i p l e t h a n d r u g s , or h y p n o t i c s u g g e s t i o n ? N o, s a y t h e s c e p t i c s , just a m i x t u r e of flukes a n d c o m m o n sense. Yes, says F r e u d , bttt p r o c e e d s to g i v e this t t o w e r y a n d m e t a p h o r i c a l e x p l a n a t i o n o f w h y they are better (p. 188).
C i t i n g t h e a n a l o g y a b o u t p a i n t i n g a n d s c u l p t i n g , T o u l m i n aptly, o b s e r v e d that, " I t c o u l d h a r d l y lye said t h a t a given b l o c k of s t o n e c o n t a i n e d o n l y o n e s t a t u e , so w e are left w i t h t h e a p p a r e n t l y a r b i t r a r y n a t u r e "of a n a l y t i c p s y c h o t h e r a p y still u n e x p l a i n e d ( p. 1 3 4 ) . XVe s h o u l d go f u r t h e r . Plainly, it is r a t h e r silly, to s a y t h a t the p a i n t e r a d d s , w h e r e a s t h e Sculptor r e m o v e s , m a t e r i a l s u b s t a n c e s , a n d t h a t t h e s e a c t i o n s c h a r a c t e r i z e t h e i r w o r k . T h e m e t a p h o r c o u l d b e u s e d e q u a l l y well to p r o v e t h e o p p o s i t e of w h a t F r e u d a r g u e d . T h u s , o n e c o u l d a s s e r t t h a t t h e h y p n o t i s t , like t h e s c u l p t o r , r e m o v e s s o m e t h i n g , n a m e l y , s y m p t o m s ; w h e r e a s t h e a n a l y s t , like t h e p a i n t e r , a d d s s o m e t h i n g , n a m e l y , i n t e r p r e t a t i o n s . B o t h a r g u m e n t s a r e n o n s e n s i c a l a n d o n l y s h o w h o w u n f o r t u n a t e this m e t a p h o r is. Since F r e u d , h o w e v e r , w a s v e r y a s t u t e in s e l e c t i n g s t r i k i n g a n d s u i t a b l e a n a l o g i e s , it m i g h t b e p r u d e n t to ask w h y h e c h o s e s u c h a p o o r o n e in this instance. I I e d i d so, it w o u l d s e e m , t ) e c a u s e h e o v e r r e a c h e d in his d e s i r e to e m p h a size the n o n i n t e r f e r i n g c h a r a c t e r of a n a l y s i s , in c o n t r a s t to t h e i n t r u s i v e n a t u r e of h y p n o s i s . T h e s a m e i d e a w a s e x p r e s s e d l a t e r w h e n t h e a n a l y s t w a s c o m p a r e d to a s c r e e n a n d a m i r r o r . T h e a n a l y s t ' s n o n i n t e r f e r e n c e w i t h t h e patient's personality his so-called n e u t r a l i t y was thus systematically exagg e r a t e d in the t I m o r e t i e r e c o n s t r u c t i o n of the a n a l y t i c process.
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A l t h o u g h F r e u d ' s w ish to dissociate h i m s e l f f r om the autlaoritative-suggestive meflaods of p s y c h o t h e r a p y p o p u l a r in his d a y is u n d e r s t a n d a b l e a n d l a u d a b l e , it r e s u l t e d in a grave distortion of the thee1 T of p s y c h o a n a l y t i c treatment. I n s t e a d of focusing on the analyst's d i s t i n c t i v e i n f l u e n c e on his patient, u n d u e e m p h a s i s was p l a c e d on d i s t i n g u i s h i n g p s y c h o a n a l y s i s fi'om suggestion. P e r h a p s n o t h i n g else was possible tat the time. If so, w e s h o u l d at least r e c o g n i z e the c o m p l i c a t i o n s w h i c h this n e g a t i v e a p p r o a c h to defini n g p s y c l m a n a l y s i s in terms of w h a t it is not h a s caused, mad w h i c h w e m u s t correct if w e are to m a k e progress. I n a s m u c h as F r e u d first de f ine d sugge stive p s y c h o t h e r a p y as "additive'" a n d int~'usive a n d p s y c h o a n a l y s i s as the opposite of suggestion, he was comp e l l e d to i n s i s t that the a n a l y t i c m e t h o d "adds n o t h i n g " to the patient, b u t only "brilags out" w h a t is in h i m . T h i s v i e w of a n a l y t i c the r a py, w h i c h F r e u d l i k e n e d to the work of the archeologist, was n e c e s s i t a t e d lest, if anyt h i n g b e s u p p l i e d b y the a n a l y t i c therapist, his work b e b r a n d e d as , n o t h i n g b u t suggestion.'" F r e u d was thus e n s n a r e d in a logical trap that r e c o g n i z e d only two classes, A a n d B. A c c o r d i n g to this view, all ite ms to b e classified b e l o n g e i t h e r in class A or in class B. T h e relation b e t w e e n the two c la sse s i s expressed b y t]ae f o r m u l a : "'Anything that is not a m e m b e r of class A is a m e m b e r of class B, a n d vice versa.'" T h e l i m i t a t i o n s of such a v i e w m a y b e i l l u s t r a t e d b y cons i d e r i n g w h a t it w o u l d do to our u n d e r s t a n d i n g of la ngua ge s. L e t us s a y t h a t p e o p l e w h o s e n a t i v e tongue is E n g l i s h fall in class A, a n d those w h o s e native t o n g u e is not E n g l i s h fall in class B. This classification m a y b e u s e f u l for e m p h a s i z i n g the differences b e t w e e n the E n g l i s h langt.~age a n d all others, b u t for n o t h i n g e l s e . I n d e e d , it w i l l p r e v e n t us f r om d i f f e r e n t i a t i n g a m o n g p e o p l e w hose n a t i v e tongue is F r e n c h , H u n g a r i a n , I t a l i a n , Spanish, a n d so forth; t h e y w ill all b e l u m p e d toge the r in one c l a s s as n o n - E n g l i s h . F r e u d d i d s o m e t h i n g very similar. H e p o s t u l a t e d t h a t all p s y c h o t h e r a p i e s u s e d prior to the i n t r o d u c t i o n of the a n a l y t i c m e t h o d w e r e suggestive, a n d m a y tlms b e p l a c e d in one class. A n d he d e f i n e d p s y c l m a n a l y s i s as v i r t u a l l y a n y meflaod of p s y c h o t h e r a p y w h i c h f a l l s outside this class. This i s r a t h e r l i k e . d e s c r i b i n g the F r e n c h l a n g u a g e b y s a y i n g it is not English. T h e r e are, h o w e v e r , m a n y l a n g u a g e s that are not E n g l i s h , o n l y o n e of w h i c h is F r e n c h ; likewise, t h e r e are m a n y n o n - s u g g e s t i v e p s y c h o t h e r a p i e s , only One o f w h i c h is p y s c h o a n a l y s i s . 13ut h o w shall w e k n o w w h i c h is p s y c h o a n a l y s i s , so lo n g as w e do not identi~y it positively, b u t say only: "'It is n o t this, a n d n o t that." A l t h o u g h d a t i n g f r o m the e a r l y histor y of p s y c h o a n a l y s i s , the distin c tio n b e t w e e n analysis a n d suggesiSon has p r o v e d p o p u l a r a n d lasting. T h e b e s t theoreticians of p s y c h o a n a l y s i s h a v e used it. T h a t these i d e a s are still t i m e l y m a y b e illusta-ated b y F e n i c h e l ' s discussion of the n a t u r e of p s y c h o t h e r a p y . H e wrote: T h e n e u r o t i c c o n f l i c t is t h e b a s i s o f e v e r y p s y c h o n e u r o s i s . O n l y a c h a n g e relations of the constituents of this conflict can change the neurosis. In c o u l d b e d o n e in t w o w a y s ; e i t h e r b y a n i n c r e a s e o r b y a n a n n u h n e n t o f t h e c r e a s e m a y e n d e a v o r to r e p r e s s a n e w t h e w h o l e n e u r o s i s as a d e r i v a t i v e o f warded off previously. An annuhnent of tim defense would, of course, end flict.
