FREUD’S SHIFT IN FOCUS, from the individual to society, came in tandem with a change in his own circumstances. He had long considered himself old, and he had always been focused on death. In 1923, he confronted a concrete indicator of mortality. For six years he had been aware of a lesion in his mouth. Now it required diagnosis. He turned to a series of doctors, hoping to avoid the inevitable demand that he give up cigars. The result was that he put himself in the hands of an incompetent surgeon, who subjected him to a bloody operation followed by painful radiation treatments for what was obviously an incurable cancer.
There were other grounds for discouragement. A beloved niece had just committed suicide. Then Freud’s favorite grandson, Sophie’s child, died of tuberculosis. Freud entered an interval of depression in which he said that he no longer cared for his grandchildren.
Partly because of his debilitated state, Freud’s colleagues and physicians shielded him from his own diagnosis. But further surgeries followed, requiring prostheses to separate the oral and nasal cavities. Freud recovered his health and his level of energy, but his speech and hearing remained impaired. He was frequently in pain and in need of repeated medical attention, to revise the prostheses and the surgery.
Freud had wearied of patient care. To one colleague, he had written, “In the first place, I get tired of people. Secondly…I am not basically interested in therapy, and I usually find that I am engaged—in any particular case—with the theoretical problems with which I happen to be interested at the time…. I am also too patriarchal to be a good analyst.” To another colleague, Freud wrote that he tried to avoid gravely ill patients. At the same time, he found work with neurotics repetitive. Here, he suggested that he no longer relied on his practice as an aid in developing his theories.
But financial considerations demanded that Freud continue to see patients. Much of what we know about his style comes from these late years. Freud was famous, and so his clients kept diaries. In the late 1920s, a patient of Freud’s—she later became Anna’s companion—gave him a chow. Freud took to the dog, and ever after he was accompanied in his sessions by one in a series of chows. They feature in more than one reminiscence.
Many of Freud’s analyses in these years were dual purpose, serving both as treatment and as training, for prospective therapists. Whether for this reason or because he had always indulged himself, Freud was didactic, insisting on his interpretations and explaining them at length in terms of his theories. Though in his writing, Freud emphasized the interpretation of transference, in practice, he liked to be admired, and he accepted gifts. With favored patients, he would let the conversation drift to areas of his own interest, discussing his collection of antiquities and allowing individual pieces to be examined. A number of patients socialized with Freud and his family. With the less favored, Freud could be stern. He told one patient that the analysis would not progress unless he stopped masturbating. He admonished another (who may have been in the midst of an affair with Freud’s son Martin) not to have sex at all for the duration of the analysis. Some patients believed that the sessions were helpful. Many did not, a surprising result given Freud’s renown and the power of expectancy.
Joseph Wortis, an American psychiatrist who remained a skeptic about psychoanalysis, saw Freud in the mid–1930s and contributed a wry account of his approach. Freud was never a neutral observer but always an advocate for his doctrines. When Wortis associated to a dream symbol, Freud “would wait until he found an association which would fit into his scheme of interpretation and pick it up like a detective at a line-up who waits until he sees his man…. [T]he procedure is far from foolproof and lends itself easily to pseudoscientific conclusions on an arbitrary basis.” Wortis found Freud tendentious and, what is perhaps worse, behind the times.
Toward the start of treatment, for instance, Freud informed Wortis that psychoanalysis requires a degree of honesty that is impossible in bourgeois society. Wortis replied that “I on the contrary had never thought that I had to practice any great degree of concealment or dishonesty in the society in which I moved, least of all with my good friends.” Wortis wondered “whether Freud’s theories of repression were not limited in their application to the kind of society in which he still seemed to live.” Wortis’s “social group and generation” spoke about sex freely. It seemed to Wortis that in the wake of the Roaring Twenties, Freud was still fighting the battles of the 1880s.
Wortis was especially concerned that Freud had backward, fixed convictions about homosexuality, a topic that interested Wortis as a researcher. Freud informed Wortis that homosexuality is “something pathological…an arrested development,” like being five feet tall when you should be six. This analogy included the possibility that homosexuals can be “perfectly decent people.” But Freud insisted that the repression of homosexual leanings was useful. Enforcing “decency” gave rise to creative energy, through sublimation.
