From Dr. Loy 2 February 1913
You answer several of my questions in a decidedly affirmative tone, taking it as proved that in cures by the cathartic method the main role is played by faith in the analyst and his method and not by “abreacting” the real or imaginary traumata.
I think so too.
Equally I agree with your view that the old “apothecaries’ messes,” as well as the Lourdes cures or those of the mental healers, Christian Scientists, and persuasionists, are to be attributed to faith in the miracle-worker rather than to any of the methods employed.
But now comes the ticklish point: the augur can remain an augur so long as he himself believes that the will of the gods is made manifest by the entrails of the sacrificial beast.
When he no longer believes, he can ask himself: Shall I continue to use my augur’s authority to promote the welfare of the State, or shall I make use of my newer, and I hope truer, convictions of today? Both ways are possible.
The first is called opportunism, the second the pursuit of truth and scientific honesty.
For the doctor, the first way perhaps brings therapeutic success and fame, the second brings the reproach that such a man is not to be taken seriously.
What I esteem most highly in Freud and his school is just this passionate desire for truth.
On the other hand some people pronounce a different verdict: “It is impossible for a busy practitioner to keep pace with the development of the views of this investigator and his initiates” (Frank, Affektstorungen, Introduction, p. 2).
One can easily disregard this little quip, but self-criticism needs to be taken more seriously.
One can after all ask oneself: Since science is in continual flux, have I the right to ignore on principle any method or combination of methods by which I
know I can get therapeutic results?
Looking more closely at the fundamental reason for your aversion to the ancillary use of hypnosis (or semi-hypnosis; the degree matters nothing) in treatment by suggestion (which as you say every doctor and every therapeutic method makes use of willy-nilly, no matter what it is called), one must say that what has disgusted you with hypnotism is at bottom nothing but the so-called “transference” to the doctor, which you, with your purely psychoanalytic procedure, can eliminate as little as anybody else, and which actually plays an essential part in the success of the treatment.
Your requirement that the psychoanalyst must be responsible for the cleanness of his hands—here I agree unreservedly—is the logical conclusion.
But is the possible recourse to hypnosis in a psychotherapeutic procedure any more “augurish” than the unavoidable use of the “transference to the analyst” for therapeutic purposes?
In either case we bank on faith as the healing agent.
As for the feeling which the patient—whether man or woman—entertains for the analyst, is there never anything in the background save a conscious or unconscious sexual wish?
In many cases your impression is certainly correct, and more than one woman has been frank enough to confess that the beginning of hypnosis was accompanied by a voluptuous sensation.
But it is not true in all instances—or how would you explain the underlying feeling in the hypnotizing of one animal by another, e.g., snake and bird?
Surely you would say that here the feeling of fear prevails, which is an inversion of libido, whereas in the hypnoid state that comes over the female before she succumbs to the male it is the pure libido sexualis that predominates, though possibly still mixed with fear.
However that may be, from your three cases I cannot draw any ethical distinction between ”susceptibility to the hypnotist” and “transference to the analyst” that would condemn a possible combination of hypnosis with psychoanalysis, as an auxiliary.
You will ask why I cling so much to the use of hypnosis, or rather of the hypnoid state.
It is because I think there are cases that can be cured much more quickly in this way than by a purely psychoanalytic procedure.
For example, in no more than five or six interviews I completely cured a fifteen-year-old girl who had suffered from enuresis nocturna even since infancy,
but was otherwise perfectly sound, gifted, first in her class, etc.
Previously she had tried all sorts of treatment without any result.
Perhaps I ought to have sought out the psychoanalytic connections between the enuresis and her psychosexual disposition, explained it to her, etc., but I couldn’t, the girl had only the short Easter holidays for treatment: so I just hypnotized her and the trouble vanished.
In psychoanalysis I use hypnosis to help the patient overcome “resistance.”
Further, I use semi-hypnosis in conjunction with psychoanalysis to accelerate the “reconstruction” stage.