in t h e d ~ m a m i e principle, this defense. An inwhat has been tim whole con-
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The first type of "'therapy" is represented 1)y the old-fashioned suggestion-hypnosis in which the authority of the doctor prohil)its the patient from producing symptoms. The same temporary effect may also be attempted in an indirect way t)y techniques that increase tim patient's anxiety and thereby his reI)ressions, by threats, maltreatments, sy~bolic castrations, and rel)roachcs. ~leasures of this kind try to induce the patient to "repress the whole neurosis." The second type, the treatment l)y means of full annuhnent of the repression, is ,represented by psychoanalysis, in which the undoing of the repression enal)les the infantile sexual strivings to participate in the development of the personality and to turn into satisJqab|e adult sexuality. Seemingly, these two methods are strictly contradictory, l~ut actually many compromises e.xis't between tlaem in the sense that an undoing of a repression might be tlsed for tim intensification of some other repression, or that an increase in a specific repression might result in the creation of some less distorted derivatives tat some other place, l)ifferent types of this kind have been discussed as causes ~)f spontaneolJs recoveries or improw:~ments. Nearly all psyehotherapies are of such compromise nature and represent an art i/~cial imitation of the spontaneous improvements (I)P..556-557).1 H o w e v e r a t t r a c t i v e this f o r n m l a t i < m m i g h t a p p e a r , i t is n o t p r a c t i c a l . T i l e o r i g i n a l d i c h o t o m y b e t w e e n a n a l y s i s a n d s u g g e s t i o n is m e r e l y e l a b o r a t e d : n o w i t is 1 ) e t w e e n d r i v e a n d d e f e n s e , e x p r e s s i o n a n d r e p r e s s i o n . B u t it is a l l to n o a v a i l . P s y d 3 o t h e r a p y is a s e t of a c t i o n s . I t c a n n o t b e d e s c r i b e d solel y b y r e f e r e n c e to t h e p a t i e n t ' s i n t r a p s y c h i c o r g a n i z a t i o n a n d its m o d i f i c a t i o n s ; t h e a c t i o n s of t h e t h e r a p i s t a n d of t h e p a t i e n t m u s t a l s o b e s p e c i f i e d , l~.~r' F e n i c h e l s a y s t h a t n e u r o s i s is t h e r e s u l t o f a c o n f l i c t b e t w e e n d r i v e a n d d e fense. If one increases the defenses, h e does s u g g e s t i o n ; if one d i m i n i s h e s t h e m , p s y c h o a n a l y s i s . A g a i n , a n u n t e n a b l e d i c l m t o m y , o n e of s e v e r a l t h a t a n a l y s t s c r e a t e d , a n d h a d to a b a n d o n w h e n its s h o r t c o m i n g s p r o v e d t o o e m barrassing. I n t h e f o l l o w i n g list of t h e r a p i e s , e a c h is d e f i n e d b y c o n t T a s t i n g it w i t h its o p p o s i t e , a n d e a c h p a i r s e e m s to b e a d e r i v a t i v e o f t h e o r i g i n a ! d i c h o t o m y between psychoanalysis and suggestion. 1. l t e p r e s s i v e v e r s u s e x p r e s s i v e p s y c h o t h e r a p y ; -9,. S u p e r f i c i a l v e r s u s d e e p p s y d m t h e r a p y ; 3. S u p p o r t i v e v e r s u s u n c o v e r i n g p s y c h o t h e r a p y ; 4. I d a n a l y s i s v e r s u s e g o a n a l y s i s ; 5. ~,lodifled a n a ] y s i s v e r s u s b a s i c m o d e l t e c h n i q u e ; 6. R a p p o r t t h e r a p y v e r s u s p s y c h o a n a | y s i s . T h e first m e m b e r of e a c h p a i r is c o n s i d e r e d to b e a r e l a t i v e l y i n f e r i o r folma of t h e r a p y , u s e d e i t h e r b e c a u s e t h e p a t i e n t is "'too s i c k , " or b e c a u s e t h e t h e r a p i s t is t o o i n e p t ; t h e s e c o n d m e m b e r o f e a c h p a i r is r e g a r d e d as t h e d e s i r a b l e , r a t i o n a l , n o n i n t r u s i v e t h e r a p y . Yet, n o n e of t h e s e d e s c r i p t i o n s o f p s y c h o t h e r a p y is o f m u c h v a l u e . A c t u a l l y , e a c h d i e h o t o n a y is a d o d g e , a n e a s y w a y o u t o f a d i f f i c u l t s i t u a t i o n . E a c h of t h e d i c h o t o m i e s offers a j u d g m e n t , in p l a c e o f a d e s c r i p t i o n : o n e f o r m o f p s y c h o t h e r a p y is d e p r e c a t e d , a n o t h e r e x t o l l e d . N o n e offers a n a d e q u a t e s p e c i f i c a t i o n of t h e r u l e s of t h e t h e r a l ) e u t i e g a m e . \ V e h a v e t h u s b e c o m e u s e d to j u d g i n g p s y c h o t h e r a p y i n s t e a d of d e s c r i b i n g it. I n d e e d , w e h a v e v i r t u a l l y r u n o u t o f n o n - e v a l u a t i v e a d j e c t i v e s , a n d s h a l l
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h a v e to work h a r d on c r e a t i n g some. Ca]|ing psychoflaerapy suggestive, or supportive, or superficial is to c o n d e m n it; c a l l i n g i t analytSc, or d y n a m i c , or deep is to praise it. N o n e of these adjectives, w h i c h a r e often used to m o d i f y the noun " p s y c h o t h e r a p y , " possess a p p r e c i a b l e i n f o r m a t i o n a l content. F o r tliis too, F r e u d m i g h t have laid the ground. I]e wrote: I t is v e r y p r o b a b l e , too, t h a t t h e a p p l i c a t i o n of o u r t h e r a p y to n u m b e r s will c o m p e l us to alloy the pure gohl of analysis p l e n t i f u l l y w i t h th¢~ copper of dirvct" ,.uggesticn~; a n d e v e n h y p n o t i c i n f l t m n e e m i g h t flnd a p l a c e in it a g a i n , as it has in t h e t r e a t m e n t o f w a r n e u r o s e s ( p: z]02; nay i t a l i c s ) . 5
Tim g o o d - b a d d i c h o t o m y runs t h r o t l g h all t h e s u b s e q u e n t pairings that I h a v e listed. In s p e a k i n g of repressive t h e r a p y versus expressive t h e r a p y , it is clear that the former is c o n s i d e r e d bad, or at least not p a r t i c u l a r l y g o o d ; this m u c h is implicit in the term "repressionS" once it i s i d e n t i f i e d a s a potentially p a t h o g e n i c psychological m e c h a n i s m . Psychoanalysis t]ius b e c a m e e q u a t e d , in t h e p o p u l a r mind, with t h e a d v o c a c y of the t h r o w i n g o f f o f repressions. H a v i n g c r e a t e d a nonoperational, j u d g m e n t a l definition of analysis, F r e u d was soon c a l l e d u p o n to defend it a g a i n s t misinteq~retations, for example, b y "wild analysts., A n d yet, the " i n t e r p r e t a t i o n s " of the "%vild analysts" w e r e surely n o t s u g g e s t i v e , i n t h e t r a d i t i o n a l s e n s e ; n e i t h e r ' w e r e t h e y analytic, h o w e v e r ; a n d F r e u d lind to r e p u d i a t e them as i n c o r r e c t uses o f h i s technique. T h e h i s t o r y of psychoanalysis has been a s u c c e s s i o n of one cycle of misdefinition, m i s u n d e r s t a n d i n g , a n d correction, followed b y another. E a c h misdefinition a n d m i s u n d e r s t a n d i n g was created, at l e a s t partly, becausefa.utede-mie~tx, p s y c h o a n a l y s i s was defined negatively; b y c o n t r a s t i n g i t w i t h one or a n o t h e r d e p r e c i a t e d m o d e l o f p s y c h o t h e r a p y . In so d o i n g , a n a l y s i s was identified w i t h c e r t a i n features alien to i t ; i n v a r i a b l y tlaese c r e a t e d difl-iculties. F o r example, the c 0 n t r a s t b e t w e e n superficial a n d d e e p a n a l y s i s tends t o drive the t h e r a p i s t to a relative neglect of c u r r e n t life prolglem s a n d to a c o l r e s p o n d i n g o v e r e m p h a s i s of c h i l d h o o d events a n d fantasies. This error w a s corrected in two ways. First, b y the : w o r k of tile Sullivanian a n d culturalist schools of analysts, w h o r e e m p h a s i z e d t h e significance of c u r r e n t events in the life of the p a t i e n t (as if t h e y c o u l d e V e r h a v e been u n i m p o r t a n t ) ° S e c o n d , within the p s y c h o a n a l y t i c m o v e m e n t itself, t h e r e was a t u r n i n g a w a y f r o m id analysis a n d t h e analysis o f drives, a n d t o w a r d ego analysis a n d the analysis 3f defenses. PSYCI.][OANALYSIS AND SUGGESTION: A I:~EAPPllAISAL
T h e a r g u m e n t s a b o u t the antiflmtical n a t u r e of p s y c h o a n a l y s i s a n d suggestion h a v e r e m a i n e d v i r t u a l l y unehm,~,ged since the b e g i n n i n g of t h e century. s Glover s t a t e d : I t u s e d to b e s a i d . . . t h a t h o w e v e r m u c h p s y e h o t h e r a p e u t i e t e c h n i q u e s a p p e a r e d t o v a r y t h e r e w e r e f u n d a m e n t a l l y o n l y t w o m a i n varieties o f p s y c h o t h e r a p y , n a m e l y ; p s y c h o analysis a n d s u g g e s t i o n ( p . 7 5 ) . 9
