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.

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."

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.

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).

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.

    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.