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Though generally thought of as a brilliant social commentator, Fromm was first a great psychoanalyst. These posthumous writings combine two aspects of Fromm's thinking, building on Freudian theory and also modifying it with a unique humanist view. For Fromm, the essence of psychological health involves communication between the irrational and rational parts of the personality. The art of therapy is the art of listening.
Curing Factors According to Sigmund Freud and My Critique
When speaking about factors leading to analytic cure, I think the most important work written on the subject was Freud's paper Analysis, Terminable and Interminable (1937c), which is one of his most brilliant papers, and, if one could put it that way, one of his most courageous papers, although Freud never lacked in courage in any of his other work. It was written not long before his death, and in a way it is Freud's own last summarizing word about the effect of analytic cure. I first shall summarize briefly the main ideas of this paper and then, in the main part of this lecture, try to comment on it and possibly make some suggestions in connection with it.
First of all, what is interesting in this paper is that Freud presents in it a theory of psychoanalysis which had not really changed since the early days. His concept of neurosis is that neurosis is a conflict between instinct and the Ego: either the Ego is not strong enough, or the instincts are too strong, but at any rate, the Ego is a dam; it is not capable of resisting the onrush of instinctual forces, and for this reason neurosis occurs. This is in line and consequent with his early theory, and he presented it also in its essence without trying to embellish or modify it. What follows from that is that analytic cure consists essentially in strengthening the Ego which in infancy was too weak, enabling it to cope now with instinctual forces, in a period in which the Ego would be strong enough.
Secondly, what according to Freud is cure? He makes it very clear, and I may quote here from Analysis, Terminable and Interminable (1937c, S. E., Vol. 23, p. 219): "First the patient"—provided we speak of cure—"shall no longer be suffering from his [former] symptoms and shall have overcome his anxieties and his inhibitions. There is another very important condition. Freud does not assume that cure of the symptoms, disappearance of the symptoms per se constitutes cure. Only if the analyst is convinced that enough unconscious material has been brought to the surface which would explain why the symptoms have disappeared [naturally in terms of the theory]—only then can the analyst be convinced that the patient is cured, and is not likely to have repetitions of his former symptoms. Actually, Freud speaks here of a "taming of the instincts" (cf. loc. cit., p. 220). The analytic process is a taming of the instincts or, as he also says, making the instincts more "accessible to all the influences of the other trends in the Ego" (loc. cit., p. 225). First, the instincts are brought to awareness because how can you tame them otherwise?—and then in the analytic process the Ego becomes stronger and gains the strength which it failed to acquire in childhood.
Thirdly, what are the factors which Freud mentioned in this paper as determining the results of analysis—either cure or failure? He mentions three factors: first, "the influence of traumas"; secondly, "the constitutional strength of the instincts"; and thirdly, "the alterations of the Ego" in the process of defense against the onrush of the instincts (cf. loc. cit., p. 225).
An unfavorable prognosis, according to Freud, lies in the constitutional strength of the instincts, plus or combined with a modification, an unfavorable modification of the Ego in the defense conflict. It is well known that for Freud the constitutional factor of the strength of instinct was a most important factor in his prognosis for a patient's cure in an illness. It is a strange thing that Freud throughout his work, from the early writings on until this very latest of his writings, emphasized the significance of constitutional factors, and that neither the Freudians nor the non-Freudians have done more than paying lip service at the very most to this idea which for Freud was very important.
So, Freud says one unfavorable factor for cure is the constitutional strength of the instincts, even, he adds, if the Ego is normally strong. Secondly, even the Ego modification, he says, can be constitutional. In other words, he has a constitutional factor on two sides: on the side of the instincts and on the side of the Ego. He has a further factor which is unfavorable, and that is that part of the resistance which is rooted in the death instinct. That, of course, is an addition which comes from his later theory. But naturally, in 1937, Freud would consider also that as one factor unfavorable to cure.
What is the favorable condition for cure according to Freud? This is something which many people are not aware of when they think of Freud's theory, namely, that according to this paper of Freud's, the stronger the trauma the better are the chances for cure. I shall go into the question why this is so and why I think this was so in Freud's own mind, although he does not talk too much about it.
The person of the psychoanalyst is the other factor which hopefully is favorable to the cure. Freud makes here, in this last paper, a very interesting remark on the analytic situation which is worthwhile mentioning: The analyst, he says, "must possess some kind of superiority so that in certain analytic situations he can act as a model for his patient, and in others as a teacher. And, finally, we must not forget that the analytic relationship is based on a love of truth—that is, on a recognition of reality— and that it precludes any kind of sham and deceit." (S. Freud, 1937c, S. E. Vol. 23, p. 248.) I think that is a very important statement Freud made here very clearly.
