A Most Dangerous Wish
The furor sanandi of Sándor Ferenczi
DANIEL ROSENGART
In Freud’s landmark essay “Observations on Transference-Love,” Freud introduces a new word to his ever-evolving lexicon. Neither highlighted nor defined within the essay, it does not seem to be a particularly important addition. Unlike most of the important terms Freud introduced—such as sublimation, transference, or projection—it does not come from another science. The term only appears once in this essay and never again, neither in Freud’s published writings nor in his letters. Nonetheless, once introduced, it was considered a key concept in Freudian theory, both clinical and metapsychological. The term is “neutrality.”
Neutrality, particularly in the American context, became a shorthand for a sort of psychoanalysis that many would recognize: treatment conducted through an abiding silence punctuated by omniscient interpretation. This clinically elaborated neutrality of the mid-twentieth century was the scientific armor behind which orthodox ego psychologists could stand and claim that the best treatment was one that paid no attention to objective suffering or life circumstances, and provided only interpretation or reflection, and never sympathy or care.
But before there could be the flat mirror of the ego psychologist, Freud had to offer his one and only usage of the word: “Besides, the experiment of letting oneself go a little way in tender feelings for the patient is not altogether without danger. Our control over ourselves is not so complete that we may not suddenly one day go further than we had intended. In my opinion, therefore, we ought not to give up the neutrality towards the patient, which we have acquired through keeping the counter-transference in check.”
In this passage, he takes “neutrality” to mean a slight modification of the more common term “abstinence,” which is an immensely important idea to Freud, and which appears countless times throughout his writing. The histories of the two, of “neutrality” and “abstinence,” are wrapped up together, though the former only becomes important later, for Freud’s descendants.
Despite there being no record in Freud’s writing, public or private, that he ever had any concept similar to the postwar version of “neutrality,” the term becomes a mark of Freudian-ness itself, a shibboleth that Freud would have utterly failed to recognize.
For Freud, neutrality is the emotional counterpart of the reality of the analyst remaining abstinent from involvement with the patient. The German word, Indifferenz, is more clearly rendered “indifference,” and the connection to abstinence is more obvious. If abstinence is the denial of a wish (here, for love or sex), then indifference is the analyst’s self-denial of the pleasure of falling in love with the patient (here, seemingly, because it might lead to a sexual boundary violation). In contrast to this original definition, the term came to mean, especially in the epoch of American ego psychology, a total blankness and emotional uninvolvement, a hiding or (more generously) concealing of the self of the analyst in all aspects of treatment.
It’s not unusual for a psychoanalytic term to change meanings. How we use today concepts like “transference,” “countertransference,” “hysteria,” and so on would be baffling to an analytic reader a hundred years ago. Yet, “neutrality” undergoes a particularly strange transformation, one that represses its own history and insists that there has been no change at all. Despite there being no record in Freud’s writing, public or private, that he ever had any concept similar to the postwar version of “neutrality,” the term becomes a mark of Freudian-ness itself, a shibboleth that Freud would have utterly failed to recognize.
All the signs point to a repression, a problem in the theory that has been papered over, desymbolized. The result is a hole in the theory where the problem once stood. Some archaeological detective work is needed to find the initial problem Freud was addressing, which he was unable to entirely figure out and that his successors felt the need to sweep aside. That problem is what Freud dismissively calls the furor sanandi: the passionate desire to cure. To get to the source of furor sanandi, what Freud was trying to do with the concept of neutrality, and why the wish to cure was understood as more dangerous than the wish to use patients for sex or monetary gain, we must follow two threads.
The first is the shifting path of the psychoanalytic cure: by 1915, when “Observations on Transference-Love” was written, it was not clear exactly what the psychoanalytic method of cure was, or what psychoanalysis would be without a defined and linear path toward cure. The second is the more famous problem of the connection between psychoanalytic treatment and both romantic and sexual love. Two of Freud’s most famous students had recently had affairs with patients, which Freud considered an existential threat to psychoanalysis as a movement, and after chiding his followers, rushed to cover up. Freud saw these two problems as linked and, to bring his wild students back into the fold, he appealed not to a cure that would be damaged by these violations but directly against the wish to cure itself.
