Excerpts from Must Read Books & Articles on Mental Health
Topics
Books, Part XVIII
The Discovery of the Unconscious: The History and Evolution
of Dynamic Psychiatry
Henri F. Ellenberger
Chapter Two: The Emergence of Dynamic Psychiatry, pp. 53-69
The emergence of dynamic psychiatry can be traced to the year 1775, to a clash between
the physician Mesmer and the exorcist Gassner. Gassner, an immensely successful and
popular healer, personified the forces of tradition. He had mastered an age-old technique
that he applied in the name of the established religion, but the spirit of the times was
against him. Mesmer, a son of the "Enlightenment," had new ideas, new
techniques, and great hopes for the future. He was instrumental in defeating Gassner and
believed that the time was propitious for the onset of the scientific revolution that he
had in mind.
However, the overthrow of a declining tradition does not in itself
inaugurate a new one. Mesmer's theories were rejected, the organization he had founded was
short-lived, and his therapeutic techniques were modified by his disciples. Nonetheless,
he had provided the decisive impulse toward the elaboration of dynamic psychiatry, even
though it would be a century before the findings of his disciples were to he integrated
into the official corpus of neuropsychiatry by Charcot and his contemporaries.
Gassner and Mesmer
In the first months of 1775, crowds of people, rich and poor, noblemen and peasants,
including among them patients of all kinds, swarmed to the small town of Ellwangen, in
Wurttemberg, to see Father Johann Joseph Gassner, one of the most famous healers of all
time. He exorcized patients in the presence of Catholic and Protestant church authorities,
physicians, noblemen of all ranks, members of the bourgeoisie, and sceptics as well as
believers. His every word and gesture and those of his patients were recorded by a notary
public, and the official records were signed by the distinguished eyewitnesses. Gassner
himself was a modest country priest; but once he had donned his ceremonial garments, had
taken his seat, and had the patient kneeling before him, astonishing things would take
place. Numerous collections of official records have survived, as well as accounts given
by eyewitnesses. Among the latter was an Abbe Bourgeois, from whose narrative we borrow
the following details:
The first patients were two nuns who had been forced to leave their community on
account of convulsive fits. Gassner told the first one to kneel before him, asked her
briefly about her name, her illness, and whether she agreed that anything he would order
should happen. She agreed. Gassner then pronounced solemnly in Latin: "If there be
anything preternatural about this disease, I order in the name of Jesus that it manifest
itself immediately." The patient started at once to have convulsions. According to
Gassner, this was proof that the convulsions were caused by an evil spirit and not by a
natural illness, and he now proceeded to demonstrate that he had power over the demon,
whom he ordered in Latin to produce convulsions in various parts of the patient's body; he
called forth in turn the exterior manifestations of grief, silliness, scrupulosity, anger,
and so on, and even the appearance of death. All his orders were punctually executed. It
now seemed logical that, once a demon had been tamed to that point, it should be
relatively easy to expel him, which Gassner did. He then proceeded in the same manner with
the second nun. After the seance had ended, Abbe Bourgeois asked her whether it had been
very painful; she answered that she had only a vague memory of what had happened and that
she had not suffered much. Gassner then treated a third patient, a high-born lady who had
previously been afflicted with melancholia. Gassner called forth the melancholia and
explained to the lady what she was to do in order to overcome it in case she was troubled
by it again.
Who was the man whose almost miraculous healings attracted such
crowds? The life history of Johann Joseph Gassner (1727-1779) is not well known. Among
biographical accounts, one, by Sierke, is strongly prejudiced against him; another, by
Zimmermann, is better documented but is biased in his favor; both are based mainly on
contemporary pamphlets, not on archive material. Gassner was born in Braz, a village of
indigent peasants in Vorarlberg, a mountainous province of western Austria. He was
ordained into the priesthood in 1750, and beginning in 1758 carried out his ministry in
Klosterle, a small village in eastern Switzerland. A few years later, according to
Zimmermann, he began to suffer from violent headaches, dizziness, and other disturbances
that became worse whenever he began celebrating the Mass, preaching, or hearing
confession. This particular detail led him to suspect that "the Evil One" might
be at work; he resorted to the Church's exorcism, prayers, and his troubles eventually
disappeared. He then began to exorcise sick people within his parish, apparently with much
success, since patients started to come to him from all the neighboring districts. In 1774
his fame was increased after he had cured a high-horn lady, the Countess Maria Bernardine
von Wolfegg.
In the same year Gassner wrote a booklet in which he explained the
principles of his healing method.° He distinguished two kinds of illnesses:
natural ones, that belonged to the realm of the physician, and preternatural ones, that he
classified into three categories: circumsessio (an imitation of a natural illness, caused
by the devil) ; obsessio (the effect of sorcery) ; and possessio (overt diabolical
possession), the least frequent of them. In all of these cases Gassner first told the
patient that faith in the name of Jesus was an essential prerequisite to heing healed and
asked his consent for the use of exorcismus probativus (trial exorcism). He then solemnly
entreated the demon to make manifest the symptoms of the disease; if the symptoms were
produced, Gassner considered it proven that the disease was caused by the devil and
proceeded to exorcize him. But if no symptoms appeared, he sent the patient to a doctor.
In that manner he felt his position to be unimpeachable, both from the viewpoint of
Catholic orthodoxy and from that of medicine.
Because of his sudden fame, Gassner received invitations from various
places; including Constance, where he performed cures by exorcism without apparently
succeeding in gaining the favor of Cardinal Roth, Bishop of Constance. But he found a
powerful protector in the Prince Bishop of Regensburg, Count Fugger, who appointed him to
an honorary office al his own court. Gassner thus took up residence in the old churchtown
of E'llwangen and lived there between November 1774 and June 1775. During this period he
reached the peak of his activities; patients thronged to Ellwangen, and a storm of
polemics raged around him. Dozens of pamphlets were published, either for or against him,
in Germany, Austria, Switzerland, and even in France.
Gassner had the support of some ecclesiastical protectors in addition
to that of the masses and of those who hoped to be cured by him. (His enemies added that
he was particularly popular with the innkeepers and carriage drivers, who largely
benefited from the fad.) One of his admirers was the celebrated Zurich pastor Lavater.
Among his adversaries were the Catholic theologian Sterzinger, the Protestant theologian
Semmler, and most of the representatives of the Enlightenment. Rumors were circulated that
cases of possession were sure to occur wherever Gassner's visit was announced; imitators,
among them even peasants and children, began exorcizing with his method. In Vienna,
animated controversies took place, both for and against him.
Why was there such an outburst of passion? This can be better
understood by looking at the situation in Europe in 1775. Politically, Europe had
begun to leave behind the old feudal organization to move toward the development of
national states. In contrast with unified nations such as France and England, Germany,
under the nominal sovereignty of the Emperor, was an inextricable conglomerate of more
than three hundred states of all sizes. Most of continental Europe was under the
domination of the Austrian monarchy, which ruled not only over Austria proper but also
over a dozen subjected nations. Vienna, an artistic and scientific center of the first
order, was the seat of its brilliant court. A strong and rigid system of hereditary social
classes prevailed everywhere: nobility, bourgeoisie, peasantry, and laborers, each class
having its subclasses. "The Church had a firm grip on the lower and middle classes.
But Europe had come under the spell of a new philosophy, the Enlightenment, which
proclaimed the primacy of Reason over ignorance, superstition, and blind tradition. Under
the guidance of Reason, mankind was expected to proceed along a path of uninterrupted
progress toward a future of universal happiness. In Western Europe the Enlightenment had
developed radical tendencies that were to materialize later in the American and French
revolutions. 'The remainder of Europe was ruled by "enlightened despotism," a
compromise between the principles of Enlightenment and the interests of the ruling
classes. Maria Theresa of Austria, Frederick II of Prussia, and Catherine the Great of'
Russia were the typical representatives of that system. In the Church, too,
"enlightened" tendencies were gaining ground: the order of Jesuits was taken as
scapegoat and abolished in 1773. The notorious witch hunts and processes had not yet
completely disappeared (one of the last executions was to be that of Anna Goldi in Glarus,
Switzerland, in 1782), but everything related to demons, possession, or exorcism was
shunned.
In view of this atmosphere, it becomes understandable why so much
opposition arose against Gassner, and also why even his most faithful protectors were
forced into positions of extreme caution. The Prince Bishop of Regensburg ordered an
inquiry that took place in June 1775, after which Gassner was advised to reduce his
activity and to exorcize only patients who had been sent to him by their respective church
ministers. The University of Ingolstadt delegated a commission with representatives from
its four faculties to make an inquiry. This inquiry was held on May 27, 1775, in
Regensburg and had a rather favorable outcome. The Imperial Court in Vienna also took an
active interest in the matter.
In Munich the Prince-Elector Max Joseph of Bavaria also appointed an
inquiry commission. This commission invited Dr. Mesmer, who claimed to have discovered a
new principle called animal magnetism and who had just returned from a journey along the
Rhine and to Constance, where he was said to have performed marvelous cures. Mesmer
arrived in Munich, and, on November 23, 1775, gave demonstrations during which he elicited
in patients the appearance and disappearance of various symptoms, even of convulsions,
simply by a touch of his finger. Father Kennedy, the Secretary of the Academy, was
suffering from convulsions, and Mesmer showed that he was able to bring them forth in him
and dispel them at will. On the following day, in the presence of court members and
members of the Academy, he provoked attacks in an epileptic and claimed that he was able
to cure the patient through animal magnetism. In effect this amounted to Gassner's
procedure, without involving the use of exorcism. Mesmer declared that Gassner was
undoubtedly an honest man, but that he was curing his patients through animal magnetism
without being aware of it. We can imagine that, upon hearing of Mesmer's report, Gassner
must have felt somewhat like Moses when the Egyptian wizards reproduced his miracles in
the Pharaoh's presence. But unlike Moses, Gassner had not been permitted to witness
Mesmer's performance or to reply to his report.
