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object:2.01 - The Therapeutic value of Abreaction
book class:The Practice of Psycho therapy
author class:Carl Jung
subject class:Psychology
class:chapter


I
THE THERAPEUTIC VALUE OF ABREACTION 1
[255]
In his discussion of William Browns paper, The Revival of
Emotional Memories and Its Therapeutic Value, William McDougall,
writing in the British Journal of Psychology, gave expression to some
important considerations which I would like to underline here. The
neuroses resulting from the Great War have, with their essentially
traumatic aetiology, revived the whole question of the trauma theory of
neurosis. During the years of peace this theory had rightly been kept in the
background of scientific discussion, since its conception of neurotic
aetiology is far from adequate.
2
[256]
The originators of the theory were Breuer and Freud. Freud went on to
a deeper investigation of the neuroses and soon adopted a view that took
more account of their real origins. In by far the greater number of ordinary
cases there is no question of a traumatic aetiology.
[257]
But, in order to create the impression that the neurosis is caused by
some trauma or other, unimportant and secondary occurrences must be
given an artificial prominence for the sake of the theory. These traumata,
when they are not mere products of medical fantasy, or else the result of
the patients own compliancy, are secondary phenomena, the outcome of
an attitude that is already neurotic. The neurosis is as a rule a pathological,
one-sided development of the personality, the imperceptible beginnings of
which can be traced back almost indefinitely into the earliest years of
childhood. Only a very arbitrary judgment can say where the neurosis
actually begins.
[258]
If we were to relegate the determining cause as far back as the
patients prenatal life, thus involving the physical and psychic disposition
of the parents at the time of conception and pregnancya view that seems
not at all improbable in certain casessuch an attitude would be morejustifiable than the arbitrary selection of a definite point of neurotic origin
in the individual life of the patient.
[259]
Clearly, in dealing with this question, one should never be influenced
too much by the surface appearance of the symptoms, even when both the
patient and his family synchronize the first manifestation of these with the
onset of the neurosis. A more thorough investigation will almost invariably
show that some morbid tendency existed long before the appearance of
clinical symptoms.
[260]
These obvious facts, long familiar to every specialist, pushed the
trauma theory into the background until, as a result of the war, there was a
regular spate of traumatic neuroses.
[261]
Now, if we set aside the numerous cases of war neurosis where a
traumaa violent shockimpinged upon an established neurotic history,
there still remain not a few cases where no neurotic disposition can be
established, or where it is so insignificant that the neurosis could hardly
have arisen without a trauma. Here the trauma is more than an agent of
release: it is causative in the sense of a causa efficiens, especially when we
include, as an essential factor, the unique psychic atmosphere of the
battlefield.
[262]
These cases present us with a new therapeutic problem which seems
to justify a return to the original Breuer-Freud method and its underlying
theory; for the trauma is either a single, definite, violent impact, or a
complex of ideas and emotions which may be likened to a psychic wound.
Everything that touches this complex, however slightly, excites a
vehement reaction, a regular emotional explosion. Hence one could easily
represent the trauma as a complex with a high emotional charge, and
because this enormously effective charge seems at first sight to be the
pathological cause of the disturbance, one can accordingly postulate a
therapy whose aim is the complete release of this charge. Such a view is
both simple and logical, and it is in apparent agreement with the fact that
abreactioni.e., the dramatic rehearsal of the traumatic moment, its
emotional recapitulation in the waking or in the hypnotic stateoften has a
beneficial therapeutic effect. We all know that a man feels a compelling
need to recount a vivid experience again and again until it has lost its
affective value. As the proverb says, What filleth the heart goeth out by the mouth. The unbosoming gradually depotentiates the affectivity of the
traumatic experience until it no longer has a disturbing influence.
[263]
This conception, apparently so clear and simple, is unfortunatelyas
McDougall rightly objectsno more adequate than many another equally
simple and therefore delusive explanation. Views of this kind have to be
fiercely and fanatically defended as though they were dogmas, because
they cannot hold their own in the face of experience. McDougall is also
right to point out that in quite a large number of cases abreaction is not
only useless but actually harmful.
[264]
In reply, it is possible to take up the attitude of an injured theorist and
say that the abreactive method never claimed to be a panacea, and that
refractory cases are to be met with in every method.
[265]
But, I would rejoin, it is precisely here, in a careful study of the
refractory cases, that we gain the most illuminating insight into the method
or theory in question, for they disclose far more clearly than the successes
just where the theory is weak. Naturally this does not disprove the efficacy
of the method or its justification, but it does at least lead to a possible
improvement of the theory and, indirectly, of the method.