One last word about Freud's concept here, which he does not put explicitly but which is implicit and which goes through his whole work if I understand it correctly. Freud always had a somewhat mechanistic view of the process of cure. Originally the view was, if one uncovers or discovers the repressed affects then the affect by becoming conscious gets out of the system, so to speak; this was called abreacting, and the model was a very mechanical one, like getting pus out of an inflamed spot and so on, and it was supposed to be quite natural, quite automatic, that this happened.
Freud and many other analysts saw that this wasn't true because, if it were true, then the people who act out most their irrationality would be the healthiest ones because they would get the stuff out of their system—and they don't. So, Freud and other analysts gave up the theory. But this was replaced by the less explicit idea that the patient has insight, or, if you use another word, becomes aware of his unconscious reality, then his symptoms simply disappear. One does not really have to make a special effort, except the one to come, to free associate, and to go through the anxieties which this necessarily involves. But it is not a question of the patient's particular effort, particular will—he will get well provided one succeeds in overcoming the resistances, and the repressed material comes to the fore. This is by no means as mechanistic as Freud's original abreacting theory was. But it is still somewhat mechanistic, as I see it. It contains the implication that the process is a smooth one, in the sense that, if one uncovers the material, then the patient will get well in this process.
Now I want to make some further comments on, some additions to and some revisions of these views of Freud on the causes which effect cure. First of all, I want to say that, if one asks what is analytic cure, then I think that what unites, or what is common to all psychoanalysts, is Freud's basic concept that psychoanalysis can be defined as a method which tries to uncover the unconscious reality of a person and which assumes that in this process of uncovering the person has a chance to get well. As long as we have this aim in mind, then a good deal of fighting among various schools would be somewhat reduced in importance. If one really has that in mind, one knows how very difficult and treacherous it is to find the unconscious reality in the person, and then one does not get so excited about the different ways in which one tries to do that, but one asks which way, which method, which approach is more conducive to this aim, which is the aim of all that can be called psychoanalysis. I would say that any therapeutic method which does not have that aim may be therapeutically very valuable, however it has nothing to do with psychoanalysis, and I would make a clear-cut division right at this point.
As to Freud's concept that analytic work is like reinforcing a dam against the onrush of the instincts, I don't want to argue against this point, because I think many things can be said in favor of it. Especially, I believe, if we deal with the question of psychosis as against neurosis, then we really deal with the brittleness of the Ego and the strange thing that one person does and another person does not collapse under the impact of certain impulses. So I'm not denying the validity of the general concept that Ego strength has something to do with the process. But nevertheless, with this qualification, it seems to me that the main problem of neurosis and cure is precisely not that of here come the irrational passions and there is the Ego which protects the person from becoming sick.
There is another contradiction, and that is the battle between two kinds of passion, namely, the archaic, irrational regressive passions as against other passions within the personality. I shall be a little more explicit to make myself understood. I mean by the archaic passions: intense destructiveness, intense fixation to the mother, and extreme narcissism.
By intense fixation I mean the fixation which I would call a symbiotic fixation, or which in Freudian terms one would call the pre-genital fixation to the mother. I mean that deep fixation in which the aim is really to return to the mother's womb or even return to death. I should like to remind you that Freud himself in his later writings stated that he underestimated the significance of the pre-genital fixation. Because in his whole work he put so much emphasis on the genital fixation, he therefore underestimated the problem of the girl. While for the boy it is plausible that all this should start with the erotic genital fixation to the mother, with a girl it doesn't really make sense. Freud saw that there is a great deal of pre-genital—that is to say, not sexual in the narrower sense of the word—fixation to the mother, which exists both in boys and girls and which he had not paid sufficient attention to in his work in general. But this remark of Freud's also got lost somewhat in the analytic literature, and when analysts speak about the Oedipal phase and the Oedipal conflict and the whole business, they usually think in terms of the genital, not of the pre-genital fixation or attachment to the mother.
By destructiveness I mean not destructiveness which is essentially defensive, in the service of life, or even secondarily in the defense of life, like envy, but destructiveness in which the wish to destroy is its own aim. I have called that necrophilia. [Strong mother fixation, necrophilic destructiveness and extreme narcissism are malignant passions]—malignant because they are related to, they are causative of severe illness. Against these malignant passions you have also the opposite passions in man: the passion for love, the passion for the interest in the world—all that which is called Eros, the interest not only in people, but also the interest in nature, the interest in reality, the pleasure in thinking, all artistic interest.