Meanwhile, the Imperial Court, which was decidedly not favorably
disposed toward Gassner, had asked the Prince Bishop of Regensburg to dismiss him, and he
was sent to the small community of Pondorf. In Rome, Pope Pius VI (Giovanni Angelo
Braschi) had ordered an investigation into Gassner's activities. In the decree that
followed, it was stated that while exorcism was a common and salutary practice of the
Church, it was to he performed with discretion and with strict adherence to the
prescriptions of the Roman ritual.
Gassner died in Pondorf on April 4, 1779. His tombstone bore a lengthy
inscription in Latin, describing him as the most celebrated exorcist of his time. No
one ever questioned Gassner's absolute piety, his lack of pretentions, and his
unselfishness. Unfortunately for him, he had come too late, and the controversies that had
been raging around him had a much more important object: the struggle between the new
Enlightenment and the forces of tradition. Gassner's downfall prepared the way for a
healing method that retained no ties with religion and satisfied the requirements of an
"enlightened" era. Curing the sick is not enough; one must cure them with
methods accepted by the community.
Franz Anton Mesmer (1734-1815)
The fateful turning point from exorcism to dynamic psychotherapy was thus reached in 1775
by Franz Anton Mesmer, who has been at times compared to Columbus. Both Columbus and
Mesmer discovered a new world, both remained in error for the remainder of their lives
about the real nature of their discoveries, and both died bitterly disappointed men.
Another point of similarity is the imperfect knowledge we have of the details of their
lives.
None of Mesmer's disciples seems to have been interested in the story
of his master's life. The first to inquire about it was Justinus Kerner, who traveled to
Meersburg, where Mesmer had died, and gathered firsthand documents and information about
him. Recently, the research done by Tischner, Schurer-Waldheim, Bittel, Wohleb, Milt, and
Vinchon has shed some light on several periods of Mesmer's life, about which, however,
large gaps still remain.
Franz Anton Mesmer was born on May 23, 1734, in Iznang, a small village
on the German shore of Lake Constance, the third of nine children. His father was a game
warden in the service of the Prince Bishop of Constance. Nothing is known of Franz Anton's
childhood and youth; the first recorded fact of his life states that in 1752, at the age
of 18, he was registered at the Jesuit Theological School in Dillingen. In 1754, Mesmer
registered at the Jesuit University of Ingolstadt for his third year in theology. His
activities and whereabouts during the years 1754 to 1759 are not known. It is likely that
he spent them studying philosophy. He registered as a law student in Vienna in 1759 and
changed to medicine the following year. Mesmer completed his medical studies in Vienna,
where his dissertation on the influence of planets on human diseases won him his degree in
1766, at the age of thirty-three.
Mesmer's scholastic career was remarkable in several regards. It was
certainly not unusual for the Church to notice an intelligent and diligent boy, and to
provide him with the possibility of studying in ecclesiastical schools with a view toward
a future clerical vocation. One of his brothers, Johann, later became a priest in a nearby
community, and this is obviously how Franz Anton also began his studies. However it is
most unlikely that the Church or his family continued supporting him when he changed from
theology to philosophy, then to law, and finally from law to medicine. It is more probable
that he found rich protectors, as he did in later periods of his life. lie might also have
been associated with secret societies.
In 1767 the young doctor married a wealthy widow of noble descent,
Maria Anna von Posch, and established himself in Vienna as a physician. A refined man of
the world and a patron of the arts, he lived on a splendid estate of which Leopold Mozart
said: "The garden is incomparable, with its avenues and statues, a theater, a
birdhouse, a dove-cot, and a belvedere on the summit."' Friends who visited the house
included the musicians Gluck, Haydn, and the Mozart family. (Wolfgang Amadeus Mozart's
earliest opera, Bastien and Bastienne, had its first performance in Mesmer's
private theater.) Mesmer was one of the first to play the glass harmonica, a new musical
instrument that had been perfected in America by Benjamin Franklin.
During the years 1773 to 1774, Mesmer treated in his own home a
twenty-seven-year-old patient, Fraulein Oesterlin, who was afflicted with no less than
fifteen seemingly severe symptoms. He studied the quasi-astronomical periodicity of her
crises and became able to predict their recurrence. He then endeavored to modify their
course. It had just become known that some English physicians were treating certain
diseases with magnets, and it occurred to Mesmer to provoke an "artificial tide"
in his patient. After making her swallow a preparation containing iron, he attached three
specially conceived magnets to her body, one on her stomach, the two others on her legs.
The patient soon began to feel extraordinary streams of a mysterious fluid running
downward through her body, and all her evils were swept away for several hours. This
happened, Mesmer reported, on July 28, 1774, a historical date."' He
understood that these effects on the patient could not possibly be caused by the magnets
alone, but must issue from an "essentially different agent," that is, that these
magnetic streams in his patient were produced by a fluid accumulated in his own person,
which he called animal magnetism. The magnet was but an auxiliary means of reinforcing
that animal magnetism and giving it a direction.
Mesmer was forty years old when he made this discovery. He was to
devote the rest of his life to its elaboration and to present it to the world. As a result
of this new method, Fraulein Oesterlin improved so greatly that she was able to marry
Mesmer's stepson and become a healthy wife and mother. But the first disappointments were
not long in coming. Father Hell, the astronomer who had provided Mesmer with magnets,
claimed that the discovery was his, while Mesmer's medical friends strongly disapproved of
his new research trend. Notwithstanding, Mesmer must have at that time become somewhat of
a celebrity, because in June 1775, Baron Horeczky de Horka, a Hungarian nobleman,
invited him to his castle in Rohow, Slovakia. The Baron was suffering from nervous spasms,
which had persisted despite the efforts of Vienna's foremost physicians. Mesmer's stay in
Rohow lasted about two weeks, of which an account was written by the Baron's house teacher
Seyfert, who served as Mesmer's interpreter and, assuming that he was a quack, observed
him keenly in order to unmask him.
Shortly after Mesmer's arrival, several of the castle's inhabitants
began to feel pains or peculiar sensations in their bodies as soon as they came near him.
Even the skeptical Seyfert noticed that he was seized with an invincible sleepiness when
Mesmer played music. It was not long before he became thoroughly convinced of Mesmer's
extraordinary powers. He saw how Mesmer could elicit morbid symptoms in people around him,
particularly in those whom he had magnetized. A lady who was singing lost her voice as
soon as Mesmer touched her hand and recovered it when he made a gesture with his finger.
As they were sitting together, Seyfert saw that Mesmer was able to influence people
sitting in another room simply by pointing to their images reflected in a mirror, even
though these people could see him neither directly nor indirectly in the mirror. At
another time, when two musicians were playing the horn, Mesmer touched one of the
instruments; immediately, a group of people-who could not see him-began to have symptoms
that disappeared when Mesmer removed his hand. Meanwhile, the rumor had spread that an
extraordinary healer had arrived at Rohow, and patients came from all the neighboring
areas to see him. Mesmer magnetized many of them, while sending others to see their own
doctors.
On the sixth evening, Mesmer announced that the Baron would have a
crisis on the following morning-which actually happened. The crisis was unusually violent,
and it was reported that the fever increased or decreased according to whether Mesmer came
closer to the patient or drew away from him. A second, less violent crisis occurred a few
days later, but the Baron found the treatment too drastic and Mesmer left Rohow, though
not without healing, at the last minute, a peasant who had suddenly lost his hearing six
weeks before.
Seyfert also relates his talks with Mesmer, who admitted that Gassner
possessed magnetism to an extraordinary degree and that his own powers were not as great,
wherefore he had to reinforce it by certain means. Seyfert had reasons to believe that
Mesmer did so by wearing magnets on his body and by keeping them in his bed.
The following month, July 1775, Mesmer traveled to the shores of Lake
Constance, his homeland, where he performed several sensational cures closely following in
Gassner's footsteps. His stay in Rohow had apparently convinced him that he was able to
outdo Gassner. As we have seen, this glorious period of Mesmer's life culminated in his
being called to Munich by the Prince-Elector, his demonstration of his own magnetic
powers, his testimony about Gassner, and his nomination as a member of the Bavarian
Academy of Sciences. When he returned to Vienna at the end of 1775, Mesmer must have been
sure that his grandiose discovery would bring him lasting fame.
But the Viennese medical world was still indifferent or even hostile.
