Resistance and Suppression IN order to progress in our understanding of the neuroses, we need new experiences and we are about to obtain two. Both are very remarkable and were at the time of their discovery, very surprising. You are, of course, prepared for both from our discussions of the past semester. In the first place: When we undertake to cure a patient, to free him from the symptoms of his malady, he confronts us with a vigorous, tenacious resistance that lasts during the whole time of the treatment. That is so peculiar a fact that we cannot expect much credence for it. The best thing is not to mention this fact to the patient's relatives, for they never think of it otherwise than as a subterfuge on our part in order to excuse the length or the failure of our treatment. The patient, moreover, produces all the phenomena of this resistance without even recognizing it as such; it is always a great advance to have brought him to the point of understanding this conception and reckoning with it. Just consider, this patient suffers from his symptoms and causes those about him to suffer with him. He is willing, moreover, to take upon himself so many sacrifices of time, money, effort and self-denial in order to be freed. And yet he struggles, in the very interests of his malady, against one who would help him. How improbable this assertion must sound! And yet it is so, and if we are reproached with its improbability, we need only answer that this fact is not without its analogies. Whoever goes to a dentist with an unbearable toothache may very well find himself thrusting away the dentist's arm when the man makes for his sick tooth with a pair of pincers. The resistance which the patient shows is highly varied, exceedingly subtle, often difficult to recognize, Protean-like in its manifold changes of form. It means that the doctor must become suspicious and be constantly on his guard against the The first reaction we call out by laying down this basic technical rule is that the patient directs his entire resistance against it. The patient tries in every way to escape its requirements. First he will declare that he cannot think of anything, then, that so much comes to his mind that it is impossible to seize on anything definite. Then we discover with no slight displeasure that he has yielded to this or that critical objection, for he betrays himself by the long pauses which he allows to occur in his speaking. He then confesses that he really cannot bring himself to this, that he is ashamed to; he prefers to let this motive get the upper hand over his promise. He may say that he did think of something but that it concerns someone else and is for that reason exempt. Or he says that what he just thought of is really too trivial, too stupid and too foolish. I surely could not have meant that he should take such thoughts into account. Thus it goes on, with untold variations, in the face of which we One can scarcely find a patient who does not make the attempt to reserve some province for himself against the intrusion of the analysis. One patient, whom I must reckon among the most highly intelligent, thus concealed an intimate love relation for weeks; and when he was asked to explain this infringement of our inviolable rule, he defended his action with the argument that he considered this one thing was his private affair. Naturally, analytic treatment cannot countenance such right of sanctuary. One might as well try in a city like Vienna to allow an exception to be made of great public squares like the Hohe Markt or the Stephans Platz and say that no one should be arrested in those places—and then attempt to round up some particular wrong-doer. He will be found nowhere but in those sanctuaries. I once brought myself around to permit such an exception in the case of a man on whose capacity for work a great deal depended, and who was bound by his oath of service, which forbade him to tell anyone of certain things. To be sure, he was satisfied with the results—but not I; I resolved never to repeat such an attempt under these conditions. Compulsion neurotics are exceedingly adept at making this technical rule almost useless by bringing to bear all their over-conscientiousness and their doubts upon it. Patients suffering from anxiety-hysteria sometimes succeed in reducing it to absurdity by producing only notions so remote from the thing sought for that analysis is quite unprofitable. But it is not my intention to go into the way in which these technical difficulties may be met. It is enough to know that finally, by means of resolution and perseverance, we do succeed in wresting a certain amount of obedience from the patient toward this basic rule of the technique; the resistance then makes itself felt in other ways. It appears in the form of an intellectual resistance, battles by means of arguments, and makes use of all difficulties and improbabilities which a normal yet uninstructed thinking is bound to find in the theory of analysis. Then we hear from one voice alone the same criticisms and objections which thunder about us in mighty chorus in the scientific literature. Therefore the critics who shout to us from outside cannot tell us anything new. It is a veritable tempest in a teapot. Still the patient The intellectual resistances are not the worst, one can always get ahead of them. But the patient can also put up resistances, within the limits of the analysis, whose conquest belongs to the most difficult tasks of our technique. Instead of recalling, he actually goes again through the attitudes and emotions of his previous life which, by means of the so-called "transference," can be utilized as resistances to the physician and the treatment. If the patient is a man, he takes this material as a rule from his relations to his father, in whose place he now puts the physician, and in so doing constructs a resistance out of his struggle for independence of person and opinion; out of his ambition to equal or to excel his father; out of his unwillingness to assume the burden of gratitude a second time in his life. For long times at a stretch one receives the impression that the patient desires to put the physician in the wrong and to let him feel his helplessness by triumphing over him, and that this desire has completely replaced his better intention of making an end to his sickness. Women are adepts at exploiting, for the Resistances of this sort must not be narrow-mindedly condemned. They contain so much of the most important material of the patient's past and