FREDERICK

1945, Homey emphasized the significance of hopelessness, both in thepat ient and in the therapist as products of unresolved conflicts and approached it as an analytic problem. She warned the therapist to take the patient's hopelessness seriously, not to give superficial reassurance but to restore hope by helping the patient to resolve his inner con- flictsJ r In recent years other authors reaffirm- ed the role of hope as a therapeutic factor. French considers hope to be a vital factor in the integration o f behavior, and the late Harold Wolf scientitlcally documented the

A. WEISS

decisive role which hope plays in the treat ment of psychosomatic and some organic ill- nesses.

Hope, based not on magic but on faith in one's real self, and will, not in the nineteenth- century sense of will power but as commitment to the values of one's own choice, are vital therapeutic forces. They have to be reincluded into psychoanalytic therapy to make it more effective in helping the patient to realize his inherent human potential for freedom and re- sponsibility.

REFERENCES

1. Weiss, F. A.: a) Some aspects of Sex in Neuroses, Am. J. Psychoan., X, 27, 1950.

b) Psychoanalysis and Moral Values, Am. J. of Psychoan., Vol. 12, No. 1, 1952, 39.

c) Self-Alienation, Psychoanalysis and the Wholeness of Man. In: Progress of Psychoan., Goettingen, 1964, 43.

d) What Leads to Basic Change in Psy- choanalytic Therapy? Am. J. of Psy- choan., Vol. 25, 2.

e) The Changing Image of Psychoana- lysis, Am. J. Psychoan., Vol. 26, 2, 1966.

f) Emphasis on Health in Psychoanal- ysis, Am. J. Psychoan., Vol. 26, 2, t966.

2. Freud, S.: General Introduction to Psycho- analysis. Berlin: Kiepenheuer, 1935, 95.

3. Freud, S.: The Ego and the Id. London: Hogarthy, 1949, 72.

4. Brierley, M.: Trends in Psychoanalysis. London: Hogarthy, 1951, 288.

5. Wheelis, A.: The Quest for Identity. New York: Norton, 1958, 44.

6. Brenner, C.: An Elementary Textbook of

Psychoanalysis. New York: Int'l. Univ. Press 1955, 12.

7. Skinner, B. F.: Science and Human Be- havior. New York: Macmillan, 1953,

8. Maslow, A. H.: Toward a Psychology of Being. Princeton: Van Nostrand, 1962, 178.

10. Weiss, F. A.: Ref. lb, 41. 11. Homey, K.: Neurosis and Human Growth.

New York: W. W. Norton, 1950, 157. 12. Lorenz, K.: Das Sogenannte Boese, Zur

Naturgeschichte der Aggression (The So- Called Evil, Contribution to the Natural History of Aggression). Vienna: Borotha- Schoeler, 1963, 327.

13. Erikson, E. H.: Insight and Responsibility, New York, W. W. Norton 1964. 118, 148.

14. James, W.: Quoted in: Perry, R. B., The Thought and Character of William James, Boston: Little Brown, 1935.

15. Rank, O.: Will Therapy. New York: Knopf 1950, 45.

16. Alexander, F.: In Science and Psycho- analysis, V. J. Masserman (ed.), New York: Grune and Stratton, 1962, 174.

17. Homey, K.: Our Inner Conflicts. New York: W. W. Norton, 1945, 179.

MARIANNE H . ECKARDT

v alues, determinism and responsibility are basic topics that recur with nagging per-

sistence in spite of unpleasant memories of rehashed cliches and pointless meanderings.

They recur, however, for very good reasons. No matter how unsatisfactory our answers, the issues exist and require continuous recon- sideration.

Marianne H. Eckardt, M.D., is a Member of The American Academy of Psychoanalysis, and on the Faculty of the Washington School of Psychiatry.

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DETERMINISM AND FREEDOM IN PSYCHOANALYSIS: AWARENESS AND RESPONSIBILITY

The key word in our topic is responsibility. It is the main characteristic of what we mean by maturity, and it is also considered to be very square. This nicely ilustrates our dilem- ma. Because of this atmospheric bias, we may do well to reacquaint ourselves with the word. Its ingredients are response and ability. Abil- ity refers to "being able" to do something, as well as to do it "ably," that is, well. The English word response is less active than the French r~pondre or the German antworten, meaning to reply or answer. The German word for responsibility Uerantwortung seems to be most appropriate as it means to answer for one's actions. The emphasis is thus on our ability to reply adequately to the challenges of a situation according to our best judg- ment. It includes the necessities of a given situation as well as an activity of considera- tion and decision on our part.

When we use the word awareness in rela- tion to responsibility we do not mean self- awareness. We mean a more comprehensive awareness. When we are responsible, we are alive to a situation; we note the given require- ments; we are aware of our role in it, aware of our potential contribution, aware of what efforts such action may demand, a n d aware of potential obstacles and the consequences of our action and inaction. Our evaluation is directed towards the issue, the situation, our evaluation of it, and our plans for it. An analytic self-awareness is always limited.

