by C. G. Jung
Another patient’s story revealed to me the psychological background of psychosis and, above all, of the “senseless” delusions. From this case I was able for the first time to understand the language of schizophrenics, which had hitherto been regarded as meaningless. The patient was Babette S., whose story I have published elsewhere.4 In 1908 I delivered a lecture on her in the town hall of Zürich.
She came out of the Old Town of Zürich, out of narrow, dirty streets where she had been born in poverty-stricken circumstances and had grown up in a mean environment. Her sister was a prostitute, her father a drunkard. At the age of thirty-nine she succumbed to a paranoid form of dementia praecox, with characteristic megalomania. When I saw her, she had been in the institution for twenty years. She had served as an object lesson to hundreds of medical students. In her they had seen the uncanny process of psychic disintegration; she was a classic case. Babette was completely demented and given to saying the craziest things which made no sense at all. I tried with all my might to understand the content of her abstruse utterances. For example, she would say, “I am the Lorelei”; the reason for that was that the doctors, when trying to understand her case, would always say, “Ich weiss nicht, was soll es bedeuten.”5 Or she would wail, “I am Socrates’ deputy.” That, as I discovered, was intended to mean: “I am unjustly accused like Socrates.” Absurd outbursts like: “I am the double polytechnic irreplaceable,” or, “I am plum cake on a corn-meal bottom,” “I am Germania and Helvetia of exclusively sweet butter,” “Naples and I must supply the world with noodles,” signified an increase in her self-valuation, that is to say, a compensation for inferiority feelings.
My preoccupation with Babette and other such cases convinced me that much of what we had hitherto regarded as senseless was not as crazy as it seemed. More than once I have seen that even with such patients there remains in the background a personality which must be called normal. It stands looking on, so to speak. Occasionally, too, this personality—usually by way of voices or dreams—can make altogether sensible remarks and objections. It can even, when physical illness ensues, move into the foreground again and make the patient seem almost normal.
I once had to treat a schizophrenic old woman who showed me very distinctly the “normal” personality in the background. This was a case which could not be cured, only cared for. Every physician, after all, has patients whom he cannot hope to cure, for whom he can only smooth the path to death. She heard voices which were distributed throughout her entire body, and a voice in the middle of the thorax was “God’s voice.”
“We must rely on that voice,” I said to her, and was astonished at my own courage. As a rule this voice made very sensible remarks, and with its aid I managed very well with the patient. Once the voice said, “Let him test you on the Bible!” She brought along an old, tattered, much-read Bible, and at each visit I had to assign her a chapter to read. The next time I had to test her on it. I did this for about seven years, once every two weeks. At first I felt very odd in this role, but after a while I realized what the lessons signified. In this way her attention was kept alert, so that she did not sink deeper into the disintegrating dream. The result was that after some six years the voices which had formerly been everywhere had retired to the left half of her body, while the right half was completely free of them. Nor had the intensity of the phenomena been doubled on the left side; it was much the same as in the past. Hence it must be concluded that the patient was cured—at least halfway. That was an unexpected success, for I would not have imagined that these memory exercises could have a therapeutic effect.
Through my work with the patients I realized that paranoid ideas and hallucinations contain a germ of meaning. A personality, a life history, a pattern of hopes and desires lie behind the psychosis. The fault is ours if we do not understand them. It dawned upon me then for the first time that a general psychology of the personality lies concealed within psychosis, and that even here we come upon the old human conflicts. Although patients may appear dull and apathetic, or totally imbecilic, there is more going on in their minds, and more that is meaningful, than there seems to be. At bottom we discover nothing new and unknown in the mentally ill; rather, we encounter the substratum of our own natures.
It was always astounding to me that psychiatry should have taken so long to look into the content of the psychoses. No one concerned himself with the meaning of fantasies, or thought to ask why this patient had one kind of fantasy, another an altogether different one; or what it signified when, for instance, a patient had the fantasy of being persecuted by the Jesuits, or when another imagined that the Jews wanted to poison him, or a third was convinced that the police were after him. Such questions seemed altogether uninteresting to doctors of those days. The fantasies were simply lumped together under some generic name as, for instance, “ideas of persecution.” It seems equally odd to me that my investigations of that time are almost forgotten today. Already at the beginning of the century I treated schizophrenia psychotherapeutically. That method, therefore, is not something that has only just been discovered. It did, however, take a long time before people began to introduce psychology into psychiatry.
While I was still at the clinic, I had to be most circumspect about treating my schizophrenic patients, or I would have been accused of woolgathering. Schizophrenia was considered incurable. If one did achieve some improvement with a case of schizophrenia, the answer was that it had not been real schizophrenia.
