The unmistakable feature of the neuroses is the fact that their causes are psychic, and that their cure depends entirely upon psychic methods of treatment. The attempts to delimit and explore this special field – both from the side of psychiatry and from that of neurology – led to a discovery which was very unwelcome to the science of medicine: namely, the discovery of the psyche as an etiological or causal factor in disease.
All attempts to explain the psychic factor in terms of more elementary physical factors were doomed to failure. There was more promise in the attempt to reduce it to the con-[197] cept of the drive or instinct – a concept taken over from biology. It is well known that instincts are observable physiological urges based on the functioning of the glands, and that, as experience shows, they condition or influence psychic processes. What could be more plausible, therefore than to seek the specific cause of the psychoneuroses not in the mystical notion of the soul, but in a disturbance of the instincts which might possibly be curable in the last resort by medicinal treatment of the glands. ///Freud’s theory of the neuroses is based on this standpoint: it explains them in terms of disturbances of the sexual instinct. Adler likewise resorts to the concept of the drive, and explains the neuroses in terms of disturbances of the urge to power a concept which, we must admit, is a good deal more psychic than that of the physiological sexual instinct. . . . ///We may even consider the possibility that everything “psychic” is comprised in the sum total of instincts, and that the psyche itself is therefore only an instinct or a conglomerate of instincts, being in the last analysis nothing but a function of the glands.///A psychoneurosis, would then be a glandular disease. There is, however, no proof of this statement, and no glandular extract that will cure a neurosis has yet been found. On the other hand, we have been taught by all too many mistakes that organic therapy fails completely in the treatment of neuroses, while psychic methods cure them. These psychic methods are just as effective as we might suppose the glandular extracts would be.///So far, then, as our present knowledge goes, neuroses are to be influenced or cured by approaching them not from the proximal end, i.e., from the functioning of the glands, but from the distal end, i.e., from the psyche, just as if the psyche were itself a substance. For instance, a suitable explanation or comforting word to the patient can have something like a healing [198] effect which may even influence the glandular secretions.///The doctor’s words, to be sure, are only vibrations in the air, yet their special quality is due to a particular psychic state in the doctor. His words are effective only in so far as they convey a meaning or have significance. It is this that makes them work. But meaning is something mental or spiritual. Call it a fiction if you like. Nevertheless this fiction enables us to influence the biochemical processes of the body. Whether the fiction forms itself in me spontaneously or reaches me from outside via human speech, it can make me ill or cure me. Fictions, illusions, opinions are perhaps the most intangible and unreal things we can think of; yet they are the most effective of all in the psychic and even the psychophysical realm. ///It was by recognizing these facts that medicine discovered the psyche, and it can no longer honestly deny the psyche’s reality. It has been shown that the instincts are a condition of the psychic activity, while at the same time psychic processes seem to condition the instincts.///The reproach levelled at the Freudian and Adlerian theories is not that they are based on instincts, but that they are one sided. It is psychology without the psyche, and this suits people who think they have no spiritual needs or aspiration. But here both doctor and patient deceive themselves.///Even though the theories of Freud and Adler come much nearer to getting at the bottom of the neuroses than any earlier approach from the medical side, their exclusive concern with the instincts fails to satisfy the deeper spiritual needs of the patient. They are too much bound by the premises of nineteenth-century science, too matter of fact, and they give too little value to fictional and imaginative processes. In a word, they do not give enough meaning to life. And it is only meaning that liberates. Ordinary reasonableness, sound human judgment, science as a compendium of common sense, these certainly help us over a good part of the road, but they never take us beyond the frontiers of life’s most commonplace realities, beyond the merely average and normal. They afford no answer to the question of psychic suffering and its profound significance.///A psycho neurosis must be understood, ultimately, as the suffering of a soul [199] which has not discovered its meaning. But all creativeness in the realm of the spirit as well as every psychic advance of man arises from the suffering of the soul, and the cause of suffering is spiritual stagnation, or psychic sterility. With this realization the doctor sets foot on territory which he enters with the greatest caution. He is now confronted with the necessity of conveying to his patient the healing fiction, the meaning that quickens – for it is this that the sick person longs for, over and above everything that reason and science can give him. He is looking for something that will take possession of him and give meaning and form to the confusion of his neurotic soul.///Is the doctor equal to this task? To begin with, he will probably hand his patient over to the clergyman or philosopher, or abandon him to that vast perplexity which is the special note of our day. As a doctor he is not required to have a finished outlook on life, and his professional conscience does not demand it of him. But what will he do when he sees only too clearly why his patient is ill; when he sees that he has no love, but only sexuality; no faith, because he is afraid to grope in the dark; no hope because he is disillusioned by the world and by life; and no understanding, because he has failed to read the meaning of his own existence.///There are many well-educated patients who flatly refuse to consult a clergyman. Still less will they listen to a philosopher, for the history of philosophy leaves them cold, and intellectual problems seem to them more barren than the desert. And where are the great and wise men who do not merely talk about the meaning of life and of the world, but really possess it? One cannot just think up a system or truth, which would give the patient what he needs in order to live, namely faith, hope, love and understanding.///These four highest achievements of human endeavour [faith, hope, love and understanding] are so many gifts of grace, which are neither to be taught nor learned, neither given nor taken, neither withheld nor earned, since they come through experience, which is an irrational datum not subject to human will and caprice.///Experiences cannot be made. They happen – yet fortunately their independence of man’s activity is not absolute but relative. We can draw closer to them – that much lies within our human reach. There are ways which bring us nearer to living experience, yet we should beware of calling these ways methods. The very word has a deadening effect. The way to experience, moreover, is anything but a clever trick; it is rather a venture which requires us to commit ourselves with our whole being.///Thus in trying to meet the therapeutic demands made upon him, the doctor is confronted with a question which seems to contain an insuperable difficulty. How can he help the sufferer to attain the liberating experience which will bestow upon him the four great gifts of grace and heal his sickness? We can, of course, advise the patient with the best intentions that he should have true love, or true faith, or true hope; and we can admonish him with the phrase: Know thyself. But how is the patient to obtain beforehand that which only experience can give him?///Saul owed his conversion neither to true love, nor to true faith, nor to any other truth. It was solely his hatred of the Christians that set him on the road to Damascus, and to that decisive experience which was to alter the whole course of his life. He was brought to this experience by following out, with conviction, his own worst mistake. This opens up a problem which we can hardly take too seriously. And it confronts the psychotherapist with a question which brings him shoulder to shoulder with the clergyman: the question of good and evil.///