Beyond the Pleasure Principle (10 page)

‘Remembering’ took a very simple form in these hypnotic treatments. The patient reverted to an earlier situation, which he appeared never to confuse with his present one, conveyed the psychic processes of that earlier situation in so far as they had remained normal, and in addition conveyed whatever resulted from translating the unconscious processes of that time into conscious ones.

I shall add a few remarks at this point that every analyst has seen confirmed by his own experience.
²
The forgetting of impressions, scenes, experiences comes down in most cases to a process of ‘shutting out’ such things. When the patient speaks of these ‘forgotten’ things, he rarely fails to add I've always known that really, I've just never thought about it.’ He not uncommonly expresses disappointment that so few things seem to want to come to mind that he can acknowledge as ‘forgotten’, things that he has never thought about again since the time they happened. Even this yearning, however, is capable of being gratified, particularly in the case of conversion hysterias.
³
The term ‘forgetting’ becomes even less relevant once there is due appreciation of the extremely widespread phenomenon of screen-memories.
⁴
In quite a number of cases of childhood amnesia,
⁵
that familiar condition so important to us in the terms, I have gained the impression that the amnesia is exactly counterbalanced by the patient's screen-memories. These
memories contain not merely
some
essential elements of the patient's childhood, but
all
such elements. One simply has to know how to use analysis to retrieve these elements from the memories. The latter represent the forgotten childhood years as completely as the manifest content of dreams represents the dream-thoughts.

The other group of psychic processes which, as purely internal acts, can be contrasted to impressions and experiences – fantasies, relationary processes,
⁶
emotional impulses, thought-connections
⁷
– need to be considered separately as regards their relationship to forgetting and remembering. Something that occurs particularly frequently here is that something is ‘remembered’ that can never have been ‘forgotten’, since it was never at any point noticed, never conscious; moreover it appears to make no difference whatsoever to the psychic outcome whether such a ‘connection’ was a conscious one that was then forgotten, or whether it never reached the status of consciousness in the first place. The conviction that the patient arrives at in the course of analysis is entirely independent of this kind of memory.

Particularly in the case of the many forms of obsessional neurosis, forgetting is limited in the main to losing track of connections, misremembering the sequence of events, recalling memories in isolation.

A memory usually cannot be retrieved at all in the case of one particular group of extremely important experiences, namely those occurring at a very early stage of childhood that are experienced at the time without understanding, but are then
subsequently
understood and interpreted. We become aware of them via the patient's dreams, and are compelled to credit their existence by overwhelming evidence within the overall pattern of the neurosis; we are also persuaded by the fact that, once the patient has overcome his resistances, he does not see the absence of a memory or sensation of familiarity as grounds for not accepting that they took place. This topic needs to be approached with so much care, however, and introduces so much that is new and disturbing, that I shall deal with it quite separately with reference to appropriate material.
⁸

Now the introduction of the new technique has meant that very little, and in many instances nothing whatever, has remained of this splendidly smooth progression of events. Here, too, there are cases that initially develop just as they would under the hypnotic technique, only to diverge at a later stage; other cases behave differently right from the outset. If for the purposes of defining the difference we stick to the latter type, then we may say that the patient does not
remember
anything at all of what he has forgotten and repressed, but rather
acts it out
. He reproduces it not as a memory, but as an action; he
repeats
it, without of course being aware of the fact that he is repeating it.

For example, instead of the patient recounting that he remembers having been defiant and refractory
vis-à-vis
his parents' authority, he behaves in just such a manner towards the physician. Instead of remembering that he became hopelessly stuck in his infantile sexual explorations, he presents a mass of confused dreams and associations, wails that he is no good at anything, and sees it as his fate never to bring any undertaking to a successful conclusion. Instead of remembering that he was intensely ashamed of certain sexual activities and fearful of discovery, he exhibits shame regarding the treatment that he has embarked upon, and tries to keep it secret from all and sundry – and so on.

More particularly, he
begins
the treatment with just such a repetition. Often when one has explained the basic rule of psychoanalysis to a patient with an eventful life story and a long history of illness, and asks him to say whatever comes into his mind, and then expects a stream of utterances to come bursting forth, the first thing one discovers is that he has no idea what to say. He remains silent, and maintains that nothing at all has come into his mind. This is of course nothing other than the repetition of a homosexual stance, which manifests itself as a resistance to remembrance of any kind. He remains in the grip of this compulsion to repeat for as long as he remains under treatment; and in the end we realize that this is his way of remembering.

What is chiefly going to interest us, of course, is the relationship that this repetitional compulsion bears to the transference and
the resistance exhibited by the patient. We soon realize that the transference is itself merely an instance of repetition, and that this repetition involves transference of the forgotten past not only onto the physician, but onto all other areas of the patient's current situation. We must therefore expect that the patient will yield to the compulsion to repeat – which now takes the place of the impulse to remember – not only in his personal relationship to the physician, but in all other activities and relationships taking place in his life at the same time; for example, if during the course of the treatment he chooses a love-object, takes some task upon himself, involves himself in a project of any sort. The role played by resistance is also easy to recognize. The greater the resistance, the more thoroughly remembering will be replaced by acting out (repetition). After all, in hypnosis the ideal form of remembering corresponds to a condition in which resistance is completely pushed aside. If the treatment begins under the aegis of a mild and tacit regime of positive transference, this initially encourages submersion in the domain of memory (just as happens in hypnosis), during the course of which even the symptoms of the patient's illness are mute; however, if this transference subsequently becomes hostile or unduly intense, and therefore needs to be repressed, then remembering immediately gives way to acting out. From that point onwards it is the resistances that determine the sequence of what is repeated. The patient uses the arsenal of the past to arm himself with weapons to fight against the continuation of the treatment – weapons that we have to wrest from him one by one.