reproduce it in such a convincing manner, that they become of the greatest aid to the analysis, if a skillful technique is able to turn them in the right direction. It is only remarkable that this material is at first always in the service of the resistance, for which it serves as a barrier against the treatment. One can also say that here are traits of character, adjustments of the ego which were mobilized in order to defeat the attempted change. We are thus able to learn how these traits arose under the conditions of the neurosis, as a reaction to its demands, and to see features more clearly in this character which could otherwise not have shown up so clearly or at least not to this extent, and which one may therefore designate as latent. You must also not get the impression that we see an unforeseen endangering of the analytic influence in the appearance of these resistances. On the contrary, we know that these resistances must come to light; we are dissatisfied only when we do not provoke them in their full strength and so make them plain to the patient Indeed, we at last understand that overcoming these resistances is the essential achievement of analysis and is that portion of the work which alone assures us that we have accomplished something with the patient. You must also take into account the fact that any accidental occurrences which arise during the treatment will be made use of by the patient as a disturbance—every diverting incident, every statement about analysis from an inimical authority in his circle, any chance illness or any organic affection which complicates the neurosis; indeed, he even uses every improvement of his condition as a motive for abating his efforts. You will then have gained an approximate, though still an incomplete picture But if the establishment of the resistance thus becomes a matter of such importance, then surely we must give our caution full rein, and follow up any doubts as to whether we are not all too ready in our assumption of their existence. Perhaps there really are neurotic cases in which associations appear for other reasons, perhaps the arguments against our hypothesis really deserve more consideration and we are unjustified in conveniently rejecting all intellectual criticisms of analysis as a resistance. Indeed, ladies and gentlemen, but our judgment was by no means readily arrived at. We had opportunity to observe every critical patient from the first sign of the resistance till after its disappearance. In the course of the treatment, the resistance is moreover constantly changing in intensity. It is always on the increase as we approach a new theme, is strongest at the height of its elaboration, and dies down again when this theme has been abandoned. Furthermore, unless we have made some unusual and awkward technical error, we never have to deal with the full measure of resistance of which the patient is capable. We could therefore convince ourselves that the In what way shall we now account for the observation that the patient so energetically resists our attempts to rid him of his symptoms and to make his psychic processes function in a normal way? We tell ourselves that we have here come up against strong forces which oppose any change in the condition; furthermore, that these forces must be identical with those which originally brought about the condition. Some process must have been functional in the building up of these symptoms, a process which we can now reconstruct by means of our experiences in solving the meaning of the symptoms. We already know from Breuer's observations that the existence of a symptom presupposes that some psychic process was not carried to its normal conclusion, so that it could not become conscious. The symptom is the substitute for that which did not take place. Now we know where the forces whose existence we suspect must operate. Some violent antagonism must have been aroused to prevent the psychic process in question from reaching consciousness, and it therefore remained unconscious. As an unconscious thought it had the power to create a symptom. The same struggle during the analytic treatment opposes anew the efforts to carry this unconscious thought over into consciousness. This We are now ready to obtain a more definite idea of this process of repression. It is the preliminary condition for the formation of symptoms; it is also a thing for which we have no parallel. If we take as prototype an impulse, a psychological process which is striving to convert itself into action, we know that it may succumb before a rejection, which we call "repudiation" or "condemnation." In the course of this struggle, the energy which the impulse had at its disposal was withdrawn from it, it becomes powerless; yet it may subsist in the form of a memory. The whole process of decision occurs with the full knowledge of the ego. The state of affairs is very different if we imagine that this same impulse has been subjected to repression. In that case, it would retain its energy and there would be no memory of it left; in addition, the process of repression would be carried out without the knowledge of the ego. Through this comparison, however, we have come no nearer understanding the nature of repression. I now go into the theoretical ideas which alone have shown themselves useful in making the conception of repression more definite. It is above all necessary that we progress from a purely descriptive meaning of the word "unconscious" to its more systematic meaning; that is, we come to a point where we must call the consciousness or unconsciousness of a psychic process only one of its attributes, an attribute which is, moreover, not necessarily unequivocal. If such a process remained unconscious, then this separation from consciousness is perhaps only an indication of the fate to which it has submitted and not this fate itself. To bring this home to us more vividly, let us assume that every psychological process—with one exception, which I will go into later—first exists in an unconscious state or phase and only goes over from this into a conscious phase, much as a photographic picture is first a negative and then becomes a picture by being printed. But not every negative need become a positive, and just as little is it necessary that every unconscious psychological process should be changed into a conscious one. We find it advantageous to express ourselves as follows: Any particular process belongs in the first place to Now I know you will say that these conceptions are as crude as they