Mesmer took several patients into his own home. One of them, Maria-Theresia Paradis, the
eighteen-year-old daughter of a wealthy and influential civil servant, had been blind
since the age of three and one-half. According to a biographer, she had been given the
most refined education with the help of specially devised instruments, such as embossed
maps to teach her geography, and Kempelen, the famous maker of automatons, had built her a
printing machine with which she was able to write. She moved around gracefully, could
dance and perform needlework-but her greatest talent was music, which gained her the
special attention and protection of the Empress Maria Theresa. Vienna's foremost
physicians had treated her for many years without results (she had even received more than
three thousand electric discharges). But after a series of magnetic sessions with Mesmer,
she declared that she was seeing. Her first visual perception was that of Mesmer; she
found that the human nose had a strange, even frightening shape and expressed fear that it
might hurt her eyes. tier sight was gradually restored-or, this is what she said and what
Mesmer announced-and her family expressed great delight. But her previous physicians
denied the reality of the cure. A medical commission emphasized that the patient claimed
to see only when Mesmer was present. An acute conflict arose between Mesmer and the
Paradis family; the patient lost her sight for good. She returned home and pursued her
career as a blind musician. Mesmer suggested that her cure was neither in her nor in her
family's interest: she would have lost her fame as a blind musician, and perhaps also the
generous financial support of the Empress.
Soon afterward, in the latter part of the year 1777, Mesmer left
Vienna. The reasons for his departure are unknown; his enemies later contended that he had
been forced to leave. It had been assumed that he was disturbed by his failure in the case
of Maria-Theresia Paradis and by the hostility of his colleagues. It may also be that the
young patient had developed a strong attachment for him, and Mesmer a similarly strong
attachment for her. (It is noteworthy that his wife remained in Vienna; he never saw her
again.) But the true reason lies perhaps in Mesmer's oversensitive and unstable character,
in his psychopathology.
According to his own account, Mesmer had undergone a depressive period.
He despaired of ever finding the truth. He would walk in the woods, talking to the trees,
and for three months tried to think without the help of words. Gradually, he recovered his
peace of mind and his self confidence, and came to visualize the world in a completely new
aspect. He now felt that it was his mission to make his great discovery known to the
world. He left for Paris and arrived there in February 1778.
The atmosphere that Mesmer found in Paris was quite different from the
one he had left in Vienna. The Austrian Empire was a stable state with an energetic
government, a proficient administration, a watchful police. Paris was no less a cultural
center than Vienna, but life there was strangely restless. Under a weak king and a
frivolous queen the government was unstable and the financial situation catastrophic;
enormous sums of money were engulfed in graft, speculation, and gambling. The ideas of
Enlightenment developed a radical and antireligious tendency. The nobility was clinging
obstinately to its exorbitant privileges, but paradoxically was showing a remarkable trend
toward philanthropy and disinterested public service. In a disastrous war against England,
France had lost India and Canada; now, partly out of feelings of revenge, the public was
enthusiastic about the American War of Independence. There was, especially in Paris, a
general tendency toward mass hysteria; the public went from one craze to another.
It seems that Mesmer's fame had preceded him to Paris, where at that
time a peculiar interest prevailed for distinguished foreigners. Mesmer was forty-three
years of age, a tall, sturdy, handsome man whose imposing personality and worldly manners
gained him easy access into French society, despite his strong German accent. For reasons
not known, he soon parted with his first associate, the French surgeon Le Roux, and began
magnetizing patients in a private residence in Creteil. He then settled in a private
mansion on the Place Vendome, where he received patients from the highest social circles
and magnetized them for large fees. He was extremely eager to form contacts with
representatives of the scientific bodies: Academie des Sciences, Societe Royale de
Medecine, Faculte de Medecine. He gained at least one influential disciple in Dr. D'Eslon,
private physician to the Count d'Artois, one of the King's brothers. Mesmer supplemented
his efforts with publications written by himself and by D'Eslon.
In the meantime his practice had gradually increased. Before leaving
Vienna, he had dispensed with the use of magnets and electricity as auxiliary means. In
1780 or 1781, having more patients than he was able to treat individually, he inaugurated
a collective treatment, the baquet, which will be discussed later. Two of his
clients showed him strong personal devotion: Nicolas Bergasse, a skillful lawyer with keen
philosophical interests, who was politically active and the banker Kornmann, whose young
child Mesmer treated for a severe eye disease.
Mesmer's system, as he expounded it in 27 points in the year 1779, can
be summarized in four basic principles. (1) A subtle physical fluid fills the universe and
forms a connecting medium between man, the earth, and the heavenly bodies, and also
between man and man. (2) Disease originates from the unequal distribution of this fluid in
the human body; recovery is achieved when the equilibrium is restored. (3) With the help
of certain techniques, this fluid can be channeled, stored, and conveyed to other persons.
(4) In this manner, "crises" can be provoked in patients and diseases cured.
It is fairly easy to distinguish the various elements in what Mesmer
and his disciples called the doctrine. The first and most immediate one was Mesmer's
intuition of being the bearer of a mysterious fluid, animal magnetism, which he had
noticed in himself for the first time when treating Fraulein Oesterlin. Mesmer described
how he was able to provoke the appearance of symptoms in patients by his physical presence
or by his gestures; he also reported that when he approached a man who was undergoing a
bloodletting, the blood began flowing in a different direction. According to Mesmer, every
human being possesses a certain amount of animal magnetism: Gassner possessed it to a very
high degree, Mesmer had it somewhat less, and the sick have less than the healthy. An
analogy could be drawn between this theory and the Polynesian concept of "mana,"
a universal, impersonal energy that can be stored in persons, objects, or places, and can
be detected only through its objective effects.
The second element of the doctrine was the physical theories that were
supposed to explain the nature and action of animal magnetism. Being a son of the
Enlightenment, Mesmer was seeking a "rational" explanation and rejected any kind
of mystical theory. On the other hand, since psychology w as almost nonexistent at that
time, he was naturally led to think of a physical concept, of something in the form of
Newton's universal gravitation or of electricity. In his medical dissertation, Mesmer had
already described a universal fluid pervading the cosmos, which he had named gravitatio
universalis. Through this phenomenon, the influence of the sun, moon, and planets on
the human body could be explained, as well as the periodical manifestations of certain
diseases. He later called this fluid general agent. It was believed to exist in several
forms: one was the influence of the magnet, another was electricity, and another was
animal magnetism. This physical part of the doctrine was undoubtedly its weakest point and
always remained unclear in Mesmer's mind because he was not a good systematizer.
A third element of Mesmer's system was the analogies given by the
contemporary discoveries in the field of electricity. Mesmer imagined his fluid as having
poles, streams, discharges, conductors, isolators, and accumulators. His baquet,
an instrument that was supposed to concentrate the fluid, was an imitation of
the recently invented Leyden jar. He also taught that there was a positive and a negative
fluid that neutralized each otheran assumption that was never accepted by his disciples.
The fourth element of the doctrine was the theory of crises, obviously
derived from Gassner's practice. Gassner believed the crisis to be the evidence of
possession as well as the first step in the procedure of exorcism. For Mesmer, the crisis
was the artificially procured evidence of the disease and the means to its cure. Crises,
he said, were specific: in an asthmatic it would be an attack of asthma and in an
epileptic it would be an epileptic fit. When the patient was repeatedly provoked, these
crises became less and less severe. Eventually they disappeared, and this meant recovery.
These basic ingredients that Mesmer tried to synthesize in his doctrine
led to his famous aphorism: "There is only one illness and one healing." No
medication or therapeutic procedure ever cured a patient by itself; cures were achieved
only through the effect of magnetism, although physicians had not been aware of it. Animal
magnetism would now furnish mankind with a universal means of curing and preventing all
illnesses, thus "bringing medicine to its highest point of perfection."
Mesmer's egocentricity led him to expect that medical schools would
accept a theory that would cancel all that had been discovered since Hippocrates, and
would cause the medical profession to become superfluous. Not surprisingly, the type of
therapy performed by Mesmer was as repugnant to contemporary medicine as contemporary
medicine was to him. Mesmer used no medication other than magnetic water. He would sit in
front of his patient with his knees touching the patient's knees, pressing the patient's
thumbs in his hands, looking fixedly into his eyes, then touching his hypochondria and
making passes over his limbs. Many patients felt peculiar sensations or fell into crises.
This was supposed to bring forth the cure.
Mesmer's collective method was still more extraordinary. An English
physician, John Grieve, who was in Paris in May 1784, described in a letter his visit to
Mesmer's house, noting that there were never less than two hundred patients at one time:
I was in his home the other day and was witness to his method of operating. In the
middle of the room is placed a vessel of about a foot and a half high which is called here
a baquet. It is so large that twenty people can easily sit round it; near the edge
of the lid which covers it, there are holes pierced corresponding to the number of persons
who are to surround it; into these holes are introduced iron rods, bent at right angles
outwards, and of different heights, so as to answer to the part of the body to which they
are to be applied. Besides these rods, there is a rope which communicates between the baquet
and one of the patients, and from him is carried to another, and so on the whole
round. The most sensible effects are produced on the approach of Mesmer, who is said to
convey the fluid by certain motions of his hands or eyes, without touching the person. I
have talked with several who have witnessed these effects, who have convulsions occasioned
and removed by a movement of the hand. . .
The entire setting was intended to increase the magnetic influences: large mirrors
reflected the fluid, which was conveyed by musical sounds emanating from magnetized
instruments. Mesmer himself sometimes played on his glass-harmonica, an instrument that
many people found to be shattering. The patients sat in silence. After a while some of
them would experience peculiar bodily feelings, and the few who fell into crises were
handled by Mesmer and his assistants in the chambre des crises (crisis room).
Sometimes a wave of crises spread from one patient to another. An even more extraordinary
procedure was that of the magnetized tree, a kind of collective outdoor therapy for the
poor.