To take an example, a patient afflicted with a washing mania was sent to me after a year’s psychocathartic treatment with Dr. X.
The symbolic meaning of her washing ceremonies had previously been explained to her, but she became more and more agitated during the “abreaction” of alleged traumata in childhood, because she had persuaded herself by auto-suggestion that she was too old to be cured, that she saw no “images,”
So I used hypnosis to help her reduce the number of washings—”so that the anxiety feeling would stay away” -and to
train her to throw things on the floor and pick them up again without washing her hands afterwards, etc.
In view of these considerations I should, if you feel disposed to go further into the matter, be grateful if you would furnish me with more convincing reasons why the hypnotic procedure is to be condemned, and explain how to do without it, or what to replace it with in such cases.
Were I convinced, I would give it up as you have done; but what convinced you has not, so far, convinced me. Si duo faciunt idem, non est idem.
598 I would now like to go on to another important matter to which you alluded, but only cursorily, and to put one question: Behind the neurotic fantasies there is almost always (or always) a moral conflict belonging to the present.
That is perfectly clear to me. Research and therapy coincide; their task is: to seek the causes and the rational solution of the conflict.
Good.—But can the rational solution always be found?
“Reasons of expediency” so often bar the way, varying with the type of patient (children, young girls and women, from “pious”—hypocritical!—Catholic or Protestant families). Again that accursed opportunism!—
A colleague of mine was perfectly right when he began to give sexual enlightenment to a young French boy who was indulging in masturbation.
Whereupon, like one possessed, in rushed a bigoted grandmother, and a disagreeable scene ensued.
How to act in these and similar cases?
What to do in cases where there is a moral conflict between love and duty (conflicts in marriage)—or in general between instinct and moral duty?
What to do in the case of a girl afflicted with hysterical or anxiety symptoms, who is in need of love and has no chance to marry, or cannot find a suitable man, and, because she comes of “good family,” wants to remain chaste?
Simply try to get rid of the symptoms by suggestion? But that is wrong as soon as one knows of a better way.
How is one to reconcile one’s two consciences: that of the man who does not want to confine his fidelity to truth intra muros, and that of the doctor who must cure, or if he dares not cure according to his real convictions (owing to opportunist motives), must at least provide some alleviation?
We live in the present, but with the ideas and the ideals of the future. That is our conflict. How to resolve it?
From Dr. Jung 4 February 1913
… You have put me in a somewhat embarrassing position with your question in yesterday’s letter.
You have rightly guessed the spirit which dictated my last.
I am glad you, too, acknowledge this spirit. There are not very many who can boast of such liberalism.
I should deceive myself if I thought I was a practising physician. I am above all an investigator, and this naturally gives me a different attitude to many problems.
In my last letter I purposely left the practical needs of the doctor out of account, chiefly in order to show you on what grounds one might be moved to give up hypnotic therapy.
To anticipate a possible objection, let me say at once that I did not give up hypnosis because I wanted to avoid dealing with the basic forces of the human psyche, but because I wanted to battle with them directly and openly.
When once I understood what kind of forces play a part in hypnotism I gave it up, simply to get rid of all the indirect advantages of this method.
As we psychoanalysts find to our cost every day—and our patients also—we do not work with the “transference to the analyst,” but against it and in spite of it.
Hence we do not bank on the faith of the patient, but on his criticism. So much I would say for now about this delicate question.
As your letter shows, we are at one in regard to the theoretical aspect of treatment by suggestion.
We can therefore apply ourselves to the further task of reaching agreement on practical questions.
Your remarks on the doctor’s dilemma—whether to be a magician or a scientist—bring us to the heart of the matter.
I strive not to be a fanatic—though there are not a few who accuse me of fanaticism.
I struggle merely for the recognition of methods of research and their results, not for the application of psychoanalytic methods at all costs.
I was a medical practitioner quite long enough to realize that practice obeys, and must obey, other laws than does the search for truth.
One might almost say that the practitioner must submit first and foremost
to the law of expediency.