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A c c o r d i n g l y , G l o v c r d i c h o t o m i z c s r a p p o r t t h e r a p i e s as a g a i n s t p s y c h o analysis, t h e f o r m e r ,tsing t r a n s f e r e n c e s , t h e l a t t e r analyzing t h e m . W h i l e of c o u r s e I a g r e e w i t h this, s u c h f o r m u l a t i o n s d o n o t c a r r y us m u c h f u r t h e r t h a n w h e r e w e w e r e , say, in 1904. To b e sure, this is to b e p r e f e r r e d to t h e v i e w of m a n y o t h e r c o n t e m p o r a r y d y n a m i c psyclaia~-/sts a n d p s y c h o a n a l y s t s , w h o w o u l d , if t h e y could, t u r n t h e clock b a c k to b e f o r e 1893. T h u s , F r a n k "2 states, as if it w e r e an e s t a b l i s h e d fact, t h a t all p s y c h o t h e r a p y is p e r s u a s i o n . A l e x a n d e r d i s p o s e s of a n a l y s i s b y c o n v e r t i n g it i n t o a c o e r c i v e exercise of "'corrective e m o t i o n a l e:qgeriences,'" bIitlaely a s s u m i n g t h a t t h e p s y c h o t h e r a p i s t is t h e p r o p e r p e r s o n to d e c i d e t h e sort of "correction'" t h e p a t i e n t n e e d s . In k e e p i n g w i t h this t r e n d , c o e r c i v e t r a i n i n g a n a l y s e s a r e a c c e p t e d as a m a t t e r of c o u r s e : in s u c h "'analyses," t h e s e l e c t i o n of t h e r a p i s t , t h e l e n g t h of t h e r a p y , a n d s o m e t i m e s e v e n the "'need" f o r s e c o n d or t h i r d "'analyses" m a y b e e s t a b l i s h e d b y a n a l y s t s or a n a lytic o r g a n i z a t i o n s , t h e a n a l y s a n d o n l y h a v i n g t h e o p t i o n of sulgmitting or n o t s u b m i t t i n g to t h e c o n d i t i o n s set for h i m . I t w o u l d s e e m t h e n t h a t in c o n t e m p o r a r y h a n d s , w h a t u s e d to b e p s y c h o analysis, h a s in f a c t b e c o m e s u g g e s t i o n J 2"~-' 1 t h i n k w e c o u l d express this idea better, however, by saying that the original idea behind psychoanalytic t r e a t m e n t w a s to f o s t e r t h e p a t i e n t ' s a u t o n o m y . TM I t t h u s d i f f e r e d h ' o m s u g g e s tion, w h i c h a i m e d a t f o s t e r i n g the p a t i e n t ' s h e t e r o n o m y as e x e m p l i f i e d b y t h e h y p n o t i c s i t u a t i o n , t h e classic p a r a d i g m of a h e t e r o n o m o u s r e l a t i o n s h i p . This v i e w g r e a t l y simplifies m a t t e r s . F o r if t h e a i m of t h e r a p y is a u t o n o m y , it should be obvious that h eteronomous methods must be eschewed: w e cann o t force s o m e o n e n o t to n e e d us or to b e i n d e p e n d e n t o')f us. This e x p l a i n s w h y - ~ i f a n a l y s i s is c o n c e i v e d as a t h e r a p y d e d i c a t e d to t h e e x p a n s i o n of t h e p a t i e n t ' s a u t o n o m y ......all the " ' d y n a m i e p s y c h o t h e r a p i e s , " " ' a d a p t a t i o n a l psychod)nmmics,'" a n d o t h e r modified psychoanalyst s w h i c h G l o v e r a p t l y l u m p s t o g e t h e r as " ' r a p p o r t t h e r a p i e s " a r e i n d e e d a b a n d o m n e n t s of p s y c h o analysis. F i n a l l y , f r o m this p o i n t of v i e w , t h e a s s e r t i o n t h a t all p s y c h o t h e r a p y is p e r s u a s i o n or s u g g e s t i o n m a y b e C l e a r l y s e e n f o r w h a t it is, n a m e l y , a p i e c e of p e r n i c i o u s n o n s e n s e . S u c h a v i e w d e n i e s t h e v a l u e of s e l f - d e t e r m i n a tion a n d r e s p o n s i b i l i t y , a n d t h e f a c t t h a t , h o w e v e r difficult to a c h i e v e , nonc o e r c i v e h u m a n r e l a t i o n s h i p s a r e possible. PSYCHOANALYSIS AS EDUCATION
T h e r e i s little d o u b t t h a t b y d e f i n i n g p s y c h o a n a l y s i s as n o t - s u g g e s t i o n , F r e u d c o n t r i b u t e d h e a v i l y to t h e c o n c e p t u a l c o n f u s i o n a b o u t t h e n a t u r e of p s y c h o a n a l y t i c p s y c h o t l ~ e r a p y . Yet, h e also c o n t r i b u t e d to its clarification, b y a s s e r t i n g t h a t p s y c h o a n a l y s i s is a f o r m of e d u c a t i o n . "~7 I n this m o d e l , w e h a v e at our c o m m a n d a powerful t o o l for e l u c i d a t i n g the characteristic f e a t u r e s o f v a r i o u s f o r m s of p s y c h o t h e r a p y . O n e ~ , p e of p s y c h o t h e r a p y c a n n o w b e said to differ f r o m ~a n o t h e r as o n e t y p e of e d u c a t i o n a l r e l a t i o n s h i p or situation differs f r o m a n o t h e r . E d u c a t i o n is a b r o a d c a t e g o r y in w h i c h m a n y d i v e r s e u n d e r t a k i n g s m a y p r o p e r l y b e i n c l u d e d . V a r i o u s m e t h o d s of p s y c h o t h e r a p y s h o u l d b e r e g a r d e d as b e l o n g i n g n o t in the g e n e r a l c l a s s c a l l e d " ' t r e a t m e n t , " b u t in t h a t c a l l e d " ' e d u c a t i o n . " E l u c i d a t i n g the p r e c i s e w o r k i n g s of a n y p a r t i c u l a r m e t h o d o f
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p s y c h o t h e r a p y , b y a s c e r t a i n i n g tile sort of eq, u c a t i o n a l ,influence it exerts o n t h e p a t i e n t , w o u l d b e a ~,ast u n d e r t a k i n g ; /it n e e d n o t c o n c e r n tis h e r e . B y w a y of i/]Iustration, howe, ver, I s h o u l d li~/e to briefly c h a r a c t e r i z e Sugg e s t i v e p s y c h o t h e r a p y in e d u c a t i o n a l t e r m s . I n d o c t r i n a t i o n is a t y p e of e d u c a t i o n : the t e a c h e r c o e r c e s t h e s t u d e n t to l e a r n s o m e t h i n g a g a i n s t t h e ]atter's wishes; tile s t u d e n t s" l e a r n i n g ~ o r p e r s o n ality change is o f t e n a n a d v a n t a g e o n l y t~l, t h e t e a c h e r . C e n s o r s h i p is also a k i n d of e d u c a t i o n : the s t u d e n t is t a u g h t {rot t o k n o w s o m e t h i n g . T h i s outc o m e also m a y b e of a d v a n t a g e o n l y t o t h e t e a c h e r . I n d o c t r i n a t i o n a n d cens o r s h i p a r e s i m i l a r to h y p n o t i c - s u g g e s t i v e p s y c h o t h e r a p y . I h a v e t r i e d p r e v i o u s l y to d e s c r i b e p s y c h o a n a l y t i c t a ' e a t m e n t ill e d u c a t i o n a l t e r m s , a°.~'~ I ann n o w e n g a g e d in t h e l a r g e r t a s k of a t t e n a p t i n g to d e t a i l in full tl~e s o r t of t e a c h i n g a n d ] e a r n i n g t h a t c o n s t i t u t e t h i s process. S ifh,ilt IAIIY T h e r e l a t i o n b e t w e e n p s y c h o a n a l y s i s a n d s u g g e s t i o n ( h y p n o s i s ) w a s critically e x a m i n e d . Tlae thesis w a s o f f e r e d t h a t t h e c o n n e c t i o n b e t w e e n t h e m i s e s s e n t i a l l y historical; t h e y a r e l o g i c a l l y d i s t i n c t o p e r a t i o n s , a n d a r e t h e r e f o r e incominensurable. T h e s i m i l a r i t i e s t h a t .seem to m a k e a n a l y s i s a n d s u g g e s t i o n c o m p a r a b l e a r e d e c e p t i v e : t h e y r e s t o n t h e f a c t t h a t b o t h h a v e b e e n d e f i n e d as therapeutic activit'ies, aimed a t alleviating or curing mental s y m p t o m s or illness. O p e r a t i o n a l l y , h o w e v e r , a n a l y s i s mad s u g g e s H o n d i f f e r r a d i c a l l y in t h e k i n d s of activities, in w h i c h t h e r a p i s t a n d p a t i e n t e n g a g e w h e n d o i n g or u n d e r g o i n g o n e or a n o t h e r " ' t h e r a p y ; " t h e y also differ in t h e k i n d s of a u t h o r i t y a n d p o w e r t h a t t h e t h e r a p i s t a s s u m e s in the. t w o r e l a t i o n s h i p s : T h e d i l e m m a p o s e d b y t h e a l l e g e d Similarities a n d d i f f e r e n c e s b e ~ v e e n analysis and suggestion may be resolved by viewing both methods, and o t h e r f o r m s of p s y c h o t h e r a p y as well, a s e d u c a t i o n a l r a f f l e r t h a n as tllerap e u t i c enteqgrises. REFERENCES
1. Fenichel, O. : T h e Psychoanalytic Theory of Neurosis. New York, \V. \V. Norton, !945. 2. Frank, J . : Persuasion and Healing. Baltimore, j o l m s Hopkins l~ress, 19611 3. Freud, S-: o n p s y c h o t h e r a p y (1904). In, The standard Edition Of the Complet e Psychological works of Sigqnund F r e u d , Vol. VII, pp. 255-268. London, Hogarth Press, 1953. 4 . - - : A: General Inti'oduction to Psychoanalysis (!916-17). G a r d e n City, N. Y., ~ a r d e n City Publishing CO., 1943. 5 . - - : Turnings i n the ways of psychor analytic therapy (1919). Collected Papers, :Vol. I I , pp. 399~-402: London, Hogarth Press, 1948. 6. ~ : The Question of Lay Analysis
7. 8. 9. 10. 1I.