When talking about the forbidden wishes of analysts, the immediate associations are to the anal and the Oedipal—put simply, the wish for money and the wish for sex. These wishes may be repressed on an individual basis, but they are not socially repressed wishes. Both appear all over the clinical literature. But another wish turned out to be much more frightening for Freud, and he made a concentrated attempt to discourage even thinking about it: the desire to cure.
*
In the beginning of the method, in the 1890s, there wasn’t much need for a passionate desire to cure. For one, the cure was quite remarkably simple. After all, poor Katharina up on the mountain, a waitress at an Alpine resort suffering from hysteria whom Freud met and informally treated while on vacation, was cured in the space of a single conversation; so Freud would tell us as early as 1893. And if Freud showed any interest in the concept of abstinence, it was only in terms of pathogenesis, not technique.
Freud talked about abstinence all the time in his early letters and writing, and it is central to his theory of neurosis from the first. He ascribed anxiety neurosis,[1] hysteria,[2] and even the heart palpitations and cravings he suffered when he briefly put down cigars to the harmful effects of abstinence. During this early phase, the term “abstinence” was only used to describe the development of disease; the method of cure was to reveal the trauma, and there was no emphasis on abstinence as a clinical tool. A young (late thirties) Freud could be quite openly on the side of the cure, without any risks to his method of cure, and openly partisan against the source of the neurosis. This method of cure—quite simple and apparently of unlimited potential in those early days —required little more than lifting repression to allow for libidinal energy to be expressed in some manner other than symptomatically.
When talking about the forbidden wishes of analysts, the immediate associations are to the anal and the Oedipal—put simply, the wish for money and the wish for sex.
Transference was the first clinical setback to this seemingly simple method, spurring the first clinical shift along the pathway to a cure: the creation and resolution of transference neurosis. This method remained largely the same as the original “chimney-sweeping” (talking freely and without self-censorship), but the meaning had changed, as had the focus of the interpretations. Now the process of free association was meant to arouse and frustrate the desires of the speaker, to cause illness within the consulting room. There is still clinical optimism here, though perhaps not as great as in those heady pre-transference days when a single consultation on a mountain resort could cure a hysteric. Transference neurosis was something like a live vaccine, and the curative method was clear and directly connected to the theoretical cause of illness. Still, this was bound to cause suffering in the patient, but it was a comparatively brief suffering and so clearly tied to the cure that the procedure of inducing the illness must have felt no worse than injecting an immunization. Accordingly, holding back a wish had become a central part of the method. The interpretation, until recently the agent of an almost-magical change, had to be held back—to temporarily make the patient even sicker.
The term “abstinence” here starts to be used as a reference to a clinical tool. This is the sense in which Freud uses the term in 1915, when he also introduces the term “neutrality” in his paper on “transference-love,” and which largely defines the clinical technique of the preceding decade. Abstinence creates transference neurosis, and the analysis of that neurosis is the bulk of the psychoanalytic method. At this point, there was little contradiction between the therapeutic and the analytic, and the painfully pathogenic aspects of abstinence were thought to be necessary and comparatively brief in relation to the cure they offered.
In his “Remembering, Repeating, and Working-Through” (1914), Freud outlines this history but then introduces, almost as a reluctant afterthought, a concept that undercuts both the optimism of the method and the very idea of a concrete, quantifiable method: “working-through.” “Working-through” is an acknowledgment of a clinical reality that must have become clear to Freud between the failure of the Dora case in 1900 and the 1910s: that something other than explaining the transference to the analysand was involved in the cure. The addition of this concept of working through may seem minor, a mere technical addition or a new expansion of the timeframe of treatment, but it also vitally moves psychoanalysis from a definitive method of cure, akin to medicine, into a fundamentally different sort of treatment.
For instance, in his retrospective analysis of why his treatment of Dora went so miserably, Freud pointed to his inattention to the transference: “I ought to have listened to the warning myself. . . . And when this transference had been cleared up, the analysis would have obtained access to new memories, dealing, probably, with actual events . . . [Instead] she acted out an essential part of her recollections and phantasies instead of reproducing it in the treatment.”