When Wortis asked why we should not all act on our bisexual drives, Freud upbraided him: “Your attitude reminds me of a child who just discovered that everybody defecates and who then demands that everybody ought to defecate in public; that cannot be.” When Wortis asked what was wrong with the practice of homosexuality, Freud replied that “perversions are biologically inferior” and should remain tolerated but restricted or hidden, for the good of society.
Freud spoke of a type of homosexuality caused by a father complex. He told Wortis that when a mother dies in childbirth and a father rears the son, “[t]he boy would usually become homosexual,” because of exaggerated castration anxiety. This theory stood in obvious contrast to the one Freud had discussed when writing about Leonardo, homosexuality caused by the attentions of a single mother. When Wortis suggested that cases of single parenting would make a good subject for study, Freud objected, saying that empirical research is unnecessary: “We know how they work out without that.”
Freud wavered about the dangers of homosexuality. In 1935, he sent a kindly letter to a mother of a homosexual son. Freud wrote that the condition “is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness”—but he also repeated the formulation he had given Wortis, that homosexuality signifies an “arrest of sexual development.”
Homosexuality remained very much on Freud’s mind. It was not so much the full condition that worried him. Freud grouped “sexual inversion” with the perversions, a class that embraced coprophilia, necrophilia, and pedophilia. But then he showed a grudging admiration for perversion, as an indicator of “the omnipotence of love.” Latent homosexuality was another matter. Freud saw dangers in homosexual tendencies in heterosexual men, as the Frink and Ferenczi cases indicate. Toward the end of his life, Freud came to believe that inadequacies in sexual differentiation—insufficient masculinity in men and insufficient femininity in women—explained the failure of many analyses.
He explored this theme in his late work, Analysis Terminable and Interminable (1937). Combative to the end, Freud begins the essay with a dismissal of Otto Rank and his attempt to shorten treatments. Freud favors his own methods. He illustrates them by reference to the Wolf Man case—which he continues to count as successful despite the emergence, after treatment, of “attacks of illness” showing a “distinctively paranoid flavor.” Freud goes on to demean Sándor Ferenczi, the longtime adherent who late in life had tried to speed up analyses by offering patients active support.
But if others’ methods are defective, even classical psychoanalysis has its limitations. Some instincts, Freud now believed, are too powerful to be tamed. Some defenses serve as resistances, causing the patient to ignore the analyst’s apt interpretations. Like government and education, psychoanalysis may be an “impossible profession,” in which unsatisfying results are par for the course.
The themes most likely to frustrate the treatment are penis envy in women and castration anxiety in men, when it leads to passivity. Passivity is not evident only in patients (like Frink and Ferenczi) who are indecisive in love. Passivity can morph into “masculine protest,” a pseudo-autonomy that causes a man to resist accepting the analyst as a father-substitute toward whom he should feel gratitude. Similarly, penis envy causes a woman to become depressed in analysis and believe that the treatment will be futile. These formulations hark back to Freud’s early work. The idea that patients may be intent on frustrating the therapist echoes Freud’s formulation in the Dora/Bauer case. Now Freud is also suggesting that the problem is quasi-biological. Some people are unsuited, on the basis of their sexuality, to enter into and resolve the transference.
Freud is describing a frequent impediment. Bisexuality, he reminds his readers, is universal. So are fear and jealousy of the father. Freud singles out cases he considers difficult, such as women who are not naturally maternal. But it is hard to avoid the conclusion that finally every person is an incurable neurotic, trapped by biology that Freud calls “bedrock.” Treatment failures no longer disconfirm the analytic understanding of mind. The theory predicts a level of failure in every instance.
Freud is reasonably clear, in this late work, about what constitutes the good life. In healthy women, envy is transformed into femininity: “the appeased wish for a penis is destined to be converted into a wish for a baby and for a husband, who possesses a penis.” Successful development for men culminates in heterosexual fulfillment, with some degree of sublimation into creative work.
Analysis Terminable and Interminable is the most accurate of Freud’s works, in its acknowledgment that his methods have their limitations. There is poignancy in the arc of Freud’s writing, from the early reports of universal efficacy and the arguments for sexual fulfillment to the late admission of clinical failures and the conclusion that, in matters of gender and sex, conformity and a degree of sexual repression are for the best.