Page:The International Journal of Psycho-Analysis II 1921 3-4.djvu/116

370 in his power every time to enforce active intervention on the part of the doctor by incorrect conduct, and because some quantities which have been temporarily freed from their fixations flow off directly as short-circuits.

I have, on the other hand, occasionally tried to safeguard myself against this by transferring the management of the discipline and all active intervention to the head nurse, but I found that she now received the bulk of the transference which should have helped my analysis.

Each case has to be decided on its merits. Preceding or inter- current physical examination has proved advantageous in some cases, but in the majority unusually hindering.

Finally one has to take into account that the temporary symptom formation can assume a very crude form. A schizophrenic to whom I had proved that he was in love with one of his female relatives, rewarded me by a sudden blow with his fist that left a depressed spot as a lasting remembrance. Another schizophrenic who had confessed a secret to me immediately attacked me and then tiarned upon himself with the result that he wounded himself in the wrist with a window-pane that he had struck. Later he so far recovered that he was able to take up his difficult occupation.

Of course such sudden acts of violence occur also in consequence of trifling motives outside analytic investigation, they are not to be ascribed to the analysis, but to the low stage of organisation of the patient's motility, though an analytic talk, like any other, can cause the excitation. This possibility compels us to be more careful with communications to the patient, and to take care of ourselves. Dangerous patients I place in a corner behind a heavy table, or I use the hours when he is in a cold bandage.

I am not so pessimistic as most people regarding the possibility of a therapy for the insane in institutions, a therapy which, if not true analysis, is nevertheless carried out according to the theses gained from analysis. The improvements seen after moving the patient to another location should make us think. There are many possibilities in the direction of Ferenczi's 'active psycho-analytic technique', and in the direction of combination with the cathartic pro- cedure, which still lie within our scotoma owing to our personal imperfections. If, as is likely, schizophrenia finds an organic basis in the loss of equilibrium between the germ and puberty glands, we can point out that both are interpolated in the whole chain of