Here, Freud makes a clear equation: if the transference is addressed, it need not be acted out. Note the certainty that the analysis “would have obtained” the new material if only it had been conducted correctly. In contrast, by the time Freud was treating the Rat Man in 1907, his method shows a change that he doesn’t explicitly theorize. M. Guy Thompson, in a close reading of the Rat Man, argues that Freud’s tact at this moment breaks from what would later be called “neutrality”—such as by feeding the patient and not interpreting the transference in favor of maintaining unwavering support and kindness in response to the patient’s paranoia, which Thompson claims were all methodical on Freud’s part and not simply indulgences. “Freud’s principal goal . . . was to create optimal conditions for facilitating rapport in the treatment situation. . . . It was at this juncture—somewhere between 1909 (Freud’s [publication of the] analysis of the Rat Man) and 1911 (the first of his technical papers)—that the analyst’s behavior shifted from determining causation to instilling rapport.” This may be too strongly put, but the point is not wrong. Between 1900 (when he analyzed Dora) and 1907 (when he analyzed the Rat Man), Freud abandoned the clarity of a simple cure through elucidation of the transference.
But he did not theorize a replacement. Freud’s recommendation to analysts was to stay the course and remain assured that at some point the process of interpreting would hit home and effect change. Where previously the equation was abstinence creates transference neurosis and interpretation resolves transference neurosis, now abstinence was still required and its goal was the same, but the cure rested on the ill-defined and frankly tautological ability to find the moment “when the resistance [was] at its height.” In other words: it doesn’t work until it works, and then it works.
The method—abstinence, transference neurosis, interpretation—remained the “pure gold” of analysis, still generally unmixed with “the copper of direct suggestion.” Never again would the analytic cure look like a medical treatment. Now, the abatement or intensification of symptoms would be more fodder for transference interpretation, whose accuracy in turn could be judged only later, sometimes much later, and then only pragmatically (as Freud would much later point out himself, in his “Constructions in Analysis” [1937]). Not only had the curative limits of psycho-analysis started to become clear, but the epistemological status of interpretation had been shaken—and although it retained its centrality in the practice of psychoanalysis, it lost its status as the lynchpin of the theory of cure.
*
Thus, in 1915, Freud introduced the term “neutrality.” The paper “Observations on Transference- Love” described the virtues of abstinence in managing the romantic transference of female patients to male analysts, and argued against the alternatives of either encouraging or discouraging the transference. Arguing against the possibility of letting oneself fall for the patient, and having a romantic but sexually abstinent relationship, Freud countered that the analyst must maintain his “neutrality towards the patient, which [he] has acquired through keeping the counter-transference in check.” The meaning here was clear: neutrality is to affect what abstinence is to action. And it was necessitated because “our control over ourselves is not so complete that we may not suddenly one day go further than we had intended” [i.e., have sex with our patients]. Abstinence in action was not enough. The commandment came: we must be emotionally abstinent, too, neutral or indifferent. This was an admonition against encouraging patients’ sexual fantasies, but also directed at analysts, who must not let their own fantasies run wild. In contrast to its later expansion, neutrality had a limited scope here: desires, focused but not limited to sexual desires, were dangerous and needed to be managed just as thoroughly as actions.
“[O]ur control over ourselves is not so complete that we may not suddenly one day go further than we had intended.”
— Freud
Indifference is a stance necessitated by a changing clinical reality. When abstinence was the quick road to a full cure, even with all its uncomfortable pathogenic qualities, there was no need to create a crafted emotional stance in response to the difficulties of transference. A surgeon can mangle a patient’s body with little compunction, precisely because of their full faith (whether justified or not) in the correctness of their intervention. Pity the surgeon who worries that their slicing may not actually help. Freud, for his part, split the difference through his self-reflexive treatments: his self-reflectiveness probably would have made him a lousy surgeon, but he used his guilt over a failed surgery to help him develop his theory of wishing and dreams.
Freud might have at least partially abandoned abstinence when his theory of cure shifted. He might have moved away from a clinical stance that encouraged and heightened transference. He might even have allowed a little more psychotherapy, more Seelsorge (“pastoral work,” but literally “soul care”) into his method. Many of his disciples would pick exactly these years to do just that. Adler, Jung, and Sándor Ferenczi would all begin to split from Freud and, in different ways, propose more therapeutic methods. He might, too, have left a little more room for a curiosity and a not-knowing when it came to what effected change.