(1926). I1~ The Standard Edition of the Complete Psyeli010gieal ~¥0rks of Sigmund Freud, )tel. XX, pp. 179258. iLondon, ~Hogarth Press, 1959. --: An' Outline of PsyChoanalysis (1938). N e w York, Norton, 1949. Gitelson, NI.: Psychoanalyst, :u. s. A., 195,5. Am. J, Psychiat. 112:7007 1956. Clover, E.: Psychoanalysi s and psychotherapy: Brit. j. ~,/: Psydlok 33:7382, 1960. Szasz, T: S.: On tim theory of psychoanalytic treatment. Internat. J. PsychoanaL 38:166-182, 1957. - - : T i l e ,N'lyth 0f Nlental Illness: Foundations of ~i Theory o£ Personal Conduct. New :York, Hoeber-Harper, 1961.
"I']IO~IAS S. SZASZ
280 12. ~ :
The prol~lem of priwicy in trainlug analysis: selections :from a questionnaire s t u d y of p~,choanalytic pr~ctict~s and opinions. Psyehialry 25: 195-207, 1962. 13. ~ : IJuman naturt~ ~.md psychotlael'llpy: a further contribution to th,e theory of autonomous psychotherap)/. Conll). Psychiat. 3:268--283, 1962. I.t. ~ : 19sychoanal.vtic trcut ment ~!s education. A.M.A. Arch. Gen. Psyd~iat.
9:46-52, 1963. 15. ~ , and Ninniroff, !t. A.: A qut~sliolmairc study of psychoanalytic practict's and opinions. J. Ncrv. & Mont. Dis. ht p~'ess. 16. Touhnin, S.: "l'h<~ logical stat,~s of psycho-armlysis. In. M. M a e l ) o ~ d d , ed.: Pl!ilosophy and Analysis, 17- t 3 2 139. New York, Philo:~ophic~d Library, 1954.
TAonms S. Szasz, M. D,, Izrofe.s;s'or of l~sychiatry, State (.In,iversify of New York, Upstate Medical Center, Syracuse, N. Y.
THOSIAS S. SZASZ
H E N F R E U D F I R S T tried to define psychoanalysis, he did so by contrasting it with suggestion. ~' For a long time it was not at all clear just w h a t psychoanalytic t r e a t m e n t was; it was only clear that it was not suggestion. This dichotomy has been widely accepted. Indeed, even today most opinions on psychoanalysis fall into two groups, one emphasizing the differences between the two procedures, the other the similarities. Implicitly, t h e a d h e r e n t s of both-of these views accept the premise that the two methods are comparable. In this essay, I propose to show that the connections b e t w e e n psychoanalysis and suggestion (including hypnosis) are naainly historical; the two procedures are logically distinct and hence incommensurable.
W
TI-IE HISTOlqlCAL
BACKGROUND
W h e n Freud's interest first turned from neurology t o psychiatry, the terms p s y c h o t h e r a p y and s u g g e s t i o n were synonymous. E v e r y t-ype ot: psychot h e r a p y then practiced w a s suggestivei hypnotic suggestion being the para, digm case. The r e a s o n s for this are not h a r d to find. At:ter all, p s y c h o t h e r a p y was simply t.he exercise of the physician's Fersonal influence u p o n the patient. The nature of the influence depended, then as now, on t h e kind of relationship that existed betxveen them. Hence, the i m p o r t a n t question is: W h a t sort of physician-patient relationship was considered correct in late n i n e t e e n t h cen't-ury Vienna? "M~e answer is: O n e t h a t was benevolently a u t o c r a t i c and patriarchal. The model of the physician-patient relationship was the relationship b e t w e e n f a t h e r and child (or king and subject). Obviously, a n y t h i n g that transpires in this kind of social situation is b o u n d to be more or less suggestive. Given this sort of setting, F r e u d could not help b u t compare psychoanalysis with suggestion. This strategy m a y have been unavoidable; nevertheless, it proved to have a c~qppling effect on subsequent attempts to clarify ¢3~e nature of the psychoanalytic procedure. X,Vhy was this so? Because b y ,comparing psychoanalysis with suggestion, we become committed to certain logical consequences inherent in making comparisons. First, there is the implication that the two procedures belong in the s a m e logical class; if riley did not, no comparison would be possible. Both psychoanalysis and suggestion are thus considered treatments for mental illnesses (the former especiallv for hysteria); both belong in the class called "therapy for mental disease." There is tile additional implication that these "'treatments" are similar to theral)eutic procedures in various branches of medicine. In sum, the comparison between psychoanalysis and sl~ggestion forces analysis into a :271 C().MVm~1n.:NstvE I'SY(:mAT~Y, \rOt- 4, No. 4 ( A u c u s T ) , 1963
9_,72
T I I O ~ , I A S S. S Z A S Z
m e d i c a l = t h e r a p e u t i c c o n c e p t u a l f r a m e w o r k into w h i c h it does n o t fit. Instead of e m p h a s i z i n g the differences b e t w e e n file concepts of t r e a t m e n t a n d p sy c h o a n a lysis, analysis was de f ine d as a f or m of treatment. I n d e e d , it was c l a i m e d to be a m o r e effective t h e r a p y - - e s p e c i a l l y a ga inst some types of m e n t a l illness --than any thus far discovered. It is not surprising, then, that s u b s e q u e n t efforts to establish p s y c h o a n a l y s i s as an essentially n o n - m e d i c a l e d u c a t i o n a l enterprise h a v e e n c o u n t e r e d grave difficulties. ACTIVITY A N D AXJTHOmTY I N
PSYCFIOTI-IEItAP2t"
T h e central fallacy b e h i n d the f r e q u e n t a r g u m e n t s p u r p o r t i n g to s h o w t h a t p s y c h o a n a l y s i s a n d sugges tion are " b a s i c a l l y similar" o r " b a s i c a l l y d i g ferent'" lies in c o n f u s i n g two i m p o r t a n t concepts; n a m e l y , i n f l u e n c i n g a person a n d h a v i n g u n l i m i t e d Control over him. An a n a l o g y d r a w n from political affairs sh o uld prove i l l u m i n a t i n g . Let us i m a g i n e a person w h o is a c q u a i n t e d with only one type of political system, say h_ereditary f e u d a l m o n a r c h y , Such an i n d i v i d u a l m a y b e l i e v e that the only k i n d of g o v e r n m e n t a l control pos s ib le is t h a t w h i c h he knows, a n d h e m a y thus try to c o n t r a s t social order u n d e r a sovereign m o n m ' e h w i t h social chaos u n d e r political a na r c hy. This is the d i c h o t o m y of c o m p l e t e control versus no control. H o w w o u l d such a person j u d g e a r e p u b l i c a n t y p e of political syste m in w h i c h elective officials g o v e r n ? On the one h a n d , lle m i g h t say t h a t the r e p u b l i c a n a n d m o n a r c h i c a l systems are b a s i c a l l y similar: in b o t h , p e o p l e are seriously h a m p e r e d from d o i n g w h a t t h e y please. H e m i g h t even m a i n tain that the two s y s t e m s are e q u a l l y d e s p o t i c a n d that there are no s i g n i f cant dilt:erences b e t w e e n them. O n the o t h e r h a n d , h e m i g h t also a r g u e that the two systems are polar opposites: in absolute m o n a r c h i e s p e o p l e are p o t e n t i a l slaves, w h e r e a s in constitutional r e p u b l i c s the y enjoy g u a r a n t e e d freedoms. T h i s a n a l o g y is i n t e n d e d to show w h a t h a p p e n s w h e n we conceive of control as an all-or-none p h e n o m e n o n , a n d m a k e no provision for situations of p a r t i a l control. F r e u d and m a n y others, we m a y recall, we r e p r o n e to a r g u e that the p s y c h o a n a l y s t exerts no control over his p a t i e n t at all: he merely h e l p s the p a t i e n t b e c o m e conscious of certain desires or ideas o f w h i c h h e h a d p r e v i o u s l y b e e n u n a w a r e . This is false. T h e p s y c h o a n a l y s t does influence his patient. O u r task is to find out h o w h e does so, a n d p e r h a p s also h o w a n a l y t i c influence differs fro m other kinds. W e m a y n o w turn to our political analogy, and s u b s t i t u t e suggestion ( h y p nosis) for sovereign power, a n d p s y c h o a n a l y s i s for the more l i m i t e d p o w e r of a constitutional form of g o v e r n m e n t . T h e ' v i e w that p s y c h o a n a l y s i s is m e r e l y a form of suggestion or p e r s u a s i o n is like the anarchist's a r g u m e n t a b o u t d e m o c a r c y : since d e m o c r a t i c states also d e p r i v e persons of certain freedoms, there is no "'real" difference 1)etween d e m o c r a t i c a nd totalitarian governments. On the other h a n d , the opinion that p s y c h o a n a l y s i s is just the opposite of suggestion, that the one is e v e r y t h i n g that the other is not, is r a t h e r like the n a i v e a r g u m e n t a b o u t f r e e d o m in a d e m o c r a c y : since there is no personal despot to harass people, e v e r y o n e is free. Such freedom, however, is far from complete; it is l i m i t e d b y w h a t the la w permits. Laws, of
