Page:Freud - Selected papers on hysteria and other psychoneuroses.djvu/98

84 noticed even if they remain after the treatment is finished. Other symptoms of a similar nature seem to be taken along indirectly by the psychogenic symptoms, for indirectly they really depend on some psychic causation.

I shall now mention those difficulties and inconveniences of our therapeutic method which are not evident from the preceding histories, or from the following remarks concerning the technique of the method.—I will rather enumerate and indicate than carry them out. The process is toilsome and wearisome for the physician, it presupposes a profound interest for psychological incidents, as well as a personal sympathy for the patient. I could not conceive myself entering deeply into the psychic mechanism of a hysteria in a person who appeared to me common and disagreeable, and who would not, on closer acquaintanceship, be able to awaken in me human sympathy; whereas I can well treat a tabetic or a rheumatic patient regardless of such personal liking. Not less are the requisites on the patient's side. The process is especially inapplicable below a certain niveau of intelligence. It is rendered extremely difficult wherever there is any tinge of weakmindedness. It requires the full consent and the attention of the patients, but, above all, their confidence for the analysis regularly leads to the inmost and most secretly guarded psychic processes. A large proportion of the patients suitable for such treatment withdraw from the physician as soon as they become cognizant whither his investigations tend; to them the physician remains a stranger. In others who have determined to give themseves up to the physician and bestow their confidence upon him, something usually voluntarily given but never demanded, in all those I say, it is hardly avoidable that the personal relation to the physician should not become unduly prominent, at least for some time. Indeed, it seems as if such an influence exerted by the physician is a condition under which alone a solution of the problem is made possible. I do not believe that it makes any essential difference in this condition whether we make use of hypnosis or have to avoid or substitute it. Yet fairness demands that we emphasize the fact that although these inconveniences are inseparable from our method, they, nevertheless, cannot be charged to it. It is much more evident that they are formed