[266]
McDougall, therefore, has laid his finger on the right spot when he
argues that the essential factor is the dissociation of the psyche and not the
existence of a highly charged affect and, consequently, that the main
therapeutic problem is not abreaction but how to integrate the dissociation.
This argument advances our discussion and entirely agrees with our
experience that a traumatic complex brings about dissociation of the
psyche. The complex is not under the control of the will and for this reason
it possesses the quality of psychic autonomy.
[267]
Its autonomy consists in its power to manifest itself independently of
the will and even in direct opposition to conscious tendencies: it forces
itself tyrannically upon the conscious mind. The explosion of affect is a
complete invasion of the individual, it pounces upon him like an enemy or
a wild animal. I have frequently observed that the typical traumatic affect
is represented in dreams as a wild and dangerous animala striking
illustration of its autonomous nature when split off from consciousness.
[268]
Considered from this angle, abreaction appears in an essentiallydifferent light: as an attempt to reintegrate the autonomous complex, to
incorporate it gradually into the conscious mind as an accepted content, by
living the traumatic situation over again, once or repeatedly.
[269]
But I rather question whether the thing is as simple as that, or whether
there may not be other factors essential to the process. For it must be
emphasized that mere rehearsal of the experience does not itself possess a
curative effect: the experience must be rehearsed in the presence of the
doctor.
[270]
If the curative effect depended solely upon the rehearsal of
experience, abreaction could be performed by the patient alone, as an
isolated exercise, and there would be no need of any human object upon
whom to discharge the affect. But the intervention of the doctor is
absolutely necessary. One can easily see what it means to the patient when
he can confide his experience to an understanding and sympathetic doctor.
His conscious mind finds in the doctor a moral support against the
unmanageable affect of his traumatic complex. No longer does he stand
alone in his battle with these elemental powers, but some one whom he
trusts reaches out a hand, lending him moral strength to combat the
tyranny of uncontrolled emotion. In this way the integrative powers of his
conscious mind are reinforced until he is able once more to bring the
rebellious affect under control. This influence on the part of the doctor,
which is absolutely essential, may, if you like, be called suggestion.
[271]
For myself, I would rather call it his human interest and personal
devotion. These are the property of no method, nor can they ever become
one; they are moral qualities which are of the greatest importance in all
methods of psycho therapy, and not in the case of abreaction alone. The
rehearsal of the traumatic moment is able to reintegrate the neurotic
dissociation only when the conscious personality of the patient is so far
reinforced by his relationship to the doctor that he can consciously bring
the autonomous complex under the control of his will.
[272]
Only under these conditions has abreaction a curative value. But this
does not depend solely on the discharge of affective tension; it depends, as
McDougall shows, far more on whether or not the dissociation is
successfully resolved. Hence the cases where abreaction has a negative
result appear in a different light.[273]
In the absence of the conditions just mentioned, abreaction by itself is
not sufficient to resolve the dissociation. If the rehearsal of the trauma fails
to reintegrate the autonomous complex, then the relationship to the doctor
can so raise the level of the patients consciousness as to enable him to
overcome the complex and assimilate it. But it may easily happen that the
patient has a particularly obstinate resistance to the doctor, or that the
doctor does not have the right kind of attitude to the patient. In either case
the abreactive method breaks down.
[274]
It stands to reason that when dealing with neuroses which are
traumatically determined only to a minor degree, the cathartic method of
abreaction will meet with poor success. It has nothing to do with the nature
of the neurosis, and its rigid application is quite ludicrous here. Even when
a partial success is obtained, it can have no more significance than the
success of any other method which admittedly had nothing to do with the
nature of the neurosis.
[275]
Success in these cases is due to suggestion; it is usually of very limited
duration and clearly a matter of chance. The prime cause is always the
transference to the doctor, and this is established without too much
difficulty provided that the doctor evinces an earnest belief in his method.
Precisely because it has as little to do with the nature of neurosis as, shall
we say, hypnosis and other such cures, the cathartic method has, with few
exceptions, long been abandoned in favour of analysis.
