CHAPTER SEVEN

CRITICISM AND VALUATION OF THE PART PLAYED BY ABREACTION AND ASSIMILATION IN PSYCHIATRY

In the preceding chapter we described a method of treating trau• matic memories-what Breuer called "the cathartic method". We there observed that an essential element of the method is the discharge, or abreaction, of affects by having the patient talk about the trau• matic event he has gone through. When memories have thus been relieved of their emotional character, they are neutralized; they can be submitted to rational examination and fitted into the patient's normal context of experience. This stage of treatment is called "assimilation" or "re-association". Another thing we have noticed is that these two phases are concurrent in the process of effecting a cure. Of the two factors, Breuer and Freud in their Studien laid special stress on abreaction rather than assimilation; and after them Brown and others took the same attitude. But Freud's later, completely worked-out system gives special prominence to assimilation : to bringing the patient's previously unconscious complex, the cause of his trouble, into consciousness and integrating it with his experience. Abreaction remained, however, an element in treatment for Freud. Janet gave good examples of how simply discharging an affect can bring about a patient's recovery. But at the same time, he strongly emphasized the important part played by assimilation. Janet's evidence deserves special attention because he proved convin• cingly that abreaction has a beneficial effect on various types of neurotic patient even when it is not an element in "cathartic" therapy. This means that abreaction is not limited to use in Breuer's and Freud's cathartic method-which of course Janet practised, too. Thus, criti• cism of that method does not at all affect the psychotherapeutic importance of abreaction. It is evident that William McDougall had the general occurrence of abreaction in mind when he said that "catharsis" is a general factor of mental hygiene rather than part of a psychotherapeutic method.1 Here we should simply like to object that, even if abreaction is such a factor, it can be considered to form

1 W. McDougall, An Outline of Abnormal Psychology (London, 1926); p. 479. 94 TEACHINGS OF PSYCHIATRY part of a therapy which aims at establishing, or restoring, mental health! In examining general discussion on the cathartic method, we may observe how the function of abreaction in treatment is commonly underestimated to the benefit of work with the patient's consciousness: of assimilation. McDougall's criticism of the method, primarily as practised by William Brown, provides an instance of this tendency. 2 Pierre Janet considered that during the painful and difficult nar• ration of a traumatic memory the "forces" surrounding that memory are discharged; and he asked : "How does it happen that the traumatic memory, after it has been discharged by confession, is not immediately charged again 1" 3 In his opinion, recharge does not take place because of the high tension aroused in the patient by his emotional excitation during treatment. An "operation de haute tension" occurs; this brings assimilation of the dissociated memories and re-establishment of mental unity. Advocates of the cathartic method also hold that when the patient speaks of his traumatic memory he experiences mental tension which is brought to a high pitch and given full expression. But for Janet such tension meant a general state of excitation in (according to his theory) poorly endowed hysterics with low psychic pressure. During confession of the memory, all the concealed powers of these people are mobilized at once and there is a concentrated rallying of strength: this feat, unusual for them, produces release and assimilation of dissociated elements in their psyches. It is evident that the cathartic method brings cures in many cases of neurosis precisely because of the abreaction which it includes; it is clear, too, that abreaction, even when unconnected with that method, has a great function in psychiatry. Here the experience of psychiatrists speaks for itself. And, in our view, the theory presented by Breuer to explain the effect of abreaction-a theory adopted in the main by Freud-is the most satisfactory one. As token of the appreciation that has come to Breuer, the following hot-and-cold judgement of Freud may be cited: "Many opponents to psychoanalysis are in the habit of recalling casually that of course

2 In a discus~ion printed by The British Journal of Psychology: Medical Section (Cambridge, 1920); pp. 16-33. 3 P. Janet, La Medicine psychologique; p. 221. Cf. Les Medications psychologiques; vol. II. p. 297.