When Freud visited me in Zürich in 1908, I demonstrated the case of Babette to him. Afterward he said to me, “You know, Jung, what you have found out about this patient is certainly interesting. But how in the world were you able to bear spending hours and days with this phenomenally ugly female?” I must have given him a rather dashed look, for this idea had never occurred to me. In a way I regarded the woman as a pleasant old creature because she had such lovely delusions and said such interesting things. And after all, even in her insanity, the human being emerged from a cloud of grotesque nonsense. Therapeutically, nothing was accomplished with Babette; she had been sick for too long. But I have seen other cases in which this kind of attentive entering into the personality of the patient produced a lasting therapeutic effect.
Regarding them from the outside, all we see of the mentally ill is their tragic destruction, rarely the life of that side of the psyche which is turned away from us. Outward appearances are frequently deceptive, as I discovered to my astonishment in the case of a young catatonic patient. She was eighteen years old, and came from a cultivated family. At the age of fifteen she had been seduced by her brother and abused by a schoolmate. From her sixteenth year on, she retreated into isolation. She concealed herself from people, and ultimately the only emotional relationship left to her was one with a vicious watchdog which belonged to another family, and which she tried to win over. She grew steadily odder, and at seventeen was taken to the mental hospital, where she spent a year and a half. She heard voices, refused food, and was completely mutistic (i.e., no longer spoke). When I first saw her she was in a typical catatonic state.
In the course of many weeks I succeeded, very gradually, in persuading her to speak. After overcoming many resistances, she told me that she had lived on the moon. The moon, it seemed, was inhabited, but at first she had seen only men. They had at once taken her with them and deposited her in a sublunar dwelling where their children and wives were kept. For on the high mountains of the moon there lived a vampire who kidnaped and killed the women and children, so that the moon people were threatened with extinction. That was the reason for the sublunar existence of the feminine half of the population.
My patient made up her mind to do something for the moon people, and planned to destroy the vampire. After long preparations, she waited for the vampire on the platform of a tower which had been erected for this purpose. After a number of nights she at last saw the monster approaching from afar, winging his way toward her like a great black bird. She took her long sacrificia
l knife, concealed it in her gown, and waited for the vampire’s arrival. Suddenly he stood before her. He had several pairs of wings. His face and entire figure were covered by them, so that she could see nothing but his feathers. Wonder-struck, she was seized by curiosity to find out what he really looked like. She approached, hand on the knife. Suddenly the wings opened and a man of unearthly beauty stood before her. He enclosed her in his winged arms with an iron grip, so that she could no longer wield the knife. In any case she was so spellbound by the vampire’s look that she would not have been capable of striking. He raised her from the platform and flew off with her.
After this revelation she was once again able to speak without inhibition, and now her resistances emerged. It seemed that I had stopped her return to the moon; she could no longer escape from the earth. This world was not beautiful, she said, but the moon was beautiful, and life there was rich in meaning. Sometime later she suffered a relapse into her catatonia, and I had to have her taken to a sanatorium. For a while she was violently insane.
When she was discharged after some two months, it was once again possible to talk with her. Gradually she came to see that life on earth was unavoidable. Desperately, she fought against this conclusion and its consequences, and had to be sent back to the sanatorium. Once I visited her in her cell and said to her, “All this won’t do you any good; you cannot return to the moon!” She took this in silence and with an appearance of utter apathy. This time she was released after a short stay and resigned herself to her fate.
For a while she took a job as nurse in a sanatorium. There was an assistant doctor there who made a somewhat rash approach to her. She responded with a revolver shot. Luckily, the man was only slightly wounded. But the incident revealed that she went about with a revolver all the time. Once before, she had turned up with a loaded gun. During the last interview, at the end of the treatment, she gave it to me. When I asked in amazement what she was doing with it, she replied, “I would have shot you down if you had failed me!”
When the excitement over the shooting had subsided, she returned to her native town. She married, had several children, and survived two world wars in the East, without ever again suffering a relapse.
What can be said by way of interpretation of these fantasies? As a result of the incest to which she had been subjected as a girl, she felt humiliated in the eyes of the world, but elevated in the realm of fantasy. She had been transported into a mythic realm; for incest is traditionally a prerogative of royalty and divinities. The consequence was complete alienation from the world, a state of psychosis. She became “extramundane,” as it were, and lost contact with humanity. She plunged into cosmic distances, into outer space, where she met with the winged demon. As is the rule with such things, she projected his figure onto me during the treatment. Thus I was automatically threatened with death, as was everyone who might have persuaded her to return to normal human life. By telling me her story she had in a sense betrayed the demon and attached herself to an earthly human being. Hence she was able to return to life and even to marry.
Thereafter I regarded the sufferings of the mentally ill in a different light. For I had gained insight into the richness and importance of their inner experience.
