From Obstacle to Ally

The Evolution of Psychoanalytic Practice

Judith M. Hughes

• Publisher: Routledge
• Year: 2004
• eBook ISBN: 9781135445638
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

From Obstacle to Ally explores the evolution of the theory and practice of psychoanalysis through an investigation of historical examples of clinical practice. Beginning with Freud's experience of the problem of transference, this book is shaped around a series of encounters in which psychoanalysts have managed effectively to negotiate such obstacles and on occasion, convert them into allies.

Judith Hughes succeeds in bringing alive the ideas, clinical struggles and evolving practices of some of the most influential psychoanalysts of the last century including Sandor Ferenczi, Anna Freud, Melanie Klein, Wilfred Bion, Betty Joseph and Heinz Kohut. Through an examination of the specific obstacles posed by particular diagnostic categories, it becomes evident that it is often when treatment fails or encounters problems that major advances in psychoanalytic practice are prompted.

As well as providing an excellent introduction to the history of fundamental psychoanalytic concepts, From Obstacle to Ally offers an original approach to the study of the processes that have shaped psychoanalytic practice as we know it today and will fascinate practising psychoanalysts and psychotherapists.

Chapter 1

Hysteria: Transference

What was the “hysteria” that Freud set out to treat? Its distinctive characteristic was the existence of physical symptoms for which no demonstrable physical cause could be found. In the case of Anna O., the young woman who ranked as the first psychoanalytic patient, the symptoms were legion. Here is a partial listing:

Left-sided occipital headache; convergent squint … markedly increased by excitement; complaints that the wall of the room seemed to be falling over …: disturbances of vision …; paresis of the muscles of the front of the neck, so that finally the patient could only move her head by pressing it backwards between her raised shoulders and moving her whole back; contracture and anaesthesia of the upper right, and, after a time, of the right lower extremity. … Later the same symptom appeared in the left lower extremity and finally in the left arm.¹

Anna O. was not Freud’s patient. Josef Breuer, Freud’s mentor and senior by 14 years, was the physician in charge. The essential feature of his treatment, or rather the essential assumption on which it rested, was that the physical symptoms had psychological meaning, that they marked some prior significant happening—or as he and Freud jointly put it: “Hysterics suffer … from reminiscences.”² Over the course of time Freud parted company from Breuer and elaborated an account of his own: the symptoms, he claimed, stood as a compromise between contending psychic forces, and hence their meaning was not immediately comprehensible; and then, he further argued, it was sexual fantasies, not traumatic events, that were being represented. Despite their disagreements, both Breuer and Freud—and Freud’s early followers as well—subscribed to the view which Sándor Ferenczi summed up in pithy fashion: “Thinking with the body equals hysteria.”³

In 1897 Freud wrote his confidant Wilhelm Fliess that he had been “through some kind of neurotic experience, curious states incomprehensible to Cs. [consciousness], twilight thoughts, veiled doubts.” In his next letter he reported that “something from the depths of my own neurosis set itself against any advance in … understanding.” A month later he confided that “the chief patient I am preoccupied with is myself. My little hysteria … has resolved itself further.”⁴ Freud’s “little hysteria” seems to have included no “conversion”⁵: in his case psychical excitation was not transformed into somatic symptoms. In contrast Ferenczi complained of multiple physical ailments. He was not certain, as he wrote Freud in 1912, “how much of the neurotic symptoms in him” was “dependent on the organic substrate,” and how much that was “apparently organic” was “psychogenic.”⁶ Whether or not Freud’s and Ferenczi’s self-diagnoses would win assent today—after all hysteria has been notoriously protean and elusive—is beside the point. Rather what should be emphasized is that they, the therapists, were personally implicated—and at risk.

In this chapter the treating physicians are Freud, Ferenczi, and Michael Balint. Freud needs no further introduction; Ferenczi and Balint do.