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com-se, m a y b e good o r b a d , f a v o r a b l e to o n e group b u t u n f a v o r a b l e to another. F r e e d o m , like control, is a m a t t e r of d e g r e e . T h e t w o o p p o s i n g Views .....t h a t the a n a l y s t is eitlaer a p e r s u a d e r o r a m i r r o r .... a r e e q u a l l y false. T h e : d i g ficulty lies, as I t r i e d to s h o w , in r e g a r d i n g c o n t r o l s or i n f l n e n c e s , w h e t h e r in politics or in p s y c h i a t r y , as e i t h e r t o t a l o r n o n e x i s t e n t . I n this v i e w , o n e is e i t h e r e n s l a v e d or f r e e ; e i t h e r b r a i n w . a s h e d b y a n i n h ' u s i v e t h e r a p i s t or c o m p l e t e l y u n i n f l u e n c e d b y a n o n d i r e c t i v e screen. In actual practice, we are usually confronted with relationships falling s o m e w h e r e b e t w e e n flmse e x t r e m e s . T h e conta-ols e x e r c i s e d : b y various g o v e r n m e n t s d i f f e r in k i n d a n d d e g r e e ; so do t h e controls e x e r t e d b y therapists. I f w e w i s h t o d e e p e n o u r u n d e r s t a n d i n g of v a r i o u s m e t h o d s of psyclaot h e r a p y , w e m u s t define, a c c u r a t e l y a n d h o n e s t l y , t h e n a t u r e of t h e r e l a t i o n ship b e t w e e n t h e r a p i s t a n d p a t i e n t . T h e c e n t r a l q u e s t i o n is: "What a r e t h e rules t h a t g o v e r n t h e g a m e of p s y c h o t h e r a p y ? E a c h s e t of rules defines a d i f f e r e n t g a m e ....t h a t is, a d i f f e r e n t t y p e of p s y c h o t h e r a p y . W h e t h e r one m e t h O d o f p s y c h o t h e r a p y c a n b e c o m p a r e d to a n o t h e r will d e p e n d o n h o w r a d i e a l l y t h e t w o differ; it ~is r e a s o n a b l e to c o m p a r e c o n t r a c t - b r i d g e to a u c tion b r i d g e , b u t n o t to c h e c k e r s . I d o n o t i n t e n d , in t h i s e s s a y , to d i s c u s s t h e r u l e s : of e i t h e r t h e l l y p n o t i c g a m e o r of t h e p s y c h o a n a l y t i c g a m e i : I t s h o u l d Suffice to n o t e tlaat t h e s u g g e s t i v e t h e r a p i s t : a s p i r e s to a n d w i e l d s m o r e p o w e r o v e r liis patient than does t h e a n a l y t i c therapist~ t h e m e t h o d s f l i n t e a c h e m p l o y s I differ a c c o r d i n g l y . I n sum,: I s u b m i t :flaat p s y c h o a n a l y s i s a n d s u g g e s t i o n a r e n o t i d e n t i c a l ; n o r is o n e t h e a n t i t h e s i s of t h e Other; :hOG e v e n , is: t h e r e m u c h s i m i l a r i t y b e t ~ v e e n them. ILLUSTRATIVE EXCEI~PTS FI~O~ TI~E LITERATURE F r e u d ' s first s y s t e m a t i c a t t e m p t to d e s c r i b e p s y c h o a n a l y s i s m ~ d to - dist i n g u i s h it f r o m o t h e r m e t h o d s of p s y d m t h e r a p y w a s m a d e in his p a p e r "'On p s y c h o t h e r a p y , ( 1 9 0 4 ) . A f t e r c o m m e n t i n g b r i e f l y on his [ w o r k w i t h B r e u e r , a n d on t h e i n e f f e c t i v e n e s s of p h y s i c a l m e t h o d s of t r e a t m e n t in t h e n e u r o s e s , F r e u d l a u n c h e d i n t o a d i s c u s s i o n of v a r i o u s m e t h o d s o f p s y c h o t l a e r a p y . P e r h a p s in o r d e r to c o n c i l i a t e his a u d i e n c e b e f o r e i n t r o d u c i n g his o w ~ i d e a s , h e w e n t so f a r a s to s a y t h a t : I despise none of these methods and would use them all in appropriate circumstances. If I have actually come to confine myself to one foma of treatmerit, to the method which Breuer called c a t h a r t i G but whid~ I myself prefer to call "analytic," it is because I have allowedmyself tO be influenced by purely subjective motives (p. 259). z H e t h e n w e n t on to d e p l o r e t h e c o n f u s i o n of t h e a n a l y t i c m e t h o d w i t h " ' h y p n o t i c t r e a t m e n t b y suggestion,'" a n d o f f e r e d t h e f o l l o w i n g e x p l a n a t i o n f o r their r e s p e c t i v e m o d e s of a c t i o n : There is, actually, the greatest possible antithesis betnveen snggestive and analytie teehniquemthe same antithesis which, ira regard to the fine arts, the great Leonardo da Vinci stnnmed np in the formulas: 7~er Lqa di porre and p e r vi a d i let~,re, Painting, Says
274
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S.
SZASZ
L e o n a r d o , w o r k s p e r via. eli p o r r e , f o r it a p p l i e s a s u l ) s t a n e e - - p a r t i c l e s of c o l o u r - - w l a e r e t h e r e w a s n o t h i n g b e f o r e , on t h e e o l o u r l e s s c a n v a s ; s c u l p t u r e , h o w e v e r , p r o c e e d s p e r t~ia eli left:are, s in ce it t a k e s a w a y f r o m t h e b l o c k o f s t o n e all t h a t h i d e s t h e s u r f a c e o f t h e s t a t u e c o n t a i n e d in it+. In a s i m i l a r w a y , t h e t e c h n i q u e o f s u g g e s t i o n a i m s at p r o c e e d i n g p e r ~ i a d i porr~+; it is n o t c o n c e r n e d w i t h t h e ori gi n, s t r e n g t h a n d m e a n i n g o f t h e m o r b i d s y m p toms, b ~ t i n s t e a d , it s t q ) e r i n l p o s e s s o m e t h i n g - - a s u g g e s t i o n - - i n t h e e x p e c t a t i o n t h a t it will b e s t r o n g e n o u g h to r e s t r a i n t h e p a t h o g e n i c i d e a f r o m c o m i n g to e x p r e s s i o n . A n a l y t i c t h e r a p y , on t h e o t h e r h a n d , d o e s not s e e k to a d d or to i n t r o d u c e a n y t h i n g n e w , b u t to tak e a w a y s o m e t h i n g , to | ) r i n g o u t s o m e t h i n g ; a n d to this e n d c o n c e r n s itself w i t h fl~e g en es is o f t h e m o r b i d s y m p t o m s a n d t h e p s y c h i c a l c o n t e x t o f t h e p a t h o g e n i c i d e a w h i c h it seeks to r e m o v e ( p p . 2 6 0 - 2 6 1 ) .
This is a r a t h e r u n f o r t u n a t e analo~v...~. It h a s b e e n s e i z e d u p o n 1)v. philosophers a n d r i g h t l y so: to p o i n t u p the e p i s t e m o l o g i e a l l y u n c l e a r s t a t u s of t h e p s y c h o a n a l y t i c m e t h o d . I:.n an essay, e n t i t l e d " T h e logical s t a t u s of psychoanalysis," Toulmin wrote: A l t h o u g h it is fifty y e a r s s i n c e F r e u d ' s p i o n e e r w o r k , a n d a l t h o u g h p s y e h o - a n a l y t i e t e c h n i q u e s ar e in r e g u l a r t h e r a p e u t i c use, t h e p o s i t i o n of p s y c h o a n a l y s i s an an i n t e l l e c t u a l disc i p l i n e is still n o t c s t a l ) l i s h e d . It m a y t h e r e f o r e lye p r u d e n t f o r o n e to e n q u i r e h o w f a r t h e m y s t e r y s u r r o u n d i n g t h e s u b j e c t c.omes f r o m a d e s i r e to ask t h e w r o n g q~mstions a b o u t it, a n d h o w far a l~etter m ~ de, ; s t a ndi ng o f t h e n a t u r e a n d ]~gie o f p s y c h o a n a l y s i s will, b y itself, dispel t h e f o g ( p . 13:2). in
T h e c r u x of t h e m a t t e r , a c c o r d i n g to T o u h n i n , is this: \ V h y d o p s y c h o - a n a l y t i c c u r e s w o r k at all? A n d a r e t h e y b e t t e r in p r i n c i p l e t h a n d r u g s , or h y p n o t i c s u g g e s t i o n ? N o, s a y t h e s c e p t i c s , just a m i x t u r e of flukes a n d c o m m o n sense. Yes, says F r e u d , bttt p r o c e e d s to g i v e this t t o w e r y a n d m e t a p h o r i c a l e x p l a n a t i o n o f w h y they are better (p. 188).
C i t i n g t h e a n a l o g y a b o u t p a i n t i n g a n d s c u l p t i n g , T o u l m i n aptly, o b s e r v e d that, " I t c o u l d h a r d l y lye said t h a t a given b l o c k of s t o n e c o n t a i n e d o n l y o n e s t a t u e , so w e are left w i t h t h e a p p a r e n t l y a r b i t r a r y n a t u r e "of a n a l y t i c p s y c h o t h e r a p y still u n e x p l a i n e d ( p. 1 3 4 ) . XVe s h o u l d go f u r t h e r . Plainly, it is r a t h e r silly, to s a y t h a t the p a i n t e r a d d s , w h e r e a s t h e Sculptor r e m o v e s , m a t e r i a l s u b s t a n c e s , a n d t h a t t h e s e a c t i o n s c h a r a c t e r i z e t h e i r w o r k . T h e m e t a p h o r c o u l d b e u s e d e q u a l l y well to p r o v e t h e o p p o s i t e of w h a t F r e u d a r g u e d . T h u s , o n e c o u l d a s s e r t t h a t t h e h y p n o t i s t , like t h e s c u l p t o r , r e m o v e s s o m e t h i n g , n a m e l y , s y m p t o m s ; w h e r e a s t h e a n a l y s t , like t h e p a i n t e r , a d d s s o m e t h i n g , n a m e l y , i n t e r p r e t a t i o n s . B o t h a r g u m e n t s a r e n o n s e n s i c a l a n d o n l y s h o w h o w u n f o r t u n a t e this m e t a p h o r is. Since F r e u d , h o w e v e r , w a s v e r y a s t u t e in s e l e c t i n g s t r i k i n g a n d s u i t a b l e a n a l o g i e s , it m i g h t b e p r u d e n t to ask w h y h e c h o s e s u c h a p o o r o n e in this instance. I I e d i d so, it w o u l d s e e m , t ) e c a u s e h e o v e r r e a c h e d in his d e s i r e to e m p h a size the n o n i n t e r f e r i n g c h a r a c t e r of a n a l y s i s , in c o n t r a s t to t h e i n t r u s i v e n a t u r e of h y p n o s i s . T h e s a m e i d e a w a s e x p r e s s e d l a t e r w h e n t h e a n a l y s t w a s c o m p a r e d to a s c r e e n a n d a m i r r o r . T h e a n a l y s t ' s n o n i n t e r f e r e n c e w i t h t h e patient's personality his so-called n e u t r a l i t y was thus systematically exagg e r a t e d in the t I m o r e t i e r e c o n s t r u c t i o n of the a n a l y t i c process.