Such therapeutic procedures seemed so extravagant that few physicians
could escape from feeling that Mesmer was a quack. Professional resentment must have been
increased by Mesmer's growing success and by the fabulous fees he demanded from his noble
and wealthy patients.
In the middle of 1782, Mesmer seems to have understood that he had
reached an impasse. For five years he had worked toward having his discovery acknowledged
by the scientific societies, which he would then have sold at great profit to the French
government so that he could apply and teach his method in a public hospital. But he was
further than ever from his goal. In July 1782 he left for a sojourn in Spa-a health resort
in what is today Belgium-with his devoted friends Bergasse and Kornmann. According to
Bergasse's account, Mesmer received a letter stating that D'Eslon, pretending to replace
him, had opened a practice of animal magnetism. Mesmer was dismayed and furious at the
"traitor" and visualized his own ruin. He was sure that after having stolen his
secret, D'Eslon would also steal his clientele. The lawyer Bergasse and the financier
Kornmann then formulated a new plan: they would organize a subscription to raise a large
sum of money in order to buy Mesmer's discovery. The subscribers would be given possession
of the "secret" and would be organized into a society that would educate
students and spread Mesmer's teaching.
The project was a huge success. In spite of the enormous account of
money demanded from the subscribers, they were found. Among them were the most illustrious
names of the city and the court, names belonging to the most ancient aristocratic families
such as Noailles, Montesquieu, and the Marquis de Lafayette, as well as prominent
magistrates, lawyers, and physicians. The Bailli des Barres of the Order of Malta was to
introduce magnetism to the Knights on the island. However, growing difficulties arose
between Mesrner and his disciples. Bergasse later published a documented account about
these arduous negotiations of 1783 and 1784, which-if all the details were true-shows
Mesmer as a fundamentally egocentric and suspicious man, moody, despotic, greedy, and at
times even dishonest.
Nevertheless, the society (called Societe de1'Harmonie) -a strange
mixture of business enterprise, private school, and masonic lodge-was launched and
flourished. Branches were founded in other French cities and towns. It secured a large
fortune for Mesmer, in addition to his earnings from his magnetic practices. The society
also published an epitome of Mesmer's doctrine and transformed what had been one man's
secret into the common knowledge of an enthusiastic group. Mesmer's despotism was often
resented by his disciples, but animal magnetism was now an established institution in
France, and it developed swiftly. The interest of the public, which had been focused on
the American War of Independence and the peace treaty with England, was now released and
turned toward Mesmer.
The year 1784 was as fateful for Mesrner as 1776 had been for Gassner:
he encountered a peak of success, agitation, and then a rapid downfall. In March 1784, as
a result of the agitation around Mesmer, the King appointed a commission of inquiry
consisting of members of the Academie des Sciences and the Academic de Medecine, and
another commission consisting of members of the Societe Royale. These commissions
comprised the foremost scientists of their day: the astronomer Bailly, the chemist
Lavoisier, the physician Guillotin, and the American ambassador Benjamin Franklin. The
program of experiments had been devised by Lavoisier and was a model of the application of
the experimental method. The litigious point was not whether Mesmer cured his patients but
rather his contention to have discovered a new physical fluid. The commissions' conclusion
was that no evidence could be found of the physical existence of a "magnetic
fluid." Possible therapeutic effects were not denied, but were ascribed to
"imagination." A supplementary and secret report was drafted for the
King and pointed to the dangers resulting from the erotic attraction of the magnetized
female patient to her male magnetizer. One of the commissioners, Jussieu, disassociated
himself from his colleagues and wrote a report suggesting that there certainly was an
unknown efficient agent at work, probably "animal heat." Mesmer was
indignant because the commissioners had not come to him with their inquiries, but had gone
to the "traitor" D'Eslon. Later, however, this circumstance proved fortunate for
Mesmer: when the Public Ministry, on the basis of the commissioners' report, decided to
prohibit the practice of animal magnetism, Bergasse succeeded in his efforts to have the
interdiction lifted by Parliament-the highest judicial instance-on a legal technicality:
the commissioners' report concerned D'Eslon's, not Mesmer's practice.
In any event, the reports do not seem to have seriously harmed the
development of the magnetic movement. The Societe de I'Harmonie developed its activities
and similar societies were founded in various French cities. Simultaneously, however, the
movement experienced an unprecedented number of setbacks: Mesmer was abundantly ridiculed
in cartoons, popular songs, and satirical plays. There was the unfortunate episode
involving Court de Cebelin, a celebrated scholar who published an enthusiastic pamphlet
about Mesmer after having been "cured" by him, whereupon he suffered a relapse
and died in Mesmer's own home. But public agitation was diverted from Mesmer a few months
later by the new themes of Count Allesandrodi Cagliostro (Giuseppe Balsamo) and the
scandal of the "Queen's necklace." Far more serious, as far as Mesmer was
concerned, were the criticisms leveled against him by scientists and scholars. An
anonymous author published a book, L'anti-magnetisme, in which he traced in an
objective manner the sources of Mesmer's doctrine and showed the connection between his
healing method and that of Gassner. Another author, Thouret, published an even more
thorough study, taking Mesmer's 27 propositions one by one and showing that each of them
had already been stated in much the same terms by authors such as Paracelsus, Van Helmont
and Goclenius, and above all by Mead and Maxwell. Thouret concluded that Mesmer's theory,
far from being a novelty, was an ancient system that had been given up for almost one
century. Mesmer denied ever having read any of those authors (it had not yet become
fashionable to call such sources by the name of "precursors"). Physicists, for
their part, would not hear of the so-called magnetic fluid. A physician and physicist by
the name of Marat declared that animal magnetism had no claim to being a physical theory.
Still worse from Mesmer's point of view was the fact that he had hardly
begun to unveil his doctrine when his disciples rebelled. They found it vague and
incoherent, even though D'Eslon had already given some clear and limpid formulations of
it. A Comite d'instruction was appointed to publish the doctrine in a form
acceptable to the students. Bergasse, who was playing a prominent role in the
society, had found in Mesmerism the basis for a new world philosophy and expounded his
theory in a work titled ""Theory of the World and of Organized Beings."
It was published in limited numbers, and, in order to give it the aspect of a secret
knowledge, 115 key words were replaced by symbols so that the uninitiated were unable to
understand it. But this publication aroused Mesmer's wrath, and, following a sharp polemic
between the two men, Bergasse left the society. Meanwhile, many members had become
disillusioned and they, too, defected. Worse perhaps, from Mesmers' viewpoint, was that
one of his most faithful disciples, Puysegur, of whom we shall speak later, though
proclaiming his loyalty to Mesmer's teaching, discovered magnetic sleep, which was to give
a new direction to the movement.
Another setback of a more personal nature was an incident that occurred
on Good Friday (April 16, 1784) at the Concert Spirituel du Careme in the presence of the
royal court and the elite of Parisian society. A blind young musician had arrived from
Vienna to play the harpsicord--Maria-Theresia Paradis. Grimm reported that "all eyes
turned toward Mesmer who had been unwise enough to come to the concert. He was well aware
of being the center of attention and suffered one of the worst humiliations of his
life." His enemies promptly revived the old story that Mesmer had pretended to cure
her but it was proven that he failed. Maria-Theresia spent the following six months in
France, and her presence in Paris must have been very disturbing to Mesmer. In August of
that year the Societe de 1'Harmonie in Lyons invited him to demonstrate his skill in the
presence of Prince Henry of Prussia (a brother of King Frederick II) . To his own
consternation and to the dismay of his disciples, he failed utterly. It is likely that
Mesmer reacted to those events as he had done in 1777: by falling into a depression and
taking to flight.
In fact, Mesmer disappeared from Paris, having probably left at the
beginning of 1785. His whereabouts were unknown to his disciples. Rumors circulated that
he was living in England under an assumed name. The movement he had founded was developing
more and more in the direction given it by Puysegur.
Mesmer's activities during the following twenty years are largely
unknown. Only part of his wanderings through Switzerland, Germany, France, and Austria
have been traced. It has been found that when he returned to Vienna in 1793, he was
expelled as being politically suspect, and that, in 1794, his name was linked with an
obscure political plot. He went to Switzerland, where he acquired Swiss citizenship, and
settled in Frauenfeld, a small town near Lake Constance. He had lost part of his fortune
but was still sufficiently wealthy to live as a man of leisure for the remainder of his
life, in the style of a rich aristocrat. Recent research has revealed testimonies of
people who knew him during that time. They describe him as a man of refined worldly
manners, but as proud and egocentric, showing no interest in other people's ideas. He
resented the world that had not accepted his discovery, the physicians who had rejected
him, and his disciples who had distorted his teachings.
By that time Mesmer was so completely forgotten that most of his
disciples did not even know that he was still alive. Wolfart, a German physician, finally
went to visit him in 1812. A Romanticist and patriot, Wolfart was surprised that Mesmer
expressed himself exclusively in French--in the manner of the old German aristocracy. He
published a German translation of Mesmer's last book, which contained not only the
ultimate outline of his system but also a collection of his opinions on a great variety of
subjects: education, social life, public festivities, taxes, and prisons. Unfortunately,
most of the papers that Mesmer entrusted to Wolfart were lost. Wolfart was so careless
that, when publishing Mesmer's book, he gave his Christian name as Friedrich instead of
Franz. One or two years before his death, Mesmer moved to Meersburg, on the shores of Lake
Constance, and died there on March 5, 1815--a few miles from his birthplace.