Analytic self-contemplation is a tool to- wards greater awareness and responsiveness to the world. While the cure is taken, how- ever, the patient submerges in a partial aspect and loses the larger perspective. It is a prob- lem Freud was well aware of when he estab- lished the rule that a patient was not to make major changes in his living arrangements while in analysis. If we treat a depressed patient, and sense a smoldering antagonism against someone, we will encourage a more direct expression of his feeling. The patient may benefit from this airing, but he does not necessarily gain perspective. Chances are he should never have been in the situation he found himself in, that he never participated with interest, and that his own undercurrent antagonism had much to do With creating negative responses in his surroundings. Our assumption or hope as therapists tends to be that an awareness of repressed emotional as- pects will lead to a wisely balanced mode of

action. This hope is sometimes justified. At other times it leads to a pseudo-insight into other people's action but not into one's own. I think we need to distinguish three separate activities in order to avoid confusion in our own working hypotheses. The most difficult one is our own sound appraisal of the inter- acting forces that have shaped the patient's life; second, the activity of empathetic under- standing of the patient; and third, our ther- apeutic act ivi t ies which bring aspects into focus because we think it helps the patient.

The many post-Freudian contributions to psychoanalysis have led psychiatrists to bor- row concepts from different frames of refer- ences, to compose their own potpourri without clarifying their basic premises.

Freud started out with a distinct frame of reference: Pathology was caused by conflicts between id and superego forces, which led to repressions and defensive operations by the ego, for which a price had to be paid in energy currency. The aim was to lift repres- sions, void the need for defensive maneuver- ing and liberate energy which could then be channeled into constructive causes, an activity he called sublimation. Freud took society for granted and aimed at the individual's creative adaptivity to society. He did not speak of self-realization, as far as I know. He, in fact, concerned himself little with the meaning of sublimation, as his search was directed to childhood conflicts and their pathological con- sequences. We thus assumed that if we were not victims of pathological processes we would act maturely. Normality was defined by the absence of pathology. This conceptual vacuum concerning good functioning has plagued us ever since. Erik Erikson is the only outstand- ing author who has and is grappling with this most essential problem. In spite of the popu- larity of his books, his main messages have not penetrated into the body of our thinking. Insight and Responsibility is the significant title of his latest book, indicating that insight has to embrace a sense of responsibility for the area we touch. He sees responsibility as part of a mutually dependent relationship be- tween the individual and society, one giving significance to the other.

The problem of our relationship to society has acquired a sense of urgency. In Freud's earlier years it was not only Freud who took society for granted, but society also took itself for granted. It is well worth while to read

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MARIANNE H.

the late Franc Alexander's autobiographical comment on the social atmosphere of his early youth:

The world was a good place to live m, and a safe and stable place. Time and space were still absolutes, and so was the family, the government, and the economic system. For the present-day youth it is hard to believe that at the turn of the century the existing economic and polit- ical systems appeared to us as established forever. Gold was a solid basis for trade, four per cent interest on savings was a guarantee of future security, and moral principles and rules of social behavior were settled. Such critics as Shaw, Ibsen, Wedekind, Kierkegaard and Nietzsche had not yet found a public hearing and were considered to be eccentrics, neurotics or malcontents.

The emphasis is on security and on the ac- ceptance of the basic mores. Therapists, then, knew what they meant by normal behavior without having to define it. Our present era is distinctly different. Traditions are uprooted. The slogans speak of the age of anxiety, the isolation of man, alienation, the meaningless- ness and absurdity of life. In Freud's time society seemed well structured and difficulties arose from excessive superego restrictions. Our problems are basically different from those which Freud confronted. We deal with individuals who are lost, not because of ex- cessive pressure, but because meaningful patterns are not readily available. The individual has to structure his own life. He has freedom and choice. But if he fails to exercise these prerogatives, he finds himself a meaningless body in a meaningless situation. The pendulum also has swung in another area. A steady society and established mores favored superego activ- ities and repression of inappropriate subject- ive feelings and impulses. Now we are apt to encounter people who have unearthed all shades of emotions, but who do not know what to do with and where to take their discoveries. The problem does not lie in the existence of these feelings, but in the absence of a frame of existence. They do not know what to expect of themselves, what good func- tioning means, where their behavior is in- adequate, and where they have to make some

ECKARDT

effort in order to achieve a more desirable way of existence. I would like to stress that disturbing feelings, resentments, depressions, jealousies and irritabilities exist very often not because of the associative antecedents to these feelings, but because of an absence of vision of a better way of proceeding.