Ferenczi was born in 1873, 17 years after Freud.⁷ He was the eighth of 12 children, one of whom died in infancy. His father had migrated from Poland to Hungary and had ardently supported Hungarian independence in 1848. Out of enthusiasm for the liberal cause, he had his German-Yiddish family name of Fraenkel legally changed to the Hungarian Ferenczi. After the defeat of the Hungarian insurrection, he settled in the provincial town of Miskolc, where he opened a bookshop and a publishing establishment. He died when Sándor was 15, and his wife took over running the enterprises—with great success. She later opened a second bookshop in a neighboring town and also served as president of the Union of Jewish Women in the area. Sándor considered himself his father’s favorite; as for his mother, he claimed that from her he had received “too much severity … and [not] enough love.”⁸

Ferenczi left Miskolc after completing his secondary education, and went to Vienna for his medical training. When he returned to Hungary, he settled in Budapest. For 13 years he worked in a number of different venues, in a clinic for prostitutes, in a hospital department of Neurology and Psychiatry, in a service for a cooperative health insurance plan, and finally in private practice as general practitioner and neuropsychiatrist, functioning, in addition, as a consultant psychiatrist for the judiciary. In 1910 he left general medicine to devote himself to psychoanalysis.

Two years earlier, in February 1908, he had met Freud. They were immediately drawn to one another. The following summer Freud invited Ferenczi to join his family during their summer holiday. Ferenczi did so—and for many years he either visited Freud and his family or traveled with Freud during the summer break. When his eldest daughter, Mathilde, married in 1909, Freud replied to Ferenczi’s congratulatory telegram by confiding that “I would have liked to have seen you in the place of the young man who … has now gone away with my daughter.”⁹ Later that same year Ferenczi accompanied Freud on his one trip to the United States. There Freud was awarded an honorary degree by Clark University, in return for which he lectured on psychoanalysis. As he described it: “In the morning, before the time had come for my lecture to begin, we [he and Ferenczi] would walk together in front of the University building and I would ask him to suggest what I should talk about that day. He thereupon gave me a sketch of what, half an hour later, I improvised in my lecture.” In subsequent years the two men used their shared vacations for exchanging and elaborating ideas. “A number of papers,” Freud commented, “that appeared later in the literature under his or my name took their first shape in our talks.” Toward the end of Ferenczi’s life—he died of pernicious anemia in 1933—Freud felt that the younger man had “drifted away” from him.¹⁰ Drifted away, perhaps, but he did not desert him.

Nor did he desert the cause. In 1910 Freud prevailed on him to take the lead in establishing the International Psychoanalytic Association. In 1913 Ferenczi founded the Budapest Psychoanalytic Society. This was the year in which, as a response to Freud’s break with Carl Gustav Jung, Ferenczi joined together with Ernest Jones, Karl Abraham, Otto Rank, and Hanns Sachs to form a tight, small organization of loyalists, a clandestine “Committee,” to rally around Freud as his dependable palace guard. (It lasted into the 1920s.)¹¹ A year later Freud remarked: “Hungary, so near geographically to Austria, and so far from it scientifically, has produced only one collaborator, S. Ferenczi, but one that … outweighs a whole society.”¹² (In subsequent years the Budapest society had a most impressive roster of members—including Franz Alexander, Melanie Klein, Sándor Radó, Geza Roheim, René Spitz, along with Michael Balint.)¹³ After the First World War, psychoanalysis prospered briefly in Hungary. For a matter of months Ferenczi held the first university chair, anywhere, in psychoanalysis. Then in February 1920 the anti-semitic and anti-psychoanalytic Horthy regime took over. Forced to resign from the Hungarian Medical Society, Ferenczi became increasingly withdrawn, devoting himself to psychoanalytic research.

Given the political situation in Hungary, it is not surprising that Ferenczi should have thought of leaving. Berlin seemed attractive, and many of his co-workers moved to the German capital; the United States seemed even more so. Ferenczi decided to test the waters. In response to an invitation from the New School for Social Research, he spent the academic year 1926–1927 lecturing in New York. There he met a cool reception from members of the New York Psychoanalytic Society, with whom he (and Freud) disagreed about the psychoanalytic training of non-medical candidates. In Washington, DC, where he spoke in April 1927, he was warmly welcomed by Harry Stack Sullivan. At Sullivan’s urging, his colleague, Clara Thompson, went to Budapest for treatment with Ferenczi in the summers of 1928 and 1929, and then continuously from 1931 until Ferenczi’s death two years later.¹⁴ Freud, for one, was relieved by Ferenczi’s coming back to Europe; he had not wanted to lose him to “to the land of the dollar barbarians.”¹⁵

How, then, did Ferenczi’s drift away? As Freud saw it: after Ferenczi’s return from America, “one single problem … monopolized his interest.”