[276]
Now it happens that the analytical method is most unassailable just
where the cathartic method is most shaky: that is, in the relationship
between doctor and patient. It matters little that, even today, the view
prevails in many quarters that analysis consists mainly in digging up the
earliest childhood complex in order to pluck out the evil by the root. This
is merely the aftermath of the old trauma theory. Only in so far as they
hamper the patients adaptation to the present have these historical
contents any real significance. The painstaking pursuit of all the
ramifications of infantile fantasy is relatively unimportant in itself; the
therapeutic effect comes from the doctors efforts to enter into the psyche
of his patient, thus establishing a psychologically adapted relationship. For
the patient is suffering precisely from the absence of such a relationship.
Freud himself has long recognized that the transference is the alpha and
omega of psychoanalysis. The transference is the patients attempt to getinto psychological rapport with the doctor. He needs this relationship if he
is to overcome the dissociation. The feebler the rapport, i.e., the less the
doctor and patient understand one another, the more intensely will the
transference be fostered and the more sexual will be its form.
[277]
To attain the goal of adaptation is of such vital importance to the
patient that sexuality intervenes as a function of compensation. Its aim is to
consolidate a relationship that cannot ordinarily be achieved through
mutual understanding. In these circumstances the transference can well
become the most powerful obstacle to the success of the treatment. It is not
surprising that violent sexual transferences are especially frequent when
the analyst concentrates too much on the sexual aspect, for then all other
roads to understanding are barred. An exclusively sexual interpretation of
dreams and fantasies is a shocking violation of the patients psychological
material: infantile-sexual fantasy is by no means the whole story, since the
material also contains a creative element, the purpose of which is to shape
a way out of the neurosis. This natural means of escape is now blocked;
the doctor is the only certain refuge in a wilderness of sexual fantasies, and
the patient has no alternative but to cling to him with a convulsive erotic
transference, unless he prefers to break off the relationship in hatred.
[278]
In either case the result is spiritual desolation. This is the more
regrettable since, obviously, psychoanalysts do not in the least desire such
a melancholy result; yet they often bring it about through their blind
allegiance to the dogma of sexuality.
[279]
Intellectually, of course, the sexual interpretation is extremely simple;
it concerns itself at most with a handful of elementary facts which recur in
numberless variations. One always knows in advance where the matter will
end. Inter faeces et urinam nascimur remains an eternal truth, but it is a
sterile, a monotonous, and above all an unsavoury truth. There is
absolutely no point in everlastingly reducing all the finest strivings of the
soul back to the womb. It is a gross technical blunder because, instead of
promoting, it destroys psychological understanding. More than anything
else neurotic patients need that psychological rapport; in their dissociated
state it helps them to adjust themselves to the doctors psyche. Nor is it by
any means so simple to establish this kind of human relationship; it can
only be built up with great pains and scrupulous attention. The continual
reduction of all projections to their originsand the transference is madeup of projectionsmay be of considerable historical and scientific interest,
but it never produces an adapted attitude to life; for it constantly destroys
the patients every attempt to build up a normal human relationship by
resolving it back into its elements.
[280]
If, in spite of this, the patient does succeed in adapting himself to life,
it will have been at the cost of many moral, intellectual, and aesthetic
values whose loss to a mans character is a matter for regret. Quite apart
from this major loss, there is the danger of perpetually brooding on the
past, of looking back wistfully to things that cannot be remedied now: the
morbid tendency, very common among neurotics, always to seek the cause
of their inferiority in the dim bygone, in their upbringing, the character of
their parents, and so forth.
[281]
This minute scrutiny of minor determinants will affect their present
inferiority as little as the existing social conditions would be ameliorated
by an equally painstaking investigation of the causes of the Great War. The
real issue is the moral achievement of the whole personality.
[282]
To assert, as a general principle, that a reductive analysis is
unnecessary would of course be short-sighted and no more intelligent than
to deny the value of all research into the causes of war. The doctor must
probe as deeply as possible into the origins of the neurosis in order to lay
the foundations of a subsequent synthesis. As a result of reductive analysis,
the patient is deprived of his faulty adaptation and led back to his
beginnings. The psyche naturally seeks to make good this loss by
intensifying its hold upon some human objectgenerally the doctor, but
occasionally some other person, like the patients husb and or a friend who
acts as a counterpole to the doctor. This may effectively balance a one-
sided transference, but it may also turn out to be a troublesome obstacle to
the progress of the work. The intensified tie to the doctor is a
compensation for the patients faulty attitude to reality. This tie is what we
mean by transference.