When Justinus Kerner visited Meersburg in 1854, he heard wondrous
stories from old people who had known the great man. He was told that when Mesmer went to
the island of Mainau, flocks of birds would fly toward him, following him wherever he
walked, and settling around him when he sat down. Mesmer, they added, had a pet canary in
an open cage in his room. Every morning the bird would fly to his master, perch on his
head, and wake him with his song. He would keep him company during his breakfast,
sometimes dropping lumps of sugar into his cup. With a slight stroke of his hand, Mesmer
would put the bird to sleep or wake it up. One morning the bird remained in its cage:
Mesmer had died during the night. The canary sang and ate no more, and a few days later he
was found dead in his cage.
What was the true personality of this man, who, in his homeland, had
left the reputation of being a wizard? We cannot obtain a satisfactory answer; too much
about him is unknown. We know nothing of his childhood nor of his emotional life, aside
from his unhappy marriage. On the basis of existing documents, several pictures can be
drawn:
The first and best-known picture is given by his French disciples,
especially by Bergasse in his lengthy account filled with bitter resentment, written after
Mesmer had expelled him from the movement. In these accounts Mesmer is shown as a man
dominated by the fixed idea that he had made an epoch-making discovery that the world
ought to accept immediately, even before it could be fully revealed. He wanted to keep his
secret to himself as long as he pleased and to make it known only when it became
convenient for him. His doctrine of animal magnetism, however, should remain his permanent
and exclusive property; no one was allowed to add, modify, of subtract anything without
his permission. He demanded absolute devotion from his disciples, although he did not feel
the need to reciprocate by showing them gratitude, and he broke with anyone who manifested
independent ideas. Mesmer felt as though he was living in a world of enemies who were
continually trying to steal, distort, or suppress his discovery. He took indifference for
hostility and contradiction for persecution. This picture of Mesmer is perhaps not very
different from that of several other great scientists. It is (in Jung's terms) the typical
syndrome of "psychological inflation" and must be considered a secondary
development superimposed on a more basic personality structure.
Mesmer felt a mysterious power within himself, which was demonstrated
by his sensational healings and by the strange occurrences at the castle of Rohow. But in
addition to these probably temporary occurrences, he possessed to a high degree a
"personal magnetism"-a compelling mixture of charm and authority. He was
unequaled in the art of convincing people and obtaining great favors from them. This may
also explain the mystery of his social climbing in an era of impermeable class
differentiation and his ability to deal with princes and aristocrats on a basis of
equality.
The fluctuations of his personal magnetism were perhaps subordinated to
certain more basic psychopathological features: a morbid oversensitivity, moodiness, and
alternating elations and depressions. During his periods of success he showed a restless,
almost hypomanic, activity. It seems that he expressed at times what might be called
paranoiac delusions of grandeur. (A Swiss physician, Egg, relates that Mesmer had told him
in 1804 that running water was magnetized because he, Mesmer, had magnetized the sun
twenty years before.) But he was also subject to sudden fits of discouragement. Mesmer
described the abnormal condition he suffered from at the end of 1776. It is quite possible
that something similar occurred in 1785. Both these episodes were perhaps associated with
his feelings that his magnetic powers were exhausted.
With his uncanny powers, Mesmer is closer to the ancient magician than
to the twentieth-century psychotherapist. His victory over Gassner reminds one more of a
contest between rival Alaskan shamans than of a modern psychiatric controversy. However,
his doctrine contained the seeds of several basic tenets of modern psychiatry:
A magnetizer, Mesmer proclaimed, is the therapeutic agent of his cures:
his power lies in himself. To make healing possible, he must first establish a rapport,
that is a kind of "tuning in," with his patient. Healing occurs through
crises-manifestations of latent diseases produced artificially by the magnetizer so that
he may control them. It is better to produce several, steadily weaker ones than one severe
crisis. In collective treatment the magnetizer should control the reactions of the
patients on one another.
Mesmer grouped his disciples into a society in which physicians and lay
magnetizers were on an equal footing. Its members, who had made heavy financial
sacrifices, learned his doctrine, discussed the results of their therapeutic work, and
maintained the unity of the movement.
It is an open question as to whether Mesmer was a precursor of dynamic
psychiatry or its actual founder. Any pioneer is always the successor of previous ones and
the precursor of others. There is no doubt, however, that the development of modern
dynamic psychiatry can be traced to Mesmer's animal magnetism, and that posterity has been
remarkably ungrateful to him.
Psychoanalytic Case Formulation
Nancy McWilliams
Chapter Seven: Assessing Identifications, pp. 122-138
One does not have to be a mental health professional to know that a central aspect of
any person's psychology involves the people who were his or her major love objects and
models. In intake interviews, clients will almost always readily discuss the people in
their backgrounds to whom they see themselves as similar, the people they have wanted to
emulate, and the people they have tried at all costs not to be like. One of the main
limitations of standard descriptive diagnosis is that any given behavior may mean
remarkably different things psychologically, depending on the individual with whom that
behavior is consciously or unconsciously identified.
There is probably no such thing as a behavior or attitude that is not
influenced by identifications, and what those identifications are can vary greatly. A
woman who habitually criticizes and carps may be unconsciously trying to be like her
beloved but over-controlling grandmother, or she may be reassuring herself that she is not
like her passive and negligent mother, who let others walk all over her. Or both. A man
who is irritatingly "rational" about things that other people experience as
emotionally loaded may be identifying with a hyper-intellectualized father, or with the
cerebral high school teacher who set an inspiring counterexample to a father who would
explode over trifles. Or he may have had younger siblings, whose emotionality was labeled
babyish, with whom he is determinedly counter-identified. Or if his mother was the emotive
one in the family, he may be reassuring himself that he is not female. To be optimally
therapeutic, practitioners need to know the identificatory meanings behind their clients'
attitudes and behavior.
Typically, in an early interview, one asks the client about his or her
mother and father or other primary caregivers: Are they alive? If not, when did they die,
and of what? If alive, how old are they? What are (were) their occupations? What are
(were) their respective personalities like, and how were they as parents? Sometimes one
learns a fair amount from inquiring about which one the client resembles, and in what
ways. It is also important to ask whether there were other significant influences on the
interviewee as he or she was growing up. Sometimes it will emerge that a teacher or clergy
person or camp counselor or therapist or friend had a powerful influence because of the
patient's identification with that person. People are conscious of many aspects of their
identifications. Yet a whole different level of information about an individual's
internalizations may come through less conscious, less verbal means.
IDENTIFICATIONS SUGGESTED BY TRANSFERENCE REACTIONS
In a clinical interview, the quickest way to assess a person's primary
identifications is to feel out the overall tone of the transference. Sometimes its
manifestations are subtle, as in the benign sense of connectedness one gets with a person
raised by loving parents, whose generosity of spirit has been internalized and permeates
the intake session. Or, equally subtly but less gratifyingly, the transference tone comes
through in the therapist's vague sense of being devalued, as when a client asks more than
a moderate number of questions about one's training, provoking the tentative hypothesis
that he or she has identified with someone skeptical or distrusting.
Sometimes an initial transference is more startling and stark. A
colleague of mine recently reported evaluating a woman who had seen several previous
practitioners in an effort to deal with her problem managing anger. All her prior
therapists had blundered in one way or another, she explained, mainly by failing to
understand her adequately. She was worried that my colleague would similarly disappoint
her. Appreciating her sensitivity to being misunderstood, he tried hard in his initial
remarks not to make any premature attributions, but at the end of the first interview he
commented, "It usually takes me a few sessions to develop a preliminary understanding
of someone. It might take me a bit longer with you because your psychology seems rather
complicated." The client went into a rage on the grounds that the term
"complicated" was an evasive way of calling her crazy. (One sees here a familiar
combination of accurate perception-she was not wrong in sensing that the therapist felt
her problems were severe-and skewed interpretation of attitude, in that the therapist was
not feeling critical and devaluing toward her.) It was natural for the therapist to infer
that this woman had internalized at least one authority whose primary attitude was
intensely critical.
Sometimes people are completely unaware of their similarity to an early
love object. One woman I interviewed spent a good part of our first meeting complaining
about her mother's intrusive, controlling, and unreasonably finicky attitude. I felt very
sympathetic to her situation as the child of someone so hard to please. We seemed to have
made a good connection, and my countertransference to her was quite warm until she was
about to leave my office. At that point she looked with unmistakable consternation at the
paintings on the wall and straightened them out so that there was no unevenness in the way
they hung. "There," she said. "Now you won't have to be embarrassed about
how your office looks."
IDENTIFICATION, INCORPORATION, INTROJECTION, AND INTERSUBJECTIVE INFLUENCING
Freud (1921) wrote about two kinds of identificatory processes, an early,
relatively unconflicted "anaclitic" object love (from the Greek word "to
lean on," implying straightforward dependency) and a later process that eventually
became known as "identification with the aggressor" (A. Freud, 1936). The former
is a benign phenomenon in which a child-or adult, for that matter, but these processes are
both more conspicuous and more consequential for personality formation in children-loves a
caregiver and wants to have the qualities that make that person lovable. When a little boy
explains, "I want to be like Mommy because she is sweet," he is expressing an
anaclitic identification. Identification with the aggressor, contrastingly, occurs in
upsetting or traumatic situations and operates as a defense against fear and the sense of
impotence. It is more automatic and less subjectively voluntary, but if one were to put
words to the process they would be, "Mother is terrifying me. I can master this
terror with the fantasy that I'm the mother, not the terrified, helpless child. I can
reenact this scene with myself as the instigator and thereby reassure myself that I will
not be the victim this time." Weiss and Sampson and their colleagues (Weiss, Sampson,
& the Mount Zion Psychotherapy Research Group, 1986) refer to this process as
"passive-into-active transformation."
