SEVEN PAPERS ON EXISTENTIAL ANALYSIS ... - Wagner College

VI. Authenticity in Existential Analysis (2007
first published in Existential Analysis 19(1), 2008, pp. pp. 81-101.
I. Diagnosis, Intervention, Treatment, Cure
In its brief history the goal of psychotherapy has changed dramatically several times. When only
a century ago the Viennese neurologist, Sigmund Freud, first decided to intervene with words
instead of available medical procedures to treat his patients’ “neurotic” complaints, as a
physician he still had in mind, first and foremost, the cure of a patient. A psychoneurosis was still,
for Freud, a disease of the nervous system and a presumed lesion was responsible for its
symptoms. More than a few steps, however, lay between the doctor’s small examining room
and his study in the apartment on Berggasse where psychoanalysis was first practiced at the
end of the nineteenth century. While it is unclear whether Freud ever ceased to see his referrals
as patients (each of them an instance of the living corpse every physician is trained to envision
presenting itself to him for care) his use of words rather than scalpel and drugs (forgetting for a
moment his early prescription of cocaine for “depression”) marked a departure from the
traditional medical model on which the physician’s approach is based.
Freud wore a three-piece suit and never unbuttoned his tie in the presence of a patient.
We are told he kept appropriate physical and absolute psychological distance from his patients,
eventually moving entirely out of their view and the diagnostic gaze to a position seated behind
the patient’s body, which was stretched out comfortably on the analytic chaise longue. Like a
surgeon, his work space was set up to shield from view his patient’s face.
Movement of the patient’s body away from the doctor’s examining eyes transformed
the medical patient into the analysand of classic psychoanalysis. The analysand was physically
there, but the data on which Freud’s treatment would be based was being gathered elsewhere,
just as today the data of any primary care physician’s physical examination of a patient are
collected for analysis elsewhere in laboratories where the patient’s blood and urine samples are
scrutinized for interpretation by the physician. The data provided by Freud’s analysand was
gathering in that immense chamber he termed the Unbewusst, a place where consciousness
could never shed its light.
Moving the site of his work with patients out of the hospital setting was decisive for
Freud’s invention of the prototype of the patient in psychotherapy, since it located the
procedure of psychoanalysis away from an environment redolent with the ambient odors of
cautery, human body products, and the chemical compounds used to cleanse wounds, induce
anesthesia and maintain a hygienic institutional environment. In Freud’s study, there was instead
the smell of food being prepared elsewhere in the doctor’s apartment, the ubiquitous, acrid
odor of cigar smoke and the musty smell of heavy Victorian fabrics and upholstery. The odors
produced by the patient’s body–the sour breath exhaled by a dyspetic or the sweetness of
acetone leaking out through a diabetic patient’s pores–was overwhelmed by the smells of
burning tobacco, simmering sausages, and his chow’s fur. Climbing the marble stairs to Freud’s
apartment, an analysand might just as well have been visiting a relative or her attorney. She
was entering a consulting room, not a hospital or dispensary.
Freud changed the being psychiatrists treated by changing a what to be treated to a
who to be treated. Although, initially he persisted in using the language of neuropathology,
Freud’s conception of a psychoneurosis was soon not that of a disorder of the nervous system
and therefore a disorder of the body, but a condition of a person’s emotional dis-array, a disorder
of the analysand’s psyche. Freud’s topographic model of the intrapsychic world of the
patient envisioned contents of an entity, the psyche, moving from one domain to another,
between the unconscious, the preconscious and the conscious. The Freudian psyche was not
the brain, yet the image was one of a thing in which energy moved from place to place. The