ROBERT MICHELS
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character pathologies, and of narcissism. Don't you then need different kinds
of treatment approaches to deal with these patients?
Robert Michels:
Yes, although I would put it in a slightly different way.
Essentially Freud started out treating the patients seen by an outpatient neu–
rologist of the nineteenth century. Freud was not a psychiatrist. He was a
neurologist. He treated the patients one sees in an ambulatory medical neu–
rology practice, patients with physical neurological symptoms. He expanded
his treatment to other patients with more psychological symptoms: panic
attacks, phobias, obsessions, and the like. He then made a critical discovery:
it was hard to treat patients because of their behavior in the treatment
process. They were not helping the treatment, but in fact struggling against
it and him. This phenomenon is called resistance. The focus of the treatment
began to shift from understanding symptoms to understanding resistance.
But what is the resistance?
It
is the way the patient behaves when faced with
the challenge of being in analysis. However, that turns out to be the same
way he behaves when facing any challenge. Resistance is character as it is
expressed within the analytic situation. Psychoanalytic treatment shifted
from treating neurotic symptoms to treating character. That shift didn't
occur until twenty-five years into the history of analysis, and with it a con–
commitant shift that isn't much talked about. Analysis rarely lasted more
than a year until 1920. The whole treatment was eight or nine months long,
from the time Freud started until the third decade of analysis, when it shift–
ed from trying to unders tand the symbolic meaning of symptoms to
understanding the patterns of resistance that emerged. The shift from symp–
tom analysis to character analysis is a shift from a one-year project to a
multi-year project. To this day, analysis continues essentially to be primarily
a treatment for character. It has expanded to treating more disturbed charac–
ters, narcissistic characters, borderline characters, but it is essentially still a
treatment for character.
It
does treat symptoms, but there are often cheaper,
faster, and even more effective ways of treating symptoms than analysis, so
if
the only goal were symptom relief, one would rarely prescribe analysis.
Other treatments for symptoms, whether psychological or pharmacological,
developed to replace analysis. There were attempts to apply analysis in the
treatment of both psychosomatic disorders and psychoses, but it generally did
rather poorly here.
It
continues to be the treatment of choice for character.
In fact, we don't have many other treatments for character. If you suffer from
a panic attack or a phobia or a depression, you can be treated without analy–
sis. If persons who are suffering have problems not only with symptoms,
but also with human relationships and the way they experience pleasure, the
way they lead their lives, the way they approach relationships wi th others,
their careers and themselves, then analysis is the treatment. Of course, Freud