Freud tended to write and speculate in greater detail about the latter
kind of identification, not because it was more common, but because it was more
unconscious, problematic, and at variance with commonsensical, rationalistic, and
behavioral explanations of behavior. His description of the identification that results
from the oedipal situation is basically an identification-with-the-aggressor explanation,
although in healthy family situations, the aggression is not so much in the parent as
projected there by the child. In the classical oedipal triangle, the child longs for one
parent, feels competitive with the other, becomes worried (because feelings and actions
are not yet fully separate in the child's mind) that his or her aggression is dangerous,
becomes afraid of retaliation from the object of the aggression, and then resolves this
anxiety-filled predicament by a decision to be like the person of whom he or she is afraid
("I can't get rid of Daddy and have Mommy, but I can be like Daddy and have a woman
like Mommy"). This scenario throws light on many diverse psychological phenomena,
including, for example, the persistence of triangular themes in literature, the anxieties
and depressive reactions people commonly suffer when they have attained some personal
triumph, and the tendency for children between three and six to have nightmares in which
they are threatened by monsters of their own aggressive imaginings.
For a period of time in the mid-twentieth century, oedipal,
identification-with-the-aggressor formulations became such a popular way of understanding
identification that research psychologists were spending considerable energy demonstrating
the existence of a nonconflictual type of identification. Sears and his colleagues (e.g.,
Sears, Rau, & Alpert, 1965), after designing a number of ingenious experiments that
elicited an automatic and emotionally uncomplicated type of identification, coined the
term "modeling" to contrast this process with the anxiety filled, defensively
motivated oedipal scenario sketched out by Freud. Interestingly, the notion of modeling is
quite similar conceptually to Freud's observations about anaclitic attachments.
Anyone who has watched preschoolers play knows how startling it is to
see them enact every detail of a parent's tone and gesture. Some identification,
especially the kind seen in young children, looks like a kind of "swallowing
whole" of the person being taken in. Even in older people-for example, a college
student who has become enamored of a particular mentor, or a cult member emulating a
revered guru-one sometimes sees such a wholesale incorporation of the esteemed object that
the person identifying seems to have disappeared and become a clone of his or her idol. An
idealizing admirer can pick up the way someone walks, talks, laughs, sighs, and eats
spaghetti. In other instances, identification strikes one as more nuanced and subjectively
voluntary: The identifier takes on some features of the object and rejects others. Most of
us can readily describe both the aspects of ourselves that represent our wish to be like a
childhood influence and the aspects that represent our resistance to such identifications.
In post-Freudian psychoanalytic writing, there is a long scholarly
tradition, fed by the distress of therapists confronting the maladaptive identifications
of their patients, of trying to understand the development of normal identificatory
processes. In 1968, Roy Schafer described a progression in children from a
swallowing-whole type of assimilation of a caregiving person (cf. Jacobson, 1964) through
stages of greater and greater discrimination and reflection, approaching finally a
seasoned process of identification, in which the object is appreciated as a complex,
differentiated Other, whose qualities are appropriated in a way that feels to the child
more selective and voluntary. While two-year-olds simply march around with their mother's
pocketbook, children in the oedipal years can comment engagingly about just which
qualities of which parent they want to adopt.
Some writers have used the term "identification" very
broadly; others, like Schafer, have tried to differentiate between earlier incorporation
and later forms of taking in the qualities of others. Empirical evidence now suggests that
the development of internal representations of caregivers proceeds simultaneously with the
development of internal representations of self (Bornstein, 1993), and that these
representations of self and other evolve in hierarchical stages, influencing a child's
perceptions, expectations, and behaviors (Horner, 1991; Schore, 1997; Wilson &
Prillaman, 1997). In contemporary psychoanalytic writing, the term
"introjection" is most commonly used (probably because it can be neatly
contrasted with its counterpart process, projection) for the kinds of internalization that
predate more mature identificatory processes. The internalized images of people important
to the developing child are thus called introjects. As the internalization process matures
from presumably unreflective mimicry to discriminating, subjectively voluntary efforts to
take on certain specific features of someone else's personality, it looks less
introjective and more deliberately identificatory.
The identification process seems quite uniform across families and
cultures. The content of an identification can be either benign or deeply problematic.
When one's earliest internalizations are maladaptive, they present grave difficulties for
therapy later because of their preverbal, automatic nature. In her doctoral research, my
former student, Ann Rasmussen (1988), interviewed women who had been repeatedly and
viciously abused by their lovers and spouses. Her subjects were the kinds of people who
typically exhaust the reserves of workers in women's shelters: They kept going back to
their abusers. During one meeting, the two-year-old son of her interviewee made a Play-Doh
representation of a scar, which he proudly stuck to his cheek and showed off to his mother
and her guest. His introjection process was normal, but the content of his effort to be
like his mother boded badly for his future.
The original psychoanalytic literature on this topic concentrated on
the child's acquisition of parental characteristics as if the child's development were
dynamic and the parent's influence were relatively static. More recent psychoanalytic
research and theorizing about development (e.g., Brazelton, Koslowski, & Main, 1974,
Brazelton, Yogman, Als, & Tronick, 1979; Trevarthan, 1980; Lichtenberg, 1983; Stern,
1985, 1995; Beebe & Lachmann, 1988; Greenspan, 1981, 1989, 1997) addresses
identificatory processes from a more intersubjective standpoint, emphasizing the mutual
influences that the child and caregiver exert on each other. In fact, the more we learn
about how people develop their sense of individual identity, the more back-and-forth the
process of identification seems to be: An infant takes in characteristics of its mother,
who changes to adapt to her particular baby, who reinternalizes the changed mother, and so
on.
The existence of this intersubjective "dance" (cf. Lerner,
1985, 1989) is one reason we cannot assume that an internalized object is equivalent to a
living person. The father I originally identified with was the omnipotent, omniscient
father of my earliest idealizing perceptions, not the man I grew to appreciate as an
adult, who was both fragile in his self-esteem and uncertain in his understanding.
Accidents of history can also affect the nature of internalizations. I once treated a
young man for a pervasive aloofness. All his relationships, including his connection with
me, seemed cold and rejecting. His explanation for his tendency to distance from people
was that his mother was a "human refrigerator," incapable of warmth. In our
initial interviews, I found him a difficult and perplexing client, incapable of mutuality
to the extent that he could not even be engaged in recounting his personal history. I
asked his permission to interview his mother and braced myself to deal with an automaton.
To my astonishment, she was not only warm but also deeply loving and concerned for her
son. It emerged in her account of his childhood that during the first months of his life,
she had had a serious contagious illness and had been forbidden to touch or hold him.
Other relatives had given him minimal custodial care. The refrigerator mother he
had internalized was nothing like the flesh-and-blood parent who wept in my office about
his rejection of all her efforts to reach him.
One important part of a diagnostic formulation is the assessment of how
primitive or mature are the client's identificatory processes. Kernberg (1984), one of the
more articulate diagnosticians in a long line of therapists who have known the value of
asking patients about their early objects, has argued for the specific utility of asking
an incoming patient to describe his or her parents and other significant influences.
Generally speaking, it is diagnostic of individuals at the borderline and psychotic levels
of psychological organization to describe others in global, holistic ways that emphasize
either their overall goodness or their irredeemable badness, while people in the neurotic
and healthy ranges give balanced and multidimensional accounts of people (cf. Bretherton,
1998). Information of this sort is important to the therapist in choosing whether to
conduct treatment along the lines of a supportive, expressive, or uncovering model
(Kernberg, 1984; Rockland, 1992a, 1992b; McWilliams, 1994; Pinsker, 1997).
Both of the aforementioned clients, the woman with the anger problem
and the aloof young man, depicted their parents in unidimensional ways. When listening to
such descriptions, the interviewer typically feels at a loss for any sense of what the
described person is really like. The object presented comes across as either a saint or a
Satan, not a struggling human being trying to cope with being a parent as well as possible
given whatever handicaps his or her own personal history and current circumstances have
created. Both of these illustrative clients were appropriately diagnosable as in the
borderline range developmentally; typologically, the woman was organized in a
predominantly paranoid way, and the man was more schizoid. The combination of paranoid and
borderline dynamics that she presented required a supportive stance from the therapist,
whereas he responded well to expressive therapy.
But even people who are quite mature psychologically can have areas in
which they have unreflectively put certain objects in all-good or all-bad categories.
Hysterically organized clients, for example, have the reputation for being quite
impressionistic about people, even when they are otherwise capable of astute and incisive
insights (Shapiro, 1965). Similarly, high-functioning depressive people tend, like more
disturbed depressive individuals, to be all-or-nothing in their identifications, often
having only negative perceptions about themselves and nothing but good to say about others
(Jacobson, 1971). In hysterically oriented and histrionic clients, this tendency to
idealize or devalue defends against perceptions that stimulate fears of being overwhelmed
or injured; in depressive ones, it protects the hope that by association with good
objects, the badness in their own soul can be counteracted.
