408
JOHN H. GAGNON
While this dedication to the vocabulary of motives is fun–
damental to treatment, it is probably not very conducive to an assess–
ment of the value of the vocabulary either to the therapy or to theoret–
ical explanations of the disorder. As Dr. Rieux says near the end of
Camus' novel
The Plague,
one "can't cure and know at the same
time."
If
a belief in one's method is central to the healing role, it is
the polar opposite, doubt, that is central to the knower's role. A
therapist, almost by definition, cannot house such doubts in his desire
to treat the patient. I feel that this is the main reason why so little
fundamental research in human behavior has come from the practic–
ing healer, and why the case reports of analysts often reflect only
specific applications of the theoretical categories. The character of
most analytic writing is very much like the Talmudic or medieval
Christian commentaries in which the case is fitted into the sacred texts,
usually the collected papers of Freud.
My point is not to discredit either Freud or the psychoanalytic
movement, nor to deny the effect of certain experiences on adult
character structure. My concern has been to separate the two elements
in the healing situation: the very process that is composed of healer,
sufferer and the expectation both have of a cure; and the system
that purports to explain the disorder and to direct the course of
therapy. As can be seen, the latter often serves only as support to the
healer or as a useful accompaniment to the treatment.
I referred earlier to disorders that seemed to be intractable to
treatment, yet there is some evidence that there is an improvement
in almost two-thirds of the patients who submit voluntarily to psycho–
analysis or other forms of therapy. This might appear to be a con–
tradiction. However, most people difficult to treat are not voluntary
patients but people who have demonstrated a resistance to change.
The demand for change commonly comes from the outside and in–
volves a fundamental shift in character structure, in some cases re–
quiring something close to a conversion. These are changes from one
social category to another, quite unlike what happens to a voluntary
patient who comes not for a transformation of his personality (though
it may be transformed), but rather for help in a troubled, but often
transitory, situation. Those persons who are not helped are in
life–
changing situations beyond the reach of verbal therapy. Thus the
shift from law-abiding citizen to felon, from an in-contact person to