The investigator would be doing him a great wrong if he accused him of not using the “one true” scientific method.
As I said to you in my last letter: “A truth is a truth, when it works.”
On the other hand, the practitioner must not reproach the investigator if in his search for truth and for new and perhaps better methods he tries out unusual procedures.
After all, it is not the practitioner who will have to bear the brunt, but the investigator and possibly his patient.
The practitioner must certainly use those methods which he knows how to apply to the greatest advantage and which give him relatively the best results.
My liberalism, as you see, extends even to Christian Science.
But I deem it most uncalled for that Frank, a practising doctor, should cast aspersions on research in which he cannot participate—the very line of research to which he owes his own method.
It is surely high time to stop this running down of every new idea.
No one asks Frank and his confreres to be psychoanalysts.
We grant them their right to existence, why should they always seek to curtail ours?
As my own “cures” show you, I do not doubt the effect of suggestion. I merely had the feeling that I might be able to discover something still better.
This hope has been justified. Not for ever shall it be said:
If ever in this world we reach what’s good We call what’s better just a plain falsehood!
I frankly confess that if I were doing your work I should often be in difficulties if I relied on psychoanalysis alone.
I can scarcely imagine a general practice, especially in a sanatorium, with no other auxiliaries than psychoanalysis.
It is true that at Bircher’s sanatorium in Zurich the principle of psychoanalysis has been adopted, at least by several of the assistants, but a whole series of other important educative influences are also brought to bear on the patients, without which things would probably go very badly.
In my own purely psychoanalytic practice I have often regretted that I could not avail myself of other methods of re-education that are naturally at hand in an institution—but only, of course, in special cases where one is dealing with particularly uncontrolled, untrained patients.
Which of us would
assert that he has discovered the panacea?
There are cases where psychoanalysis works worse than any other method.
But who has ever claimed that psychoanalysis should be used always and everywhere?
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.
This does not happen often, as a matter of fact, because patients have a way of sorting themselves out.
Those who go to a psychoanalyst usually know quite well why they go to him and not to someone else.
Moreover there are very many neurotics excellently suited for psychoanalysis.
In these matters all schematism is to be abhorred.
It is never quite wise to run your head against a brick wall.
Whether simple hypnotism, or cathartic treatment, or psychoanalysis shall be used must be determined by the conditions of the case and the preference of the doctor.
Every doctor will obtain the best results with the instrument he knows best.
But, barring exceptions, I must say definitely that for me, as well as for my patients, psychoanalysis works better than any other method.
This is not merely a matter of feeling; from manifold experiences I know many cases can still be helped by psychoanalysis that are refractory to all other methods of treatment.
I know many colleagues whose experience is the same, even men engaged exclusively in practical work.
It is scarcely credible that an altogether inferior method 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 insoluble.
People sometimes take this view because they think only of external solutions—which at bottom are not solutions at all.
If a man cannot get on with his wife, he naturally thinks the conflict would be solved if he married someone else.
When such marriages are examined they are seen to be no solution whatever.
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 then only because the patient has been brought to a different attitude.
If an external solution is possible no psychoanalysis is necessary; but if an internal solution is sought, we are faced with the peculiar task of psychoanalysis.
The conflict between “love and duty” must be solved on that level of character where “love and duty” are no longer opposites, which in reality they are not.
Similarly, the familiar conflict between “instinct and conventional morality” must be solved in such a way that both factors are taken sufficiently into account, and this again is possible only through a change of character.
This change psychoanalysis can bring about.
In such cases external solutions are worse than none at all.
Naturally, expediency determines which road the doctor must ultimately follow and what is then his duty.
I regard the conscience-searching question of whether he should remain true to his scientific convictions as a minor one in comparison with the far weightier question of how he can best help his patient.
The doctor must, on occasion, be able to play the augur.
Mundus vult decipi—but the curative effect 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 would be but idle dreaming.
Do not forget that Kepler once cast horoscopes for money, and that countless artists are condemned to work for a living wage. ~Carl Jung, CW 4, Para 584-607