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A l t h o u g h F r e u d ' s w ish to dissociate h i m s e l f f r om the autlaoritative-suggestive meflaods of p s y c h o t h e r a p y p o p u l a r in his d a y is u n d e r s t a n d a b l e a n d l a u d a b l e , it r e s u l t e d in a grave distortion of the thee1 T of p s y c h o a n a l y t i c treatment. I n s t e a d of focusing on the analyst's d i s t i n c t i v e i n f l u e n c e on his patient, u n d u e e m p h a s i s was p l a c e d on d i s t i n g u i s h i n g p s y c h o a n a l y s i s fi'om suggestion. P e r h a p s n o t h i n g else was possible tat the time. If so, w e s h o u l d at least r e c o g n i z e the c o m p l i c a t i o n s w h i c h this n e g a t i v e a p p r o a c h to defini n g p s y c l m a n a l y s i s in terms of w h a t it is not h a s caused, mad w h i c h w e m u s t correct if w e are to m a k e progress. I n a s m u c h as F r e u d first de f ine d sugge stive p s y c h o t h e r a p y as "additive'" a n d int~'usive a n d p s y c h o a n a l y s i s as the opposite of suggestion, he was comp e l l e d to i n s i s t that the a n a l y t i c m e t h o d "adds n o t h i n g " to the patient, b u t only "brilags out" w h a t is in h i m . T h i s v i e w of a n a l y t i c the r a py, w h i c h F r e u d l i k e n e d to the work of the archeologist, was n e c e s s i t a t e d lest, if anyt h i n g b e s u p p l i e d b y the a n a l y t i c therapist, his work b e b r a n d e d as , n o t h i n g b u t suggestion.'" F r e u d was thus e n s n a r e d in a logical trap that r e c o g n i z e d only two classes, A a n d B. A c c o r d i n g to this view, all ite ms to b e classified b e l o n g e i t h e r in class A or in class B. T h e relation b e t w e e n the two c la sse s i s expressed b y t]ae f o r m u l a : "'Anything that is not a m e m b e r of class A is a m e m b e r of class B, a n d vice versa.'" T h e l i m i t a t i o n s of such a v i e w m a y b e i l l u s t r a t e d b y cons i d e r i n g w h a t it w o u l d do to our u n d e r s t a n d i n g of la ngua ge s. L e t us s a y t h a t p e o p l e w h o s e n a t i v e tongue is E n g l i s h fall in class A, a n d those w h o s e native t o n g u e is not E n g l i s h fall in class B. This classification m a y b e u s e f u l for e m p h a s i z i n g the differences b e t w e e n the E n g l i s h langt.~age a n d all others, b u t for n o t h i n g e l s e . I n d e e d , it w i l l p r e v e n t us f r om d i f f e r e n t i a t i n g a m o n g p e o p l e w hose n a t i v e tongue is F r e n c h , H u n g a r i a n , I t a l i a n , Spanish, a n d so forth; t h e y w ill all b e l u m p e d toge the r in one c l a s s as n o n - E n g l i s h . F r e u d d i d s o m e t h i n g very similar. H e p o s t u l a t e d t h a t all p s y c h o t h e r a p i e s u s e d prior to the i n t r o d u c t i o n of the a n a l y t i c m e t h o d w e r e suggestive, a n d m a y tlms b e p l a c e d in one class. A n d he d e f i n e d p s y c l m a n a l y s i s as v i r t u a l l y a n y meflaod of p s y c h o t h e r a p y w h i c h f a l l s outside this class. This i s r a t h e r l i k e . d e s c r i b i n g the F r e n c h l a n g u a g e b y s a y i n g it is not English. T h e r e are, h o w e v e r , m a n y l a n g u a g e s that are not E n g l i s h , o n l y o n e of w h i c h is F r e n c h ; likewise, t h e r e are m a n y n o n - s u g g e s t i v e p s y c h o t h e r a p i e s , only One o f w h i c h is p y s c h o a n a l y s i s . 13ut h o w shall w e k n o w w h i c h is p s y c h o a n a l y s i s , so lo n g as w e do not identi~y it positively, b u t say only: "'It is n o t this, a n d n o t that." A l t h o u g h d a t i n g f r o m the e a r l y histor y of p s y c h o a n a l y s i s , the distin c tio n b e t w e e n analysis a n d suggesiSon has p r o v e d p o p u l a r a n d lasting. T h e b e s t theoreticians of p s y c h o a n a l y s i s h a v e used it. T h a t these i d e a s are still t i m e l y m a y b e illusta-ated b y F e n i c h e l ' s discussion of the n a t u r e of p s y c h o t h e r a p y . H e wrote: T h e n e u r o t i c c o n f l i c t is t h e b a s i s o f e v e r y p s y c h o n e u r o s i s . O n l y a c h a n g e relations of the constituents of this conflict can change the neurosis. In c o u l d b e d o n e in t w o w a y s ; e i t h e r b y a n i n c r e a s e o r b y a n a n n u h n e n t o f t h e c r e a s e m a y e n d e a v o r to r e p r e s s a n e w t h e w h o l e n e u r o s i s as a d e r i v a t i v e o f warded off previously. An annuhnent of tim defense would, of course, end flict.
in t h e d ~ m a m i e principle, this defense. An inwhat has been tim whole con-
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The first type of "'therapy" is represented 1)y the old-fashioned suggestion-hypnosis in which the authority of the doctor prohil)its the patient from producing symptoms. The same temporary effect may also be attempted in an indirect way t)y techniques that increase tim patient's anxiety and thereby his reI)ressions, by threats, maltreatments, sy~bolic castrations, and rel)roachcs. ~leasures of this kind try to induce the patient to "repress the whole neurosis." The second type, the treatment l)y means of full annuhnent of the repression, is ,represented by psychoanalysis, in which the undoing of the repression enal)les the infantile sexual strivings to participate in the development of the personality and to turn into satisJqab|e adult sexuality. Seemingly, these two methods are strictly contradictory, l~ut actually many compromises e.xis't between tlaem in the sense that an undoing of a repression might be tlsed for tim intensification of some other repression, or that an increase in a specific repression might result in the creation of some less distorted derivatives tat some other place, l)ifferent types of this kind have been discussed as causes ~)f spontaneolJs recoveries or improw:~ments. Nearly all psyehotherapies are of such compromise nature and represent an art i/~cial imitation of the spontaneous improvements (I)P..556-557).1 H o w e v e r a t t r a c t i v e this f o r n m l a t i < m m i g h t a p p e a r , i t is n o t p r a c t i c a l . T i l e o r i g i n a l d i c h o t o m y b e t w e e n a n a l y s i s a n d s u g g e s t i o n is m e r e l y e l a b o r a t e d : n o w i t is 1 ) e t w e e n d r i v e a n d d e f e n s e , e x p r e s s i o n a n d r e p r e s s i o n . B u t it is a l l to n o a v a i l . P s y d 3 o t h e r a p y is a s e t of a c t i o n s . I t c a n n o t b e d e s c r i b e d solel y b y r e f e r e n c e to t h e p a t i e n t ' s i n t r a p s y c h i c o r g a n i z a t i o n a n d its m o d i f i c a t i o n s ; t h e a c t i o n s of t h e t h e r a p i s t a n d of t h e p a t i e n t m u s t a l s o b e s p e c i f i e d , l~.~r' F e n i c h e l s a y s t h a t n e u r o s i s is t h e r e s u l t o f a c o n f l i c t b e t w e e n d r i v e a n d d e fense. If one increases the defenses, h e does s u g g e s t i o n ; if one d i m i n i s h e s t h e m , p s y c h o a n a l y s i s . A g a i n , a n u n t e n a b l e d i c l m t o m y , o n e of s e v e r a l t h a t a n a l y s t s c r e a t e d , a n d h a d to a b a n d o n w h e n its s h o r t c o m i n g s p r o v e d t o o e m barrassing. I n t h e f o l l o w i n g list of t h e r a p i e s , e a c h is d e f i n e d b y c o n t T a s t i n g it w i t h its o p p o s i t e , a n d e a c h p a i r s e e m s to b e a d e r i v a t i v e o f t h e o r i g i n a ! d i c h o t o m y between psychoanalysis and suggestion. 