I am often asked about my psychotherapeutic or analytic method. I cannot reply unequivocally to the question. Therapy is different in every case. When a doctor tells me that he adheres strictly to this or that method, I have my doubts about his therapeutic effect. So much is said in the literature about the resistance of the patient that it would almost seem as if the doctor were trying to put something over on him, whereas the cure ought to grow naturally out of the patient himself. Psychotherapy and analysis are as varied as are human individuals. I treat every patient as individually as possible, because the solution of the problem is always an individual one. Universal rules can be postulated only with a grain of salt. A psychological truth is valid only if it can be reversed. A solution which would be out of the question for me may be just the right one for someone else.
Naturally, a doctor must be familiar with the so-called “methods.” But he must guard against falling into any specific, routine approach. In general one must guard against theoretical assumptions. Today they may be valid, tomorrow it may be the turn of other assumptions. In my analyses they play no part. I am unsystematic very much by intention. To my mind, in dealing with individuals, only individual understanding will do. We need a different language for every patient. In one analysis I can be heard talking the Adlerian dialect, in another the Freudian.
The crucial point is that I confront the patient as one human being to another. Analysis is a dialogue demanding two partners. Analyst and patient sit facing one another, eye to eye; the doctor has something to say, but so has the patient.
Since the essence of psychotherapy is not the application of a method, psychiatric study alone does not suffice. I myself had to work for a very long time before I possessed the equipment for psychotherapy. As early as 1909 I realized that I could not treat latent psychoses if I did not understand their symbolism. It was then that I began to study mythology.
With cultivated and intelligent patients the psychiatrist needs more than merely professional knowledge. He must understand, aside from all theoretical assumptions, what really motivates the patient. Otherwise he stirs up unnecessary resistances. What counts, after all, is not whether a theory is corroborated, but whether the patient grasps himself as an individual. This, however, is not possible without reference to the collective views, concerning which the doctor ought to be informed. For that, mere medical training does not suffice, for the horizon of the human psyche embraces infinitely more than the limited purview of the doctor’s consulting room.
The psyche is distinctly more complicated and inaccessible than the body. It is, so to speak, the half of the world which comes into existence only when we become conscious of it. For that reason the psyche is not only a personal but a world problem, and the psychiatrist has to deal with an entire world.
Nowadays we can see as never before that the peril which threatens all of us comes not from nature, but from man, from the psyches of the individual and the mass. The psychic aberration of man is the danger. Everything depends upon whether or not our psyche functions properly. If certain persons lose their heads nowadays, a hydrogen bomb will go off.
The psychotherapist, however, must understand not only the patient; it is equally important that he should understand himself. For that reason the sine qua non is the analysis of the analyst, what is called the training analysis. The patient’s treatment begins with the doctor, so to speak. Only if the doctor knows how to cope with himself and his own problems will he be able to teach the patient to do the same. Only then. In the training analysis the doctor must learn to know his own psyche and to take it seriously. If he cannot do that, the patient will not learn either. He will lose a portion of his psyche, just as the doctor has lost that portion of his psyche which he has not learned to understand. It is not enough, therefore, for the training analysis to consist in acquiring a system of concepts. The analysand must realize that it concerns himself, that the training analysis is a bit of real life and is not a method which can be learned by rote. The student who does not grasp that fact in his own training analysis will have to pay dearly for the failure later on.
Though there is treatment known as “minor psychotherapy,” in any thoroughgoing analysis the whole personality of both patient and doctor is called into play. There are many cases which the doctor cannot cure without committing himself. When important matters are at stake, it makes all the difference whether the doctor sees himself as a part of the drama, or cloaks himself in his authority. In the great crises of life, in the supreme moments when to be or not to be is the question, little tricks of suggestion do not help. Then the doctor’s whole being is challenged.
The therapist must at all times keep watch over himself, over the way he is reacting to his patient. For we do not react only with our
consciousness. Also we must always be asking ourselves: How is our unconscious experiencing this situation? We must therefore observe our dreams, pay the closest attention and study ourselves just as carefully as we do the patient. Otherwise the entire treatment may go off the rails. I shall give a single example of this.
I once had a patient, a highly intelligent woman, who for various reasons aroused my doubts. At first the analysis went very well, but after a while I began to feel that I was no longer getting at the correct interpretation of her dreams, and I thought I also noticed an increasing shallowness in our dialogue. I therefore decided to talk with my patient about this, since it had of course not escaped her that something was going wrong. The night before I was to speak with her, I had the following dream.
I was walking down a highway through a valley in late-afternoon sunlight. To my right was a steep hill. At its top stood a castle, and on the highest tower there was a woman sitting on a kind of balustrade. In order to see her properly, I had to bend my head far back. I awoke with a crick in the back of my neck. Even in the dream I had recognized the woman as my patient.
The interpretation was immediately apparent to me. If in the dream I had to look up at the patient in this fashion, in reality I had probably been looking down on her. Dreams are, after all, compensations for the conscious attitude. I told her of the dream and my interpretation. This produced an immediate change in the situation, and the treatment once more began to move forward.