are fantastic, and not at all permissible in a scientific discussion. I know they are crude—indeed, we even know that they are incorrect, and if we are not very much mistaken we This becomes all the more important to me if you should warn me that this arrangement of the psychic apparatus, such as I have assumed in the explanation of neurotic symptoms, must be generally applicable and must hold for normal functioning as well. In that, of course, you are right. We cannot follow this up at present, but our interest in the psychology of the development of the symptom must be enormously increased if through the study of pathological conditions we have the prospect of finding a key to the normal psychic occurrences which have been so well concealed. You will probably recognize what it is that supports our assumptions concerning these two systems and their relation to consciousness. The watchman between the unconscious and the fore-conscious is none other than the censor under whose control we found the manifest dream to obtain its form. The residue of the day's experiences, which we found were the stimuli which set off the dream, are fore-conscious materials which at night, during sleep, had come under the influence of unconscious and suppressed wishes. Borne along by the energy of the wish, these stimuli were able to build the latent dream. Under the control of the unconscious system this material was worked over, went through an elaboration and displacement such as the normal psychic life or, better said, the fore-conscious system, either does not know at all or tolerates only exceptionally. In our eyes the characteristics of each of the two systems So much, then, for suppression. It is, however, only a prerequisite for the evolution of the symptom. We know that the symptom serves as a substitute for a process kept back by suppression. Yet it is no simple matter to bridge this gap between the suppression and the evolution of the substitute. We have first to answer several questions on other aspects of the problem concerning the suppression and its substantiation: What kind of psychological stimuli are at the basis of the suppression; by what forces is it achieved; for what motives? On these matters we have only one insight that we can go by. We learned in the investigation of resistance that it grows out of the forces of the "I," in other words from obvious and latent traits of character. It must be from the same traits also that suppression derived support; at least they played a part in its development. All further knowledge is still withheld from us. A second observation, for which I have already prepared, will help us further at this point. By means of analysis we can assign one very general purpose to the neurotic symptom. This is of course nothing new to you. I have already shown it to you in the two cases of neuroses. But, to be sure, what is the significance of two cases! You have the right to demand that it be shown to you innumerable times. But I am unable to do this. Here again your own experience must step in, or your belief, which may in this matter rely upon the unanimous account of all psychoanalysts. You will remember that in these two cases, whose symptoms we subjected to searching investigation, the analysis introduced us to the most intimate sexual life of these patients. In the first case, moreover, we could identify with unusual clearness the purpose or tendency of the symptoms under investigation. Recall the compulsive act of our first patient. The woman longs for her intensely beloved husband, with whom she cannot share her life because of his shortcoming and weaknesses. She feels she must remain true to him, she can give his place to no one else. Her compulsive symptom affords her that for which she pines, ennobles her husband, denies and corrects his weaknesses,—above all, his impotence. This symptom is fundamentally a wish-fulfillment, exactly as is a dream; moreover, it is what a dream not always is, an erotic wish-fulfillment. In the case of our second patient you can see that one of the component purposes of her ceremonial was the prevention of the intercourse of her parents or the hindrance of the creation of a new child thereby. You have perhaps also guessed that essentially she strove to put herself in the place of her mother. Here again we find the removal of disturbances to sexual satisfaction and the fulfillment of personal sexual wishes. We shall soon turn to the complications of whose existence we have given you several indications. I do not want to make reservations as to the universal applicability of these declarations later on, and therefore I wish to call to your attention the fact that everything that I say here about suppression, symptom-development and symptom-interpretation has been learned from three types of neuroses—anxiety-hysteria, conversion-hysteria, and compulsion-neuroses—and for the time being is relevant to these forms only. These three conditions, which we are in the habit of combining into one group under the name of "transference neuroses," also limit the field open to psychoanalytic therapy. The other neuroses have not been nearly so well studied by psychoanalysis,—in one group, in fact, the impossibility of therapeutic influence has been the To be sure, there are all kinds of objections possible to the declaration that neurotic symptoms are substitutes for sexual satisfaction. I shall still go into two of them today. If you yourself have analytically examined a fairly large number of neurotics you will perhaps gravely inform me that in one class of cases this is not at all applicable, the symptoms appear rather to have the opposite purpose, to exclude sexual satisfaction, or discontinue it. I shall not deny the correctness of your interpretation. The psychoanalytic content has a habit of being more complicated than we should like to have it. Had it been so simple, perhaps we should have had no need for psychoanalysis to bring it to light. As a matter of fact, some of the traits of the ceremonial of our second patient may be recognized as of this ascetic nature, inimical to sexual satisfaction; for example, the fact that she removes the clocks, which have the magic qualities of preventing nightly erections, or that she tries to prevent the falling and breaking of vessels, which symbolizes a protection of her virginity. In other cases of bed-ceremonials which I was able to analyze, this negative character was far more evident; the ceremonial might consist throughout of protective regulations |