Now having seen that the patient repeats rather than remembers, and does so under conditions of resistance, we may now ask what it really is that he repeats or acts out. The answer is that he repeats everything deriving from the repressed element within himself
⁹
that has already established itself in his manifest personality – his inhibitions and unproductive attitudes, his pathological characteristics. Indeed, he also repeats all his symptoms during the course of the treatment. And we can now see that in emphasizing the compulsion to repeat we have not discovered a new fact, but merely arrived at a more coherent view. It is now quite plain to us that the start of
a patient's analysis does not mean the end of his illness, and that we need to treat the illness not as a matter belonging to the past, but as a force operating in the present. Piece by piece the entire illness is brought within the scope and ambit of the treatment, and while the patient experiences it as something intensely real and immediate, it is our job to do the therapeutic work, which consists to a very great extent in leading the patient back to the past.

Getting the patient to remember, as practised in hypnosis, inevitably had the air of a laboratory experiment. Getting the patient to repeat, as practised under the more modern technique of analysis, means summoning up a chunk of real life, and cannot therefore always be harmless and free of risk. The whole problem arises here of ‘deterioration during treatment’, a phenomenon that often proves unavoidable.

Most importantly, the very inception of the treatment itself necessarily induces a change in the patient's conscious attitude to his illness. As a rule he has been content up to then to bemoan his illness, to despise it as so much nonsense and to underestimate its significance, whilst for the rest applying the same repressive behaviour, the same head-in-the-sand strategy, to the manifestations of his illness that he applied to its origins. Thus it can happen that he does not properly appreciate the conditions under which his phobia functions, does not listen carefully enough to what his obsessional ideas are saying to him, or does not grasp the real intention of his obsessional impulse. This of course is the last thing his treatment needs. He has to find the courage to focus his attention on the manifestations of his illness. He must no longer regard the illness as something contemptible, but rather as a worthy opponent, a part of his very being that exists for good reasons, and from which he must extract something of real value for his subsequent life. The way is thus prepared from the outset for him to be reconciled with the repressed element within himself, which expresses itself in his symptoms, whilst at the same time allowing for a certain tolerance towards his illness. And if as a result of this new relationship to his illness the patient's conflicts are exacerbated, or if symptoms are forced into the open that had previously remained in the shadows, then one can
easily reassure him on this score by pointing out that these merely constitute a necessary but transitory deterioration in his condition, and that one cannot destroy an enemy if he is absent or out of range. However, the resistance can exploit the situation for its own ends and seek to abuse the licence to be ill. It then seems to exclaim: ‘Look what happens when I really do let myself become involved in these things! Wasn't I quite right to consign them all to repression?’ Juvenile and child patients are particularly prone to use the focus on their illness necessitated by their treatment as an excuse to wallow in their symptoms.

Further dangers arise as treatment progresses, in that new, more deep-seated drive-impulses – still nascent rather than fully established – can emerge as repetition. Lastly, the patient's actions outside the transference process can cause temporary harm in his everyday life, indeed can be so chosen as to permanently undermine that very condition of health that the treatment is meant to achieve.

The tactic that the physician has to adopt in this situation is easily justified. The goal that he holds fast to, even though he knows it to be unattainable under the new technique, remains the old form of remembering, that is, reproducing things within the psychic domain. He prepares himself for a constant battle with the patient, in order to keep within the psychic domain all those impulses that the patient would prefer to divert into the motor domain, and regards it as a therapeutic triumph when he successfully uses the remembering process to resolve an issue that the patient would rather get rid of in the form of an action. If the bond formed through transference is at all effective, then the treatment will successfully prevent any really significant acts of remembering on the part of the patient, and will use the nascent stage of any attempts at such acts as material contributing to the therapeutic process. One can best protect the patient from being damaged through giving rein to his impulses if one puts him under an explicit obligation not to make any decisions during the course of his treatment that vitally affect his life, such as choosing a career or a definitive love-object, but instead to wait until he is fully recovered.

In doing this, however, it is sensible to give scope to such aspects
of the patient's personal freedom as are consistent with these precautions, and not to stop him from carrying out intentions which, though foolish, are without consequence, whilst also bearing in mind that people can really only achieve insight through their own hurt and their own experience. There are indeed also cases in which the patient cannot be prevented from entering upon some wholly inappropriate undertaking, and which only later become ripe for psychoanalytical treatment, and responsive to it. Occasionally there are also bound to be cases where one does not have the time to put the bridle of transference on a patient's rampant drives, or where the patient in the course of an act of repetition destroys the bond that ties him to the treatment. As an extreme example of this I might mention the case of an elderly lady who, when afflicted by twilight states,
¹⁰
had repeatedly left home and husband and fled somewhere or other without ever becoming conscious of the force impelling her to ‘run away’ in this manner. On starting her treatment with me she displayed a well-developed form of affectionate transference, this intensified with uncanny rapidity over the first few days, and by the end of the week she had ‘run away’ from me too, without my having had the time to say anything to her that might have prevented this repetition.