CLINICAL IMPLICATIONS OF UNDERSTANDING IDENTIFICATIONS
Data about internalizations, especially those that have an all-good or all-bad
flavor, have significant implications for psychotherapy above and beyond the general
question of conducting supportive versus expressive versus uncovering treatment. First,
they cue the interviewer about how to try to make an initial connection with a patient. A
good general rule is for the therapist to find ways, within standard professional
practice, to exemplify how he or she differs from the patient's pathogenic internalized
objects. If a person reports that a parent was unremittingly self-centered, the therapist
needs to demonstrate an altruistic sensibility. If the internalized parent is critical,
the accepting aspects of a therapy relationship require special emphasis. If the introject
is seductive, the therapist must be especially careful about professional boundaries.
These sensitive responses will not prevent the patient from eventually experiencing the
therapist as like the internalized objects, but they will make it more likely that once
such transferences appear, the client will appreciate the difference between his or her
projections and the features of the therapist that contradict what has been projected.
Second, as implied in the foregoing paragraph, these data give the
practitioner advance notice of the nature of the main transferences that will appear in
treatment. Identifications are powerful and driving psychological forces. No amount of
determined kindness from a therapist will prevent a victim of childhood abuse from going
through the experience of feeling that he or she is about to be (or has been) abused by
him or her. No demonstration of acceptance is adequate to ward off the conviction of
immanent rejection held by patients who have internalized a rejecting object. Nor would it
be advantageous to most clients if a therapist's efforts to be discriminated from the
internalized objects were successful over time. People come to therapy precisely because
experiences that "should" have counteracted the expectations laid down in their
childhoods have failed to have that effect. They need to project onto the therapist the
internalized figures that keep compromising their growth and satisfaction, and then learn
to relate to them in a manner different from the one they adopted in childhood. Freud
(e.g., 1912), reflecting on transference and its therapeutic potential, was fond of
commenting that one cannot fight an enemy in absentia.
Third, understanding the cast of characters that have lived in the mind
of one's client and what each of them means to him or her is critical to devising
strategies to help. Sometimes it is the only avenue down which one can move to a position
of influence. Some years ago, I worked with a man who was chronically and relentlessly
suicidal. When his bipolar illness did not have him completely in its grip, he was a
delightful, creative, and highly effective clergyman, husband, and father. My sessions
with him when he was not acutely depressed were riveting and moving, and they were also
productive in the sense that he valued what he was learning about himself and was able to
make numerous positive changes in his behavior.
When his depressive feelings overcame him, however, he could find no
reason to live, despite the pleadings of a substantial number of people who loved him and
relied upon him. He had a suicide kit at home, a cache of pills more than adequate to do
him in, and all my efforts at negotiating with him to get rid of the tools for his
destruction only elicited from him the comment that if I insisted that he give up the
means to kill himself, he would be glad to lie to me and say he had done it, but he had no
intention of sacrificing the sense of ultimate control and autonomy that his suicide kit
gave him. Understandably, he gave me several sleepless nights, and more than once, I
encouraged him to hospitalize himself when his wish to die seemed palpably stronger than
his interest in living.
This client's suicidal intentions were highly over-determined. His
family history suggested a clear genetic contributant to bipolar illness. In addition, he
had been unrelentingly criticized, controlled, and physically abused by his mother,
leaving him with the internal conviction that he deserved punishment, and that his
inherent badness would ultimately earn him rejection by anyone who really got to know him.
When he was a young child, his only escape from his mother's mistreatment was running
away, something he did in large and small ways from the time he could locomote. It
comforted him to know he could exit the world if life became unbearable. In his mind, his
suicide kit represented the equivalent of the escape routes he had used as a child. He had
also been sternly socialized never to express or even acknowledge the feeling of anger. He
consequently experienced any aggressive feelings as part of his badness, and he would
berate himself for even trivial instances where he felt his unwitting hostility or
selfishness had hurt someone.
His self-esteem had been damaged by a family that cared more about how
he looked to others than about how he felt internally, and his sense of efficacy had been
crippled by his powerlessness to influence either his mother's tirades or his father's
passive-aggressive, alcohol-contaminated responses to them.
I had tried, as had his psychiatrist and several emotionally astute
relatives and friends, to confront his stubborn suicidality by making his anger more
conscious, by analyzing his irrational but understandable conviction that he was bad, by
calling his attention to his wishes to pay his mother back for her abuse of him by
mortifying her with his suicide, by realistically looking at what it would mean to his
wife and three children if he killed himself, and by exploring his Tom Sawyeresque
fantasies of what people would feel and say at his funeral. I tried to get him to pay
attention to the transference, to explore how he imagined it would affect me if he died,
and to find the hostility in that and express it in less self-destructive ways. None of
this had much effect.
One thing that did engage him, however, was an exploration of his
identification with his father. A critical feature of this client's history was that his
own father had committed suicide after a particularly wounding remark by his wife. My
patient had looked desperately to this man to protect him from his mother's attacks and to
give him an alternative model of how to be an adult. It emerged that he deeply admired his
father for killing himself, as it was the only time he had ever seen anyone get the last
word with his mother. He regarded the suicide as the consummate grand gesture, an
irreversible "Fuck you!" to a woman who had acted tyrannically toward both her
husband and her boy. One of the compelling attractions of suicide to him was its meaning
as a masculine rejection of feminine dictatorship.
Once we had made this connection, we could look together at whether his
father's suicide had actually been an act of courage or whether he had simply needed to
see it that way, in preference to con fronting the painful realization that his father was
so weak and demoralized that he let his wife's mistreatment destroy him. Eventually, this
patient went through a kind of epiphany in which he realized he was furious at his father
for abandoning him. At that point, he could appreciate emotionally rather than just
intellectually what he would be doing to his children if he deprived them of his
existence. He could also think about how another man might have responded to his mother's
behavior and imagine a much less self-destructive version of masculine strength. His
identification with his father was diminished, and his emotional readiness to take in the
qualities of other male figures was enhanced.
Finally, it is important for therapists to understand primitive and
unidimensional internal presences because the appreciation of complexity and contradiction
in others and in the self is such a central aspect of psychological maturity and personal
serenity. That appreciation remains an important overall goal in long-term psychotherapy.
The clinician thus tries to help modulate a patient's all-good and all-bad images, to
bring into awareness the positive features of a hated object and the negative aspects of a
revered one, to find love alongside hate and hate where the person has been conscious only
of love. Eventually, in effective therapy, stark and unidimensional images are replaced
with realistic perceptions of the strengths and weaknesses of any individual human being.
People who become more accepting of the emotional and moral complexity of others also
become more accepting of their own assets, liabilities, and contradictions.
This principle of modifying all-bad and all-good internalized images
applies even to people who have been savagely mistreated by early authorities who seem
nothing short of monstrous to the therapist. People cling to their internalized objects,
however bad they are, in the same way that abused children cling to their abusive
caretakers. When a therapist joins a client in consigning a parent to the category of
"bad," the inevitable fact that the client loved that parent is not being let
into consciousness and embraced as part of the self. The therapist has colluded with a
disavowal of an important part of the patient's personality. Abused clients need to find
their anger at having been damaged, to grieve their tragic histories, and eventually to
appreciate that the perpetrators of their injuries were damaged human beings, usually with
horrific histories of their own. They need to remember that they both loved and hated
their abusers (Terr, 1992, 1993; Davies & Frawley, 1993).
CLINICAL POSSIBILITIES WHERE COUNTERIDENTIFICATION PREDOMINATES
The patient who is determined to be the polar opposite of a destructive parent or
caregiver is a familiar clinical phenomenon. I know many people, both among my clients and
among my friends and colleagues, whose capacity to take a counter-identificatory position
clearly saved them from the worst possible consequences of a difficult history. Research
on the sequellae of child abuse (e.g., Haugaard & Reppucci, 1989) has established that
even though it is common for abusers to have been the victim of an abusive parent
themselves, it is also true that having a brutal childhood does not destine one to be a
brute. Many maltreated people have reared their sons and daughters humanely with the help
of a powerful internal determination not to recreate their parent's transgressions.
Counter-identification can make the difference between emotional devastation and the
self-esteem that comes from resisting internal pressures to submit to a self-defeating
family pattern.
One problem with counter-identification, however, is that it tends to
be total and uncompromising. A friend of mine holds her hypochondriacal mother in such
contempt that she avoids medical treatment even when ill. Another acquaintance has been so
determined not to be like his alcoholic father that he became a moralistic teetotaler
whose children could not resist the temptation to rebel by experimenting with drugs.
Therapists are often confronted with clients who cannot consider changing their behavior
in a positive direction because the object with whom they are counter-identified used to
act that way at times. A woman I know lives in chronic clutter and disorder because her
father's second wife, whom she experienced as cold and rejecting, had a passion for
neatness and organization. Despite the self-defeating and illogical nature of her
position, this accomplished, intellectual woman explains that she cannot clean up her act
because it would make her feel too much like her stepmother. To her, being orderly means
being cold. (It may have been patients like this that propelled the behavioral movement in
psychotherapy to develop a cognitive dimension: Too many people were not doing their
homework because it made them feel like someone they hated, about whom they nurtured
powerful but irrational attitudes.)
