Page:The International Journal of Psycho-Analysis II 1921 3-4.djvu/115

 PSYCHO-ANALYSIS AND PSYCHIATRY 369

only one means of getting round this defect, namely, psycho- analysis. Its use in the investigation of mental patients requires in the first instance its previous use upon the investigator. Then, having regard to the child-like nature of the patient, the material has to be collected mostly in the same way as Dr. von Hug- Hellmuth has suggested for child analysis, namely, in play ^ and conversation. As it is more difficult to obtain a useful positive transference in these patients, the relation has to become some- thing more real than in the analysis of the transference neuroses. The rule must be adhered to that only the minimum of discharge shall be permitted. It suffices to study the effect of commands and prohibitions prescribed by the situation, and the effect of small gifts.

In society a good mutual relationship is only made possible through positive mutual transference: relics of the unconscious idea to stand to others in the relation of father or mother (brother, sister, husband) and the necessary feelings of love, are absorbed in the social relationships. This unconscious Constellation is, as we know, used in the treatment in order to be transferred on society in a more highly organised form via the analyst, and in order to re-establish the patient's rapport with society. The analyst avoids a stoppage of the process at the intermediate station, his own person, by carrying out the analysis of the transference in stages. Through the limitation of the material relation the transference becomes continually over-charged and accessible to analysis.

This method however fails in institutional patients. Most of them have a rather hostile attitude from the beginning. They see in the doctor a jailer (the worst of it is that the conditions force him to be really such), and in order to obtain a be- ginning of contact he has to make use of the expedient of favouritism or gifts; he thereby creates at the same time a degree of actual relationship which he would like to avoid. Here the claims of the institutional doctor and the analyst diverge. The former accepts the father-r61e, readily seeks the real relation, and tries to profit by it in order to bring the patient to the highest possible degree of obedience and dependence, and to lead him along this path to work and social utility. The analyst meets with resistances in the analysis that are unconquerable, because the patient has it

• The 'association experiment' belongs here. It has no special advan- tages over other occupations in common.

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