1. l t e p r e s s i v e v e r s u s e x p r e s s i v e p s y c h o t h e r a p y ; -9,. S u p e r f i c i a l v e r s u s d e e p p s y d m t h e r a p y ; 3. S u p p o r t i v e v e r s u s u n c o v e r i n g p s y c h o t h e r a p y ; 4. I d a n a l y s i s v e r s u s e g o a n a l y s i s ; 5. ~,lodifled a n a ] y s i s v e r s u s b a s i c m o d e l t e c h n i q u e ; 6. R a p p o r t t h e r a p y v e r s u s p s y c h o a n a | y s i s . T h e first m e m b e r of e a c h p a i r is c o n s i d e r e d to b e a r e l a t i v e l y i n f e r i o r folma of t h e r a p y , u s e d e i t h e r b e c a u s e t h e p a t i e n t is "'too s i c k , " or b e c a u s e t h e t h e r a p i s t is t o o i n e p t ; t h e s e c o n d m e m b e r o f e a c h p a i r is r e g a r d e d as t h e d e s i r a b l e , r a t i o n a l , n o n i n t r u s i v e t h e r a p y . Yet, n o n e of t h e s e d e s c r i p t i o n s o f p s y c h o t h e r a p y is o f m u c h v a l u e . A c t u a l l y , e a c h d i e h o t o n a y is a d o d g e , a n e a s y w a y o u t o f a d i f f i c u l t s i t u a t i o n . E a c h of t h e d i c h o t o m i e s offers a j u d g m e n t , in p l a c e o f a d e s c r i p t i o n : o n e f o r m o f p s y c h o t h e r a p y is d e p r e c a t e d , a n o t h e r e x t o l l e d . N o n e offers a n a d e q u a t e s p e c i f i c a t i o n of t h e r u l e s of t h e t h e r a l ) e u t i e g a m e . \ V e h a v e t h u s b e c o m e u s e d to j u d g i n g p s y c h o t h e r a p y i n s t e a d of d e s c r i b i n g it. I n d e e d , w e h a v e v i r t u a l l y r u n o u t o f n o n - e v a l u a t i v e a d j e c t i v e s , a n d s h a l l
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h a v e to work h a r d on c r e a t i n g some. Ca]|ing psychoflaerapy suggestive, or supportive, or superficial is to c o n d e m n it; c a l l i n g i t analytSc, or d y n a m i c , or deep is to praise it. N o n e of these adjectives, w h i c h a r e often used to m o d i f y the noun " p s y c h o t h e r a p y , " possess a p p r e c i a b l e i n f o r m a t i o n a l content. F o r tliis too, F r e u d m i g h t have laid the ground. I]e wrote: I t is v e r y p r o b a b l e , too, t h a t t h e a p p l i c a t i o n of o u r t h e r a p y to n u m b e r s will c o m p e l us to alloy the pure gohl of analysis p l e n t i f u l l y w i t h th¢~ copper of dirvct" ,.uggesticn~; a n d e v e n h y p n o t i c i n f l t m n e e m i g h t flnd a p l a c e in it a g a i n , as it has in t h e t r e a t m e n t o f w a r n e u r o s e s ( p: z]02; nay i t a l i c s ) . 5
Tim g o o d - b a d d i c h o t o m y runs t h r o t l g h all t h e s u b s e q u e n t pairings that I h a v e listed. In s p e a k i n g of repressive t h e r a p y versus expressive t h e r a p y , it is clear that the former is c o n s i d e r e d bad, or at least not p a r t i c u l a r l y g o o d ; this m u c h is implicit in the term "repressionS" once it i s i d e n t i f i e d a s a potentially p a t h o g e n i c psychological m e c h a n i s m . Psychoanalysis t]ius b e c a m e e q u a t e d , in t h e p o p u l a r mind, with t h e a d v o c a c y of the t h r o w i n g o f f o f repressions. H a v i n g c r e a t e d a nonoperational, j u d g m e n t a l definition of analysis, F r e u d was soon c a l l e d u p o n to defend it a g a i n s t misinteq~retations, for example, b y "wild analysts., A n d yet, the " i n t e r p r e t a t i o n s " of the "%vild analysts" w e r e surely n o t s u g g e s t i v e , i n t h e t r a d i t i o n a l s e n s e ; n e i t h e r ' w e r e t h e y analytic, h o w e v e r ; a n d F r e u d lind to r e p u d i a t e them as i n c o r r e c t uses o f h i s technique. T h e h i s t o r y of psychoanalysis has been a s u c c e s s i o n of one cycle of misdefinition, m i s u n d e r s t a n d i n g , a n d correction, followed b y another. E a c h misdefinition a n d m i s u n d e r s t a n d i n g was created, at l e a s t partly, becausefa.utede-mie~tx, p s y c h o a n a l y s i s was defined negatively; b y c o n t r a s t i n g i t w i t h one or a n o t h e r d e p r e c i a t e d m o d e l o f p s y c h o t h e r a p y . In so d o i n g , a n a l y s i s was identified w i t h c e r t a i n features alien to i t ; i n v a r i a b l y tlaese c r e a t e d difl-iculties. F o r example, the c 0 n t r a s t b e t w e e n superficial a n d d e e p a n a l y s i s tends t o drive the t h e r a p i s t to a relative neglect of c u r r e n t life prolglem s a n d to a c o l r e s p o n d i n g o v e r e m p h a s i s of c h i l d h o o d events a n d fantasies. This error w a s corrected in two ways. First, b y the : w o r k of tile Sullivanian a n d culturalist schools of analysts, w h o r e e m p h a s i z e d t h e significance of c u r r e n t events in the life of the p a t i e n t (as if t h e y c o u l d e V e r h a v e been u n i m p o r t a n t ) ° S e c o n d , within the p s y c h o a n a l y t i c m o v e m e n t itself, t h e r e was a t u r n i n g a w a y f r o m id analysis a n d t h e analysis o f drives, a n d t o w a r d ego analysis a n d the analysis 3f defenses. PSYCI.][OANALYSIS AND SUGGESTION: A I:~EAPPllAISAL
T h e a r g u m e n t s a b o u t the antiflmtical n a t u r e of p s y c h o a n a l y s i s a n d suggestion h a v e r e m a i n e d v i r t u a l l y unehm,~,ged since the b e g i n n i n g of t h e century. s Glover s t a t e d : I t u s e d to b e s a i d . . . t h a t h o w e v e r m u c h p s y e h o t h e r a p e u t i e t e c h n i q u e s a p p e a r e d t o v a r y t h e r e w e r e f u n d a m e n t a l l y o n l y t w o m a i n varieties o f p s y c h o t h e r a p y , n a m e l y ; p s y c h o analysis a n d s u g g e s t i o n ( p . 7 5 ) . 9
2,78
THO~,~AS S. SZASZ
A c c o r d i n g l y , G l o v c r d i c h o t o m i z c s r a p p o r t t h e r a p i e s as a g a i n s t p s y c h o analysis, t h e f o r m e r ,tsing t r a n s f e r e n c e s , t h e l a t t e r analyzing t h e m . W h i l e of c o u r s e I a g r e e w i t h this, s u c h f o r m u l a t i o n s d o n o t c a r r y us m u c h f u r t h e r t h a n w h e r e w e w e r e , say, in 1904. To b e sure, this is to b e p r e f e r r e d to t h e v i e w of m a n y o t h e r c o n t e m p o r a r y d y n a m i c psyclaia~-/sts a n d p s y c h o a n a l y s t s , w h o w o u l d , if t h e y could, t u r n t h e clock b a c k to b e f o r e 1893. T h u s , F r a n k "2 states, as if it w e r e an e s t a b l i s h e d fact, t h a t all p s y c h o t h e r a p y is p e r s u a s i o n . A l e x a n d e r d i s p o s e s of a n a l y s i s b y c o n v e r t i n g it i n t o a c o e r c i v e exercise of "'corrective e m o t i o n a l e:qgeriences,'" bIitlaely a s s u m i n g t h a t t h e p s y c h o t h e r a p i s t is t h e p r o p e r p e r s o n to d e c i d e t h e sort of "correction'" t h e p a t i e n t n e e d s . In k e e p i n g w i t h this t r e n d , c o e r c i v e t r a i n i n g a n a l y s e s a r e a c c e p t e d as a m a t t e r of c o u r s e : in s u c h "'analyses," t h e s e l e c t i o n of t h e r a p i s t , t h e l e n g t h of t h e r a p y , a n d s o m e t i m e s e v e n the "'need" f o r s e c o n d or t h i r d "'analyses" m a y b e e s t a b l i s h e d b y a n a l y s t s or a n a lytic o r g a n i z a t i o n s , t h e a n a l y s a n d o n l y h a v i n g t h e o p t i o n of sulgmitting or n o t s u b m i t t i n g to t h e c o n d i t i o n s set for h i m . I t w o u l d s e e m t h e n t h a t in c o n t e m p o r a r y h a n d s , w h a t u s e d to b e p s y c h o analysis, h a s in f a c t b e c o m e s u g g e s t i o n J 2"~-' 1 t h i n k w e c o u l d express this idea better, however, by saying that the original idea behind psychoanalytic t r e a t m e n t w a s to f o s t e r t h e p a t i e n t ' s a u t o n o m y . TM I t t h u s d i f f e r e d h ' o m s u g g e s tion, w h i c h a i m e d a t f o s t e r i n g the p a t i e n t ' s h e t e r o n o m y as e x e m p l i f i e d b y t h e h y p n o t i c s i t