These dynamics are important to understand if the therapist is to avoid
the frustration of exploring avenues of change that repeatedly encounter a stubborn
resistance. Sometimes a relatively mild observation (e.g., "Because your stepmother
was both orderly and cold, you've assumed that to be orderly means to be cold") can
liberate a client from the automatic posture of counter-identification. Sometimes it is
necessary to make interpretations that have more punch (e.g., "You're so afraid of
being like your stepmother that you reject even her good qualities" or "You
prefer your disorganization, even though it's obviously self-destructive, to giving your
stepmother-who is now dead-the satisfaction that you're like her in any way!").
Often, one cannot make headway with actions that are determined by counter-identification
until they appear in the transference ("You're getting to sessions late and cheating
yourself of the time you pay for-all because you're experiencing me as an orderly person
like your cold stepmother, whom you have to defy at any cost").
Sometimes one can take advantage of a counter-identification to help a
person change in a desired direction. A potent antidote to a maladaptive behavior is the
therapist's exposure of its meaning as an identification with an early object from whom
the patient has earnestly striven to be different. A woman I worked with, who had found
her father's grandiose, manic, controlling style unbearable, had made every conscious
effort to behave counter to his example. She took pains to be sensitive to others, to
allow them their space, to be sure her own agenda never overwhelmed those of the people to
whom she was close. She came to me for help with, among other things, the symptom of not
being able to manage money well. In particular, she could not resist any pressure from her
partner to spend more than they could afford, something she attributed to her general
compliance-that is, her counter-identification with her controlling father. It was when we
unearthed the fact that her behavior in the financial area was in subtle ways very much
like her father's, in that he had never been able to resist throwing money around in the
service of demonstrating his power, that she was able to put her determination to be
different from him into the service of economizing.
On the topic of identification and counter-identification, I cannot
resist mentioning the dissertation research of my colleague Kathryn Parkerton (1987). She
was interested in whether analysts grieve during or after the termination phase with their
analysands, and in pursuing this question, she interviewed ten very experienced
practitioners in her area. In the service of getting relevant information, she asked them
about many practices related to ending treatment. Did they become more self-disclosing in
the final weeks of therapy? Did they ever accept gifts from patients at the end of the
work? Did they discourage or encourage the person's relating to them as a colleague or
friend once the treatment was over? Did they keep in touch with former analysands? Did
they send them Christmas cards? Did they encourage them to come back for
"tune-ups" at some future time?
These ten analysts turned out to be all over the map with respect to
whether they mourned the end of an analysis. One woman denied any feelings of sadness,
explaining that she felt an exuberant sense of "Bon voyage" and the pleasant
anticipation of getting to know a new client. A male analyst confessed that he suffered
terribly, going through all the Kubler-Ross stages in relation to each patient who
"graduated." Moreover, the subjects varied widely in their answers to the
specific questions. Not only were they strikingly diverse, but also-most interesting to
me-they all believed that their particular set of rules and practices comprised the
"classical" or "accepted" standards of psychoanalytic behavior! What
their convictions actually turned out to correlate with were their own analysts'
practices: They either handled termination exactly as their own therapist had handled it
or in the polar opposite way. They all had rationales for their technical choices, but one
suspects that the identification came first and the explanations later.
ETHNIC, RELIGIOUS, RACIAL, CULTURAL, AND SUBCULTURAL IDENTIFICATIONS
Even in the current cultural climate, where issues of
diversity have been raised much more than they were during the time of my own training as
a therapist, it probably cannot be overemphasized that therapists need to appreciate the
ethnic, religious, racial, class, cultural, and subcultural identifications of their
clients. A plea for such understanding does not mean that therapists must become experts
ahead of time on all the possible backgrounds from which their patients may come (though,
as with anything else, the more general knowledge one has, the better); it means that we
all must be attentive to the possible implications of identifications very different from
our own (Sue & Sue, 1990; Comas-Diaz & Greene, 1994; Foster, Moskowitz, &
Javier, 1996). Even the Western notion of an individualized self, however automatically
those of us raised in this culture assume such a construct, is not a ubiquitous aspect of
human psychology (Roland, 1988). Nevertheless, the phenomenon of identification as a
critical developmental process seems universal.
Nothing in the DSM captures the importance for an effective therapeutic
connection of understanding how Irish families tend to socialize people to control affect,
while Italian ones socialize them to vent it, and what kinds of shame or guilt may
overcome people when their actions contravene the messages of their cultures of origin.
The kinds of questions explored in Ethnicity and Family Therapy (McGoldrick, Giordano,
& Pearce, 1996) have had inestimable value for therapists whether or not they practice
a family system model of treatment. Likewise, Lovinger's (1984) Working with Religious
Issues in Therapy has made it easier for therapists to understand the psychological
implications of the contrast between Protestant guilt about acting on one's inevitably
selfish feelings and Catholic guilt about having selfish feelings. When Grier and Cobbs
(1968) wrote Black Rage, they sensitized a whole generation of Caucasian therapists to the
implications of being African-American. More recently, Nancy Boyd-Franklin (1989) has
usefully summarized decades of work on black subcultures in Black Families in Therapy.
Sometimes it is more important to know that someone is Ukrainian than
to know that he or she suffers from a dysthymic disorder. Because a solid working alliance
is a necessary condition of doing psychotherapy, those understandings that make an
alliance possible are more critical to the success of any individual treatment than the
therapist's sophistication about the dynamics of a specific symptom. When one practices in
an area containing an ethnic population considerably different from one's own, it is
important to pursue available knowledge about working with people from that group. Studies
over the past two decades (e.g., Acosta, 1984; Trevino & Rendon, 1994) demonstrate
that with rather brief training, therapists can reduce the frustrations and consequent
premature terminations-of minority clients who are trying to make themselves understood by
therapists from the dominant culture.
If one is unfamiliar with the psychological implications of someone's
coming from a particular ethnic, racial, or cultural background and cannot find good
material on the topic, one should simply ask the patient for education about the values
and assumptions of his or her group. Not only does such an inquiry make the critical point
that there are no conversational taboos in psychotherapy (in contrast to most social
settings, where racial, ethnic, and sexual-orientation differences among people are
privately noted but rarely discussed), it has been my experience that clients are pleased
to be asked, appreciative of a therapist's genuine curiosity about their heritage, and
generous with their knowledge. In fact, the experience of teaching one's therapist can
have a nice counteractive effect on the patient's feeling that the role of the person
seeking help is a one-down position in which the therapist has expertise and the client
has only ignorance.
When misunderstandings inevitably happen in a treatment between
therapist and client of different backgrounds, therapists are well advised not to jump to
textbook conclusions about the meaning of the difficulty, but to draw out the patient
about his or her experience, expectations, and assumptions. A cautionary area in which
ethnic differences may determine what is therapeutic versus what is destructive, and where
it is hard not to make mistakes, involves instances when the client brings a gift to the
therapist. Cultures vary widely in their attitudes toward gifts, in the functions that
gift giving performs, and in their members' expectations about the proper ways gifts are
to be received. Standard psychoanalytic practice has always been for therapists to turn
down gifts-with warmth and tact, but nonetheless with the clear communication that in a
psychotherapy relationship, transactions are expected to be in words, not acts. It has
been a good general rule for therapists to assume that when a patient feels impelled to
bring a present to the therapist, something is being expressed in an action that should be
converted into a verbalization and then understood together. The old adage "Analyze,
don't gratify" (in this case, do not gratify the ostensibly generous impulse of the
gift giver-find out what is being expressed with the gift) has become lodged in the
superego of a whole generation of dynamically inclined therapists. In fact, impassioned
controversies about the theory of psychotherapy have been known to swirl around the
question of simple transactions such as whether it is ever appropriate for a clinician
simply to accept a gift without any comment other than "thank you" (e.g., Langs
& Stone, 1980).
For a therapist to turn down a small gift-however graciously from
someone strongly identified with caregivers in a subculture in which gift giving is
expected in both personal and business transactions, is to invite a therapeutic crisis. No
matter how tactfully educated, the client is likely to be wounded in his or her effort to
identify with respected others who have exemplified not only generosity but also the power
and dignity that goes with being able to give a gift. Since the ultimate rationale for the
conventional taboo against accepting gifts is to be sure that clients are talking freely
rather than acting out their thoughts and feelings, it expresses a dangerous confusion of
means and ends for a therapist to implement the "rule" of nonacceptance of gifts
in instances where the appreciation of a gift will facilitate the client's
self-disclosure, and the rejection of it will most likely provoke an injured withdrawal
(cf. Whitson, 1996).
A myth exists--and persists with astonishing stubbornness--that people
who are poor, marginal, alienated from the dominant culture, or unconventional in some
important way are not good candidates for an analytically oriented therapy. While it is
true that people in such groups usually require some education as to what the therapy
process is all about, and also require a special sensitivity and flexibility based on the
therapist's appreciation of their special circumstances, there is no evidence that the
verbal, insight-oriented therapies are not adaptable for people in such populations. In
fact, it may represent one of the most arrogant forms of prejudice for people in the
dominant sectors of a culture to pronounce its minority members "unsuited" to
the collaborative, verbal, in-depth therapies (cf. Singer, 1970; Javier, 1990; Altman,
1995; Thompson, 1996). But it is true that therapists who work with people significantly
different from themselves in terms of ethnicity, religion, race, class, culture, and
sexual orientation have some extra work to do in their efforts to understand both the
identifications of those they treat and their own silent prejudices and assumptions. |