Page:EB1922 - Volume 32.djvu/225

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PSYCHOTHERAPY
207


becomes centred upon the normal object, that is upon the op- posite sex. This development may be arrested at any point, and the arrest may later in life be displayed in various sexual perver- sions. If a person in whom such an arrest has occurred, say, at the stage of homosexuality, is living in a civilized society, difficult internal conflicts are likely in later life to ensue between the strength of his desires and his fear of outraging both social convention and legal enactment; or, owing to the fixation of his affect upon an object, not the normal end object of the sexual instinct, he may find himself impotent in his relations with one of the opposite sex. The efforts of psycho-analysis are directed towards the discovery of repression, arrest of development and the conflicts which are thus generated. If these can be brought to light there is hope that further development may occur, that unattached or badly attached affects may find appropriate and fitting objects, and that conflicts may be resolved by the co- ordinating action of the conscious.

Analysts are not, however, in complete agreement as to whether sexuality is the sole or essential cause of functional nervous symptoms. Some find in the desire of the individual to express his influence upon others, or his " will to power," an active determining cause of the internal conflict which arises when he finds himself in opposition to social conventions and to such activities of those about him as tend to impede his progress. Others again seek to find conflicts not so much in the past development of the individual as in the difficulties which arise when he endeavours to attain such ideal ends as he has proposed to himself. But whatever the value attached to the elements of causation of morbid states there is general agreement that it is not only the conscious field with its obvious conflicts which, has to be explored but that the unconscious field should also be examined in as much detail as is possible.

The form of the content of the unconscious and of the conscious mind appears to be determined by analogous processes. Percep- tions are apparently not invariably noted by the conscious. It is not an uncommon experience to discover perceptions which must have been made at a certain time and place which only well up into consciousness at some later date, while the details of a perception which were not clear or even considered at all at the time they were received, may be placed in their true position by analysis. In certain morbid states, for instance, delirium and mania, memories of events and even of languages which have been forgotten for many years, may be recovered. Such memories Me in depths of mind to which the term " un- j conscious " alone seems applicable. Constructive ideation and ; ratiocination appear also to proceed in the unconscious mind. Problems which have been propounded and set aside for a while receive, as it were suddenly and unexpectedly, a solution ; indeed such solutions are recorded as having been reached during sleep. Similarly the execution of works of art, pictorial, musical or literary, is, especially in the case of genius, often effected without immediately preceding conscious mental effort, while the ideas of preachers, orators, wits and ordinary conversationalists often seem voiced automatically. Indeed the obtrusion of con- scious effort not uncommonly mars rather than enhances the value of artistic expression. Conventionally the term "sub- conscious " has become restricted to those states of mind which, though not at the focus of conscious thought, can be brought to that focus at the will of the individual, but the differentiation between such states and those which are brought to conscious- ness only at exceptional times or by analytic methods seems to be of a very indeterminate nature. A much more particular meaning is assigned to the unconscious by some who make of it a rather sharply denned collection of primitive and instinctive infantile affects. Whatever may be the view adopted on this point, there is but little division of opinion as to the view that the affects which impel conduct, whether primitive or elaborated and sublimated, lie to a great extent in the unconscious, and the search for and examination of these affects when brought into consciousness constitute the great merit of knowledge of self. Not only does the unconscious seem to contain the powers already alluded to, but it has been sought to establish that there

is in it a something which has been termed the " censor " which seeks to prevent the emergence of unacceptable affects from the unconscious into the sub-conscious and thence into the con- scious. To this " censor " is also attributed powers of trans- mutation of ideas and symbolization which render the crude and unpalatable operations of the unconscious less unacceptable to the conscious. The examination of dreams by the analytic method is held to have demonstrated the existence of such operations. The ideas of a given dream are one by one examined, with a view to the discovery of their associations, that is of their immediate relation with other ideas, and it is found that the manifest content of the dream is but a condensation of a much wider range of ideas and only indirectly and allegorically expressive of them. The dream is found to be the expression of an affect whose existence may perhaps not hitherto have been recognized and whose passage into the conscious has been prevented. On these points also there is not a complete con- sensus of opinion, and by some the analysis of dreams is held to disclose not only or so much the expression of the most primitive affects but also the ends which the individual in fact desires but of which he is but unconfessedly and dimly, if at all, aware. Indeed the interpretation of dreams seems not infrequently to depend not so much upon a thoroughgoing analysis as upon the psychological views and imagination of the interpreter.

Another method of exploration is that by free association. The patient is placed in a comfortable position and is directed to close his eyes and then to say whatever idea comes into his head, no matter how absurd or rude or otherwise offensive it may be. Ordinary volitional precautionary control being in this way relaxed, vent is given to the repressed content or at least various groupings of ideas are disclosed. Analogous results are obtained when, owing to intoxication or disease, patients reveal trains of thought remote from those to which in healthy states they give utterance, the very existence of which has been un- known to them and which when known is repulsive.

A third method of analysis is that by the " time-association " test. In this again the patient places himself in a comfortable position and relaxes his attention to what is going on or to any particular line of thought so far as is possible. He is directed to listen to certain words pronounced by the analyst, and on hearing one forthwith to say the word which first arises in his mind. The time between the signal word and the reply is noted. Normally the length of time is two to three seconds, and if it is prolonged or if after some 45 seconds no reply has been given the reaction is considered to be worthy of further examination and to indicate the existence of a group of ideas associated with a definite and perhaps marked emotional tone, that is, with a " complex," as such a group has come to be technically called. But the time element is in fact not the only one of importance in this test, since the character itself of the reply word is put to valuation. Test words may elicit replies of a rhyming character, or altogether commonplace, but on the other hand they may be so incon- sequential and unexpected that a surmise at once arises that they imply the existence of a complex.

Such then are the methods adopted in analysis, and it must be plain that if carried out in detail they must necessarily occupy a considerable amount of time. Unhappily in practice analysis is apt, owing to the limitation of available time, to be slip-shod, while deductions are hastily drawn from hastily gathered data; this is by so much the greater a misfortune in that the out- standing merit of analysis lies in its claim to be something of an exact method of examination and thus to supply in psycho- therapy a way of discovering, and so of treating, ths basis of the symptoms complained of. Though an analysis may not be thorough or the results of a thorough analysis may be incorrect, yet some amelioration of symptoms may occur, and in such an event it is possible that the process of cure is somewhat similar to that obtaining in treatment by suggestion. Though in an impartial analysis the physician should be little more than a recording machine, it is extremely difficult for him to avoid making, or at least being the occasion of, suggestions. The patient seeks a cure at the hands of one whom he regards as