Many of our discussiom about values have been very misleading. We speak about values as if they were purely a matter of self-de- termination. We do have choices, but they are within the limits of the essential require- ments of a situation. If you plan a garden you can choose between grass, flagstones, perennials, annuals, trees and bushes in any variation but only within the limits set by the size and shadiness of the garden, by the con- dition of the soil, by your willingness to give time and care, and by the individual reqmre- ments which go with the function of our particular role. Choice and individual ap- proaches are subject to our respect for these inherent necessities.

The phrase "having choices" obscures one basic condition: if we do not make decisions other forces will shape our lives. Patients have a way of complaining about the mean- inglessness of an activity, as if life has cheated them out of something which is due them. The meaninglessness then justifies their neg- lect of whatever they were supposed to do. Meaning comes with individual care and mastery of some appropriate ski l l --an un- popular requirement for our present life style of alienation and absurdity. Timestyles have always existed. Our lifestyle concerns us only at the point where alienation stops being fun and real trouble develops. We see so many young woebegones who self-consciously mean- der into nothingness and suddenly hit bottom.

The worst thing we can do for these patients is to stress that they are the unfortunate vic- tims of undermining home or life situations. This is not easy, as we are deeply steeped in deterministic psychology. We may believe in instinctual determinants, if we are orthodox. We believe in cultural determinants if we are NeoFreudian; we see determinants in inter- personal processes if we are Sullivanians. Or we conceive them in the intricacies of neurotic conflicts if we are Horneyians. Even the Existentialists, avowed enemies of determin- ism, end up by enchaining the patient in a world conceived by himself as they are apt to minimize goals and existing structures. Of

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DETERMINISM AND FREEDOM IN PSYCHOANALYSIS: AWARENESS AND RESPONSIBILITY

past masters, only Otto Rank conceded a will to the individual. The moment we formulate neurotic drives as compulsive, as driven by anxiety, we show disrespect for the indivi- dual's most precious possession: that, for better or for worse, he did have a mind of his own and that much of his behavior, b e it neurotic or not, was decided and intended. It was not an automatic response but his answer to the situation. We have to understand previous and present llfe circumstances and to appreciate the outer and inner difficulties. But the patient needs to know that his response was his. It may have come natu- rally; it is usually understandable; it may have been justified or foolish, but it was his.

Our maxim with children is that they will not be responsible unless we give them re- sponsibility. The same may be said of our patients. We cannot expect them to develop a sense of responsibility if we do not concede them responsibility for their past and for their present life.

In summary: The goal of mental health has to encompass the integrative quality of be- havior which we call responsibility. We have thought of the individual in isolation rather than as an integrative part of society. We have thus deprived the individual of his func- tional role. Both society and he will greatly benefit from a return to partnership.

REFERENCES

1. Erikson, E. H.: Insight and Responsibility. 2. Alexander, F.: The Western Mind in Tran- NewYork: W. W. Norton and Co., 1964. sition. New York: Random Hse, 1960, 38.

BENJAMIN WOLSTEIN

F reedom and determinism, at the present time, are critical metaphors of all psycho-

logical therapy: This order of interpretative metaphors is, of course, as necessary to the structure of psychoanalysis as its empirical and systematic orders of inquiry. Even though they are metaphors, however, they are none the less necessary to the clinical study of human experience---whether it is done accord- ing to the instinct theories of classical Freud- ianism all the way to the Christian love of daseinanalysis. To put the difference briefly, freedom supports and is supported by activity psychology and by self-expansion theories of personality in which men are drawn to satisfy needs, secure goals and fulfill ideals. Deter- minism, on the other hand, supports and is supported b y mirror psychology and by energy-reduction theories of personality in which men are driven by needs, goals and ideals that press for satisfaction, security and fulfillment. Of the two, I think freedom is the superior guiding principle of psycho- analytic metapsychology, 1 if only because it is far better aligned with the central values of science, humanism and democracy--with

those ,especially, of truth, individuality and self-development. It is possible, of course, to defend the values of authoritarianism in science, absolutism in culture and totalitarian- ism in society yet, at the same time, also uphold the empirical and systematic require- ments of psychoanalysis. In one respect, it is clear, these requirements are the same for all sciences: personal and social values of their practitioners are to be distinguished from both reliability of empirical procedures and valid- ity of systematic results.

Therefore, I intend to sketch first a brief outline of psychoanalytic structure to demar- cate these empirical and systematic require- ments from such interpretive metaphors as freedom and determinism and, second, certain of their relationships to suggest where, in the actual experience of therapy, the psycho- analyst's values end and the patient's begin.

Psychoanalysis may be conceived as organ- ized inquiry into the direct experience of re- latedness and communication. The structure of this inquiry is made up of I) observations, 2) definitions, 3) postulates or points of view, 4) explanatory theory, and 5) interpretive

Benjamin Wolstein, Ph.D., Faculty, William Alanson, White Institute of Psychiatry, Psychoanalysis and Psychology; Clinical Professor of Psychology, Adelphi University.

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