Page:The International Journal of Psycho-Analysis II 1921 3-4.djvu/119

 PSYCHO-ANALYSIS AND PSYCHIATRY 373

This simile characterises the revolutioa which Freud's teaching has brought into the hfe of the psychiatrist who ventures to taste the forbidden dish. The patient's gesticulations, his phantastic delusions and confused nonsense, become full of meaning, and he becomes again a human being among human beings. He is no longer considered, as previously and even to-day by a number of scientific physicians of institutions, a more or less worthless appendage to his brain, his death being waited for with scarcely repressed impatience; and not till dead, dissected in the laboratory, does he become the object of an aesthetic cult of the dead. In other words, Freud has made possible a useful counter-transference to the failure or repression of which is due the retarded develop- ment of psychiatry.

We have therefore arrived at a point which belongs to my paper — namely, the problem of the relations between neuroses and psychoses. The neurosis itself absorbs the interest of the physician in the patient; the transference of the patient to the physician in- creases this interest and helps to get over the advancing hostile transferences. In mental patients transferences to the physician are not lacking; their unpleasant, gross and hostile expressions are too well known, they are transferences of an infantile or a negative libido (hate transferences). The transference mania of hysterics corresponds to the delusions of persecution in the psychoses, the latter being the negative-libidinal analogue of the former, i Negativism also is a kind of transference mania of negative libido.

The first aim is to fix the criteria of the concepts ' neurosis ' and 'psychosis', and this is by no means easy. It has happened in foro that the psychiatric expert, asked what actually constituted a mental patient, has answered that he did not know. Therefore we will consider the different criteria given by the laity (whose opinion is here authoritative and also is expressed in legislation), by psychiatry, and finally by psycho-analysis. Here we shall have to make two digres-sions, one of which takes for its subject the nosological position of civilisation as an entire phenomenon, the other keeps in view the development of motor inhibition.

Difficulties arise from the fact that the psychotic person like

» Freud: ' Zur Dynamik der tJbertragung ', Zcntralbl. f, Psa., Bd. II, S. 168 ff.: 'Where the capability of transference has become essentially negat- ive, as in paranoia, the possibility of influence and cure ceases.'