The need to cure and to help became paramount in him. He had probably set himself aims which, with our therapeutic means are altogether out of reach to-day. [S]o long as he had not succeeded …, he kept apart, no longer certain, perhaps, of agreement with his friends. Wherever it may have been that the road he had started along would have led him, he could not pursue it to the end.¹⁶

As Michael Balint saw it:

The tragic disagreement between Freud and Ferenczi, which caused both of them so much pain, … considerably delayed the development of our analytic technique … Ferenczi, because of his own uncertainty, could not make use of Freud’s well-meant and well-founded criticisms; he saw in them only lack of understanding. Freud, for his part, … found in Ferenczi’s experiments nothing but confirmation of his cautiousness.

The … disagreement between Freud and Ferenczi acted as a trauma on the psychoanalytic world … [T]he shock was highly disturbing and extremely painful. The … reaction to it was a frightened withdrawal.¹⁷

Despite Freud’s belief that “the history of … [his] science” would never forget Ferenczi, it came pretty close to doing so.¹⁸ In Balint’s view the forgetting amounted to repression: the psychoanalytic community adopted the hysteric’s classic defensive measure designed to ward off distressing ideas.

In Balint Ferenczi found a keeper of the flame.¹⁹ Born in Budapest in 1896, the elder of two children, Balint came from a middle-class Jewish family which had been fully assimilated for only a couple of generations—in fact, his father had learned Hungarian in secondary school as a foreign language. On reaching adulthood, Michael changed his family name legally from Bergsmann to Balint; he also converted to the Unitarian faith. If his father was dismayed by the name change and the conversion, he was pleased with his son’s decision to follow in his professional footsteps and enroll in medical school. Shortly thereafter Michael was called up for military service in the First World War. Thanks to a thumb wound, he was able to return to his studies after a two and a half year hiatus and finish them by war’s end.

Balint first encountered psychoanalysis by way of reading The Interpretation of Dreams and The Psychopathology of Everyday Life. He was critical of both. At the age of 21, he changed his mind: “the Three Contributions and Totem and Taboo … decisively and definitely conquered” him. Totem and Taboo had been given to him by a “young girl who was studying pure mathematics … because there were no facilities for studying anthropology” in Budapest. Her name was Alice Székely-Kovács, and she was the daughter of Vilma Kovács, an analysand of Ferenczi and herself a psychoanalyst. She became Balint’s wife, and until her death in 1939, they “read studied, lived and worked together.”²⁰ Because of the political situation in Budapest, the young couple moved to Berlin. Michael pursued his PhD in biochemistry and began treating psychosomatic cases at Berlin’s Charité Hospital. Simultaneously he worked half-time at the Berlin Psychoanalytic Institute and went into analysis with Hanns Sachs. He was not happy with Sachs, and in 1924 he and Alice decided to return to Budapest and to seek out Ferenczi.

Balint stayed in the Hungarian capital for another 15 years—he and Alice emigrated to England at the beginning of 1939. In the intervening decade and a half, he had two years of analysis with Ferenczi—it was terminated when his analyst went to New York. He himself became an active member of the Budapest psychoanalytic community; he helped establish an outpatient clinic; he served first as deputy-director, then as director of the Budapest Psychoanalytic Institute. All the while the political situation was getting worse and worse:

[W]e were ordered to notify the police of every one of our meetings with the result that a plain-clothes policeman attended each of them, taking copious notes of everything that was said. We could never find out what these notes contained or who read them. The only result we knew of was that on several occasions the detective, after the meeting, consulted one of us either about himself, his wife, or his children. This was quite amusing for us, but no proper discussions could develop under these circumstances.²¹

In England, after the Second World War, Balint became a member of the British Psycho-Analytical Society; he was elected scientific secretary for 1951–1953 and later president from 1968 until his death in December 1970. Within the British Society, both he and his new wife, Enid—they married in 1953—belonged to the Independent (Middle) Group, and he ranked as one of its training analysts. His psychoanalytic work during those years—both clinical and theoretical—“developed as a remarkably regular line.”²² And from his first...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• Abbreviations
• Introduction
• 1 Hysteria: Transference
• 2 Obsessional neurosis: Resistance
• 3 Depression: Negative therapeutic reaction
• 4 Paranoia: Abnormal changes in the ego
• 5 Narcissism: Megalomania
• Conclusion
• Notes
• Selected bibliography
• Index