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Cure

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Freud clearly stated that "the aim of the treatment will never be anything else but the practical recovery of the patient" (1904a, p. 253). He also declared that "Psycho-analysis was born out of medical necessity. It sprang from the need for bringing help to neurotic patients, who had found no relief through rest-cures, through the arts of hydropathy or through electricity" (1919g, p. 259).

Many of the arguments that divide psychoanalysts on the problem of the "cure" arise from their different conceptions they have of the term's meaning. The medical model leads to the idea that the cure is a matter of the disappearance of symptoms or lesions, or even of a restitutio ad integrum (restoration of health) that would actually be impossible in the mental field. Hypnosis and suggestion made disorders disappear as if by magic, but only temporarily, which is why Freud abandoned these techniques. He was more concerned with deeper causes and, from the time of Studies on Hysteria, he limited his own influence: "[Y]ou will be able too convince yourself that much will be gained if we succeed in transforming your hysterical misery into common unhappiness. With a mental life that has been restored to health, you will be better armed against that unhappiness" (1895d, p. 305).

In the analysis of "Little Hans," he insisted that "a psychoanalysis is not an impartial scientific investigation, but a therapeutic measure. Its essence is not to prove anything, but merely to alter something" (1909b, p. 104). Thus the objective is "change," giving the patient a capacity to mobilize his defenses differently and more effectively to manage both the external and internal conflicts that the cure cannot prevent from returning. In a note to The Ego and the Id, Freud wrote that "analysis does not set out to make pathological reactions impossible, but to give the patient's ego freedom to decide one way or the other" (1923b, p. 50n).

It is necessary to remove all obstacles to the attainment of this goal, and that is the work of the treatment: the unconscious must "convey itself into the preconscious" (1900a, p. 610); treatment involves "overcoming the internal resistances" (1905a, p. 267); analysis "replaces repression by condemnation" (1909b, p. 145); the patient must "make the advance from the pleasure principle to the reality principle" (1919b, p. 312); and "the aim of the treatment is to remove the patient's resistances and to pass his repressions in review and thus to bring about the most far reaching unification and strengthening of his ego, to enable him to save the mental energy which he is expending upon internal conflicts, to make the best of him that his inherited capacities will allow and so to make him as efficient and as capable of enjoyment as possible" (1923a, p. 251). From this perspective, "partial or complete sublimation" represents, as Freud wrote to James Jackson Putnam in a letter of May 14, 1911, "the goal of [psychoanalytic] therapy and the way in which it serves every form of higher development" (1971a, p. 121).

Freud never concealed the pedagogic aspect of such a program. He insisted on several occasions that psychoanalysis was a kind of "after-education" (1916-17a, p. 451; 1940a, p. 175), even though he also maintained that the psychoanalyst must not fall into the role of an educator. Similarly, he often spoke out, right up to the end of his life, against the idea that a "schematic normality" could define the end of the treatment, adding that "The business of analysis is to secure the best possible psychological conditions for the functions of the ego; with that it has discharged its task" (1937a, p. 250).

A growing awareness of the death drive and the repetition compulsion led Freud to reconsider the secondary gain from illness as an obstacle to the cure and to reexamine the role of the "negative therapeutic reaction." The latter, which satisfies unconscious guilt feelings and the need for punishment in the neurotic (through masochism), represents one of the most important obstacles to the satisfactory progress of a psychoanalytic treatment.

Freud's continuing efforts to describe and analyze the negative therapeutic reaction shows that he persisted in looking for this, in the sense of "change," despite his later pessimistic remarks. Other analysts broadened the concept of cure, even if certain remarks by Jacques Lacan seemed to devalue it. On February 5, 1957, after a lecture by Georges Favez on "The Encounter with the Analyst," Lacan expressed with the utmost clarity an idea that has since been greatly distorted by both his adversaries and partisans. He began by arguing against the idea that "if the measure of a therapeutic analysis is defined by its achieving the aim of producing a cure, that would mean that a therapeutic analysis is always something rather limited. All the same," he went on, "cure always seems to be a happy side effect—as I have said, to the scandal of certain ears—but the aim of analysis is not cure. Freud said the same thing himself, namely, that making cure the aim of analysis—making it nothing more than a means towards a specific end—leads to something like a short circuit that could only falsify the analysis. Thus analysis has another aim" (1958, p. 309).

Lacan made these remarks were within the context of an argument that pitted him against the idea of "therapeutic analysis" and against the aim of "cure"—defined by Sacha Nacht as the "disappearance of fear and the possibility of loving and being loved" (1960)—as extolled by the Psychoanalytic Institute of Paris. His remarks aimed at a "pure psychoanalysis" that Lacan associated with training analysis.

In any case, Lacan's remarks can be compared to a formulation of Freud's that is similar only if we neglect the fact that it involves the question of symptomatic suffering and not "cure." However, as stated at the outset, everything depends on how one understands the term: "The removal of the symptoms of the illness is not specifically aimed at, but is achieved, as it were, as a by-product if the analysis is properly carried through" (1923a, p. 251).

See Also

References

  1. Freud, Sigmund. (1900a). The interpretation of dreams. SE, 4 & 5: 1-751.
  2. ——. (1904a). Freud's psycho-analytic procedure. SE, 7: 247-254.
  3. ——. (1905a). On psychotherapy. SE, 7: 255-268.
  4. ——. (1909b). Analysis of a phobia in a five-year-old boy. SE, 10: 1-149.
  5. ——. (1916-17a). Introductory lectures on psychoanalysis. SE, 15 & 16: 1-496.
  6. ——. (1919b). Some character-types met with in psychoanalytic work. SE, 14: 309-333.
  7. ——. (1919g). Preface to Reik's ritual: psycho-analytic studies. SE, 17: 257-263.
  8. ——. (1923a). Two encyclopaedia articles. SE, 18: 235-259.
  9. ——. (1923d). The ego and the id. SE, 19: 1-66.
  10. ——. (1937c). Analysis terminable and interminable. SE, 23: 209-253.
  11. ——. (1940a). An outline of psycho-analysis. SE, 23: 139-207.
  12. Freud, Sigmund, et al. (1971a), James Jackson Putnam and psychoanalysis. Letters between Putnam and Sigmund Freud, Ernest Jones, William James, Sándor Ferenczi, and Morton Prince, 1877-1917 (NathanG. Hale, Ed.). Cambridge: Harvard University Press.
  13. Freud, Sigmund, and Josef Breuer. (1895d). Studies in hysteria. SE,2.
  14. Lacan, Jacques. (1958). Intervention, in G. Favez: 'Le rendez-vous avec le psychanalyste.' La Psychanalyse, 4, 305-314.