[283]
The transference phenomenon is an inevitable feature of every
thorough analysis, for it is imperative that the doctor should get into the
closest possible touch with the patients line of psychological
development. One could say that in the same measure as the doctor
assimilates the intimate psychic contents of the patient into himself, he isin turn assimilated as a figure into the patients psyche. I say as a figure,
because I mean that the patient sees him not as he really is, but as one of
those persons who figured so significantly in his previous history. He
becomes associated with those memory images in the patients psyche
because, like them, he makes the patient divulge all his intimate secrets. It
is as though he were charged with the power of those memory images.
[284]
The transference therefore consists in a number of projections which
act as a substitute for a real psychological relationship. They create an
apparent relationship and this is very important, since it comes at a time
when the patients habitual failure to adapt has been artificially intensified
by his analytical removal into the past. Hence a sudden severance of the
transference is always attended by extremely unpleasant and even
dangerous consequences, because it maroons the patient in an impossibly
unrelated situation.
[285]
Even if these projections are analysed back to their originsand all
projections can be dissolved and disposed of in this way the patients
claim to human relationship still remains and should be conceded, for
without a relationship of some kind he falls into a void.
[286]
Somehow he must relate himself to an object existing in the
immediate present if he is to meet the demands of adaptation with any
degree of adequacy. Irrespective of the reductive analysis, he will turn to
the doctor not as an object of sexual desire, but as an object of purely
human relationship in which each individual is guaranteed his proper
place. Naturally this is impossible until all the projections have been
consciously recognized; consequently they must be subjected to a
reductive analysis before all else, provided of course that the legitimacy
and importance of the underlying claim to personal relationship is
constantly borne in mind.
[287]
Once the projections are recognized as such, the particular form of
rapport known as the transference is at an end, and the problem of
individual relationship begins. Every student who has perused the
literature and amused himself with interpreting dreams and unearthing
complexes in himself and others can easily get as far as this, but beyond it
no one has the right to go except the doctor who has himself undergone a
thorough analysis, or can bring such passion for truth to the work that hecan analyse himself through his patient. The doctor who has no wish for
the one and cannot achieve the other should never touch analysis; he will
be found wanting, cling as he may to his petty conceit of authority.
[288]
In the last resort his whole work will be intellectual bluff for how
can he help his patient to conquer his morbid inferiority when he himself is
so manifestly inferior? How can the patient learn to abandon his neurotic
subterfuges when he sees the doctor playing hide-and-seek with his own
personality, as though unable, for fear of being thought inferior, to drop the
professional mask of authority, competence, superior knowledge, etc.?
[289]
The touchstone of every analysis that has not stopped short at partial
success, or come to a standstill with no success at all, is always this
person-to-person relationship, a psychological situation where the patient
confronts the doctor upon equal terms, and with the same ruthless criticism
that he must inevitably learn from the doctor in the course of his treatment.
[290]
This kind of personal relationship is a freely negotiated bond or
contract as opposed to the slavish and humanly degrading bondage of the
transference. For the patient it is like a bridge; along it, he can make the
first steps towards a worthwhile existence. He discovers that his own
unique personality has value, that he has been accepted for what he is, and
that he has it in him to adapt himself to the demands of life. But this
discovery will never be made while the doctor continues to hide behind a
method, and allows himself to carp and criticize without question.
Whatever method he then adopts, it will be little different from suggestion,
and the results will match the method. In place of this, the patient must
have the right to the freest criticism, and a true sense of human equality.
[291]
I think I have said enough to indicate that, in my view, analysis makes
far higher demands on the mental and moral stature of the doctor than the
mere application of a routine technique, and also that his therapeutic
influence lies primarily in this more personal direction.
[292]
But if the reader should conclude that little or nothing lay in the
method, I would regard that as a total misapprehension of my meaning.
Mere personal sympathy can never give the patient that objective
understanding of his neurosis which makes him independent of the doctor
and sets up a counterinfluence to the transference.[293]
For the objective understanding of his malady, and for the creation of
a personal relationship, science is needednot a purely medical
knowledge that embraces only a limited field, but a wide knowledge of
every aspect of the human psyche. The treatment must do more than
destroy the old morbid attitude; it must build up a new attitude that is
sound and healthy. This requires a fundamental change of vision. Not only
must the patient be able to see the cause and origin of his neurosis, he must
also see the legitimate psychological goal towards which he is striving. We
cannot simply extract his morbidity like a foreign body, lest something
essential be removed along with it, something meant for life. Our task is
not to weed it out, but to cultivate and transform this growing thing until it
can play its part in the totality of the psyche.




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