It is fashionable today to talk about what the Freudians call Ego functions—which I think is a poor retreat and the discovery of America after it has been discovered for a long time, because nobody ever doubted outside of Freudian orthodoxy that there are many functions of the mind which are not the result of instincts in the sexual sense. I think by this new emphasis on the Ego, one has done some retreat from that which was the most valuable part in Freud's thinking, namely, the emphasis on the passions. While Ego strength in a certain sense is a meaningful concept, the Ego is essentially the executor of the passions; it's either the executor of malignant passions or of benign passions. But what matters in man, that determines his action, what makes his personality, is what kind of passions move him. To give an example: It all depends on the question whether a person has a passionate interest in death, destruction and all that is not alive, which I called necrophilia, or a passionate interest in all that is alive, which I call biophilia. Both are passions, both are not logical products, both are not in the Ego. They are part of the whole personality. These are not Ego functions. These are two kinds of passion.
This is a revision I would suggest with regard to Freud's theory: that the main problem is not the fight of Ego versus passions, but the fight of one type of passion against another type of passion.CHAPTER 2
Benign and Malignant Neuroses—with a Case History of a Benign Neurosis
Before I go on to the question: what is analytic cure or what are the factors leading to analytic cure, naturally one has to consider and to think about the question: what kinds of neurosis are there? There are many classifications of neurosis and many changes in the classification. Dr. Menninger has recently suggested that most of these classifications have no particular value, without really suggesting a new one which has one and which he recommends as an essential classifying concept. I would like to suggest the following classification—this is a very simple one in a way—and that is the difference between benign neurosis and malignant neurosis.
A person suffers of a benign or light neurosis, if he or she is not essentially seized by one of these malignant passions, but whose neurosis is due to severe traumata. Here I am entirely in agreement with what Freud said, namely, that the best chances for cure lie precisely in those neuroses where the patient suffers from the most severe trauma. The logic is that if a patient survives a severe trauma without becoming psychotic or showing forms of sickness which are exceedingly alarming, then indeed he or she shows that from a constitutional standpoint he or she has a lot of strength. In those cases of neurosis in which what I like to call the nucleus of the character structure is not severely damaged, that is to say, is not characterized by these severs regressions, these severe forms of malignant passions, I think there analysis has its best chances. Naturally, it requires work in which whatever the patient has repressed has to be clarified, has to come to consciousness; that is to say: the nature of the traumatic factors, the reactions of the patient to these traumatic factors—which have, as is very frequent, denied the real nature of the traumatic factor.
I want to illustrate a benign neurosis with a short case history of a Mexican woman. She is unmarried, about twenty five years old, her symptom is homosexuality. Since the age of eighteen she has only had homosexual relationships with other girls. At the point where she comes to the analyst she has a homosexual relationship with a cabaret singer, goes every night to hear her friend, gets drunk, is depressed, tries to get out of this vicious circle, and yet submits to this friend, who treats her abominably. Nevertheless, she is so frightened to leave her, she is so intimidated by the threat of the other woman to leave her, that she stays on.
Now, that's rather a bad picture: a case of homosexuality, but very much characterized by this constant anxiety, light depression, aimlessness of life, and so on. What is the history of this girl? Her mother was a woman who has been the mistress of a rich man for a long time. All the time she was the mistress of the same man, and this was the offspring of the relationship, the little daughter. The man was quite faithful in a way, always supporting the woman and the little girl, but he was not a father in evidence, there was no presence of a father. The mother, however, was an utterly scheming mother who only used this little girl to get money out of the father. She sent the girl to the father to get money out of him, she blackmailed the father through the girl, she undermined the girl in every way she could. The mother's sister was the owner of a brothel. She tried to induce the little girl into prostitution, and actually the little girl did, twice—she wasn't so little then—appear naked in front of men to be paid for it. It probably took a lot of stamina not to do more. But she was terribly embarrassed because, you can imagine, the children of the block, what names they called her, being quite openly not only a girl without a father, but also the niece of the owner of the brothel.
Excerpted from The Art of Listening by Erich Fromm, Rainer Funk. Copyright © 1994 Estate of Erich Fromm. Excerpted by permission of OPEN ROAD INTEGRATED MEDIA.
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Posted December 14, 2009
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