u a t i o n , t h e classic p a r a d i g m of a h e t e r o n o m o u s r e l a t i o n s h i p . This v i e w g r e a t l y simplifies m a t t e r s . F o r if t h e a i m of t h e r a p y is a u t o n o m y , it should be obvious that h eteronomous methods must be eschewed: w e cann o t force s o m e o n e n o t to n e e d us or to b e i n d e p e n d e n t o')f us. This e x p l a i n s w h y - ~ i f a n a l y s i s is c o n c e i v e d as a t h e r a p y d e d i c a t e d to t h e e x p a n s i o n of t h e p a t i e n t ' s a u t o n o m y ......all the " ' d y n a m i e p s y c h o t h e r a p i e s , " " ' a d a p t a t i o n a l psychod)nmmics,'" a n d o t h e r modified psychoanalyst s w h i c h G l o v e r a p t l y l u m p s t o g e t h e r as " ' r a p p o r t t h e r a p i e s " a r e i n d e e d a b a n d o m n e n t s of p s y c h o analysis. F i n a l l y , f r o m this p o i n t of v i e w , t h e a s s e r t i o n t h a t all p s y c h o t h e r a p y is p e r s u a s i o n or s u g g e s t i o n m a y b e C l e a r l y s e e n f o r w h a t it is, n a m e l y , a p i e c e of p e r n i c i o u s n o n s e n s e . S u c h a v i e w d e n i e s t h e v a l u e of s e l f - d e t e r m i n a tion a n d r e s p o n s i b i l i t y , a n d t h e f a c t t h a t , h o w e v e r difficult to a c h i e v e , nonc o e r c i v e h u m a n r e l a t i o n s h i p s a r e possible. PSYCHOANALYSIS AS EDUCATION
T h e r e i s little d o u b t t h a t b y d e f i n i n g p s y c h o a n a l y s i s as n o t - s u g g e s t i o n , F r e u d c o n t r i b u t e d h e a v i l y to t h e c o n c e p t u a l c o n f u s i o n a b o u t t h e n a t u r e of p s y c h o a n a l y t i c p s y c h o t l ~ e r a p y . Yet, h e also c o n t r i b u t e d to its clarification, b y a s s e r t i n g t h a t p s y c h o a n a l y s i s is a f o r m of e d u c a t i o n . "~7 I n this m o d e l , w e h a v e at our c o m m a n d a powerful t o o l for e l u c i d a t i n g the characteristic f e a t u r e s o f v a r i o u s f o r m s of p s y c h o t h e r a p y . O n e ~ , p e of p s y c h o t h e r a p y c a n n o w b e said to differ f r o m ~a n o t h e r as o n e t y p e of e d u c a t i o n a l r e l a t i o n s h i p or situation differs f r o m a n o t h e r . E d u c a t i o n is a b r o a d c a t e g o r y in w h i c h m a n y d i v e r s e u n d e r t a k i n g s m a y p r o p e r l y b e i n c l u d e d . V a r i o u s m e t h o d s of p s y c h o t h e r a p y s h o u l d b e r e g a r d e d as b e l o n g i n g n o t in the g e n e r a l c l a s s c a l l e d " ' t r e a t m e n t , " b u t in t h a t c a l l e d " ' e d u c a t i o n . " E l u c i d a t i n g the p r e c i s e w o r k i n g s of a n y p a r t i c u l a r m e t h o d o f
I'SYCHOANALYSIS
AND
279
SUGGESTION
p s y c h o t h e r a p y , b y a s c e r t a i n i n g tile sort of eq, u c a t i o n a l ,influence it exerts o n t h e p a t i e n t , w o u l d b e a ~,ast u n d e r t a k i n g ; /it n e e d n o t c o n c e r n tis h e r e . B y w a y of i/]Iustration, howe, ver, I s h o u l d li~/e to briefly c h a r a c t e r i z e Sugg e s t i v e p s y c h o t h e r a p y in e d u c a t i o n a l t e r m s . I n d o c t r i n a t i o n is a t y p e of e d u c a t i o n : the t e a c h e r c o e r c e s t h e s t u d e n t to l e a r n s o m e t h i n g a g a i n s t t h e ]atter's wishes; tile s t u d e n t s" l e a r n i n g ~ o r p e r s o n ality change is o f t e n a n a d v a n t a g e o n l y t~l, t h e t e a c h e r . C e n s o r s h i p is also a k i n d of e d u c a t i o n : the s t u d e n t is t a u g h t {rot t o k n o w s o m e t h i n g . T h i s outc o m e also m a y b e of a d v a n t a g e o n l y t o t h e t e a c h e r . I n d o c t r i n a t i o n a n d cens o r s h i p a r e s i m i l a r to h y p n o t i c - s u g g e s t i v e p s y c h o t h e r a p y . I h a v e t r i e d p r e v i o u s l y to d e s c r i b e p s y c h o a n a l y t i c t a ' e a t m e n t ill e d u c a t i o n a l t e r m s , a°.~'~ I ann n o w e n g a g e d in t h e l a r g e r t a s k of a t t e n a p t i n g to d e t a i l in full tl~e s o r t of t e a c h i n g a n d ] e a r n i n g t h a t c o n s t i t u t e t h i s process. S ifh,ilt IAIIY T h e r e l a t i o n b e t w e e n p s y c h o a n a l y s i s a n d s u g g e s t i o n ( h y p n o s i s ) w a s critically e x a m i n e d . Tlae thesis w a s o f f e r e d t h a t t h e c o n n e c t i o n b e t w e e n t h e m i s e s s e n t i a l l y historical; t h e y a r e l o g i c a l l y d i s t i n c t o p e r a t i o n s , a n d a r e t h e r e f o r e incominensurable. T h e s i m i l a r i t i e s t h a t .seem to m a k e a n a l y s i s a n d s u g g e s t i o n c o m p a r a b l e a r e d e c e p t i v e : t h e y r e s t o n t h e f a c t t h a t b o t h h a v e b e e n d e f i n e d as therapeutic activit'ies, aimed a t alleviating or curing mental s y m p t o m s or illness. O p e r a t i o n a l l y , h o w e v e r , a n a l y s i s mad s u g g e s H o n d i f f e r r a d i c a l l y in t h e k i n d s of activities, in w h i c h t h e r a p i s t a n d p a t i e n t e n g a g e w h e n d o i n g or u n d e r g o i n g o n e or a n o t h e r " ' t h e r a p y ; " t h e y also differ in t h e k i n d s of a u t h o r i t y a n d p o w e r t h a t t h e t h e r a p i s t a s s u m e s in the. t w o r e l a t i o n s h i p s : T h e d i l e m m a p o s e d b y t h e a l l e g e d Similarities a n d d i f f e r e n c e s b e ~ v e e n analysis and suggestion may be resolved by viewing both methods, and o t h e r f o r m s of p s y c h o t h e r a p y as well, a s e d u c a t i o n a l r a f f l e r t h a n as tllerap e u t i c enteqgrises. REFERENCES
1. Fenichel, O. : T h e Psychoanalytic Theory of Neurosis. New York, \V. \V. Norton, !945. 2. Frank, J . : Persuasion and Healing. Baltimore, j o l m s Hopkins l~ress, 19611 3. Freud, S-: o n p s y c h o t h e r a p y (1904). In, The standard Edition Of the Complet e Psychological works of Sigqnund F r e u d , Vol. VII, pp. 255-268. London, Hogarth Press, 1953. 4 . - - : A: General Inti'oduction to Psychoanalysis (!916-17). G a r d e n City, N. Y., ~ a r d e n City Publishing CO., 1943. 5 . - - : Turnings i n the ways of psychor analytic therapy (1919). Collected Papers, :Vol. I I , pp. 399~-402: London, Hogarth Press, 1948. 6. ~ : The Question of Lay Analysis
7. 8. 9. 10. 1I.
(1926). I1~ The Standard Edition of the Complete Psyeli010gieal ~¥0rks of Sigmund Freud, )tel. XX, pp. 179258. iLondon, ~Hogarth Press, 1959. --: An' Outline of PsyChoanalysis (1938). N e w York, Norton, 1949. Gitelson, NI.: Psychoanalyst, :u. s. A., 195,5. Am. J, Psychiat. 112:7007 1956. Clover, E.: Psychoanalysi s and psychotherapy: Brit. j. ~,/: Psydlok 33:7382, 1960. Szasz, T: S.: On tim theory of psychoanalytic treatment. Internat. J. PsychoanaL 38:166-182, 1957. - - : T i l e ,N'lyth 0f Nlental Illness: Foundations of ~i Theory o£ Personal Conduct. New :York, Hoeber-Harper, 1961.
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The prol~lem of priwicy in trainlug analysis: selections :from a questionnaire s t u d y of p~,choanalytic pr~ctict~s and opinions. Psyehialry 25: 195-207, 1962. 13. ~ : IJuman naturt~ ~.md psychotlael'llpy: a further contribution to th,e theory of autonomous psychotherap)/. Conll). Psychiat. 3:268--283, 1962. I.t. ~ : 19sychoanal.vtic trcut ment ~!s education. A.M.A. Arch. Gen. Psyd~iat.
9:46-52, 1963. 15. ~ , and Ninniroff, !t. A.: A qut~sliolmairc study of psychoanalytic practict's and opinions. J. Ncrv. & Mont. Dis. ht p~'ess. 16. Touhnin, S.: "l'h<~ logical stat,~s of psycho-armlysis. In. M. M a e l ) o ~ d d , ed.: Pl!ilosophy and Analysis, 17- t 3 2 139. New York, Philo:~ophic~d Library, 1954.
TAonms S. Szasz, M. D,, Izrofe.s;s'or of l~sychiatry, State (.In,iversify of New York, Upstate Medical Center, Syracuse, N. Y.