Nevertheless, Freud’s response to these possibilities was a resounding “no.” For instance, as he put it at a 1918 conference, “any analyst who out of the fullness of his heart, perhaps, and his readiness to help, extends to the patient all that one human being may hope to receive from another, commits the same economic error as that of which our non-analytic institutions for nervous patients are guilty. . . . In analytic treatment all such spoiling must be avoided. As far as his relations with the physician are concerned, the patient must be left with unfulfilled wishes in abundance. It is expedient to deny him precisely those satisfactions which he desires most intensely and expresses most importunately.”
There are many such reminders in Freud’s later work, all the way until his death. Freud was never shy about pointing to the limits of psychoanalysis. He constantly contrasted himself to unethical practitioners who promise more than they can deliver. And yet, on the subject of care, he is unmovable. Why? And why does his theory, or at least what he writes down, depart so radically from his practice, where he cared unambiguously and seemingly unambivalently about (some) patients? The answer is not theoretical but political.
In 1915, when he introduces the term “neutrality,” Freud is dealing with two potentially very embarrassing crises, both caused by the very not neutral treatments of two of his most prized students. Jung and his former patient Sabina Spielrein started what was probably a sexual relationship in roughly 1908 or 1909, while Jung was married, but his loyalty was to the movement, and he did his best to keep things quiet. Perhaps even more scandalously, Sándor Ferenczi began in 1909 analysis with a woman named Gizella Pálos, who had been his lover. Shortly into their analysis, they resumed their affair. Soon after, Gizella’s daughter, Elma Pálos, began analysis with Ferenczi. Ferenczi then began a short-lived affair and became engaged to Elma. Freud entered the fray, and, sometime later, the affair with Elma was over—and Ferenczi and Gizella’s relationship resumed; they eventually married in 1919. There are other examples of prominent boundary violations as well, and more accumulated with every passing year: Ernest Jones was accused of sexual impropriety in 1913, and later found to have paid the woman hush money; Otto Gross, before he was kicked out of the movement, was known to sleep with patients, and so on. While there was obviously no official code of conduct in these early days, Freud’s letters show the outrage he felt at each new potential scandal, and his acute sense that they posed a risk to the movement. There was no doubt a double standard, and some transgressions Freud tolerated or even condoned, but when they looked to embarrass or discredit psychoanalysis, he stepped in with the same fervor as when a student proposed a heterodox theory that might lead to wild analysis.
Freud did everything he could to avert these public relations disasters, in his public writings, in his private letters to both Jung and Ferenczi, and even in conversations with the patients involved. Freud wrote a letter to Gizella Pálos seeking to explain Ferenczi’s actions and to request her silence: “Now help us and spare yourself. You will certainly have conquered the loving woman [i.e., her love for Ferenczi] more easily, but you should also restrain the tender mother [to Elma]. You should be expected to accomplish this as well.”
The tone of the letter is clear: Freud is skeptical of the plan, but most important is that it is kept discreet. A number of letters between Freud and Ferenczi follow, with Freud often invoking Ferenczi’s neuroses and his Oedipal conflicts as excuses for his behavior, and urging him toward the less scandalous Gizella and away from Elma. And, of course, the body of the transference-love essay is devoted to precisely this: the temptations and clinical costs of too much love. Indifferenz is the recommended stance specifically for a male analyst toward his female patients: do not let yourself get too close to their feelings of romantic love—it mangles the treatment and leads to unmanageable desires.
And here is where the two historical threads converge. Indifferenz is also Freud’s implicit stance toward the management of the wish to cure. He uses the word only that one time in the essay, but he makes a remarkably similar argument in regard to the wish to cure. Later in the text, he outlines his position: “When all is said, human society has no more use for the furor sanandi [passion for curing] than for any other fanaticism.” He is allowing for other treatments to exist besides psychoanalysis (though with a lower status, and only for the easy cases), but he is also getting at a point.
The caution against the wish to cure, obliquely referred to in the countertransference love essay, is spelled out in his letters to both Jung and Ferenczi. He cautions against this desire to be helpful with no obfuscation in his private letters. To Jung: “To salve my conscience I often tell myself: Above all don’t try to cure, just learn and earn some money! These are the most useful conscious aims.” And to Ferenczi: “It seems to me that in influencing the sexual drives, we can bring about nothing more than exchanges, displacements; never renunciation, giving up, the resolution of a complex. (Strictest secret!).” In the same letter, he constructs an etiology of the wish to cure, and places it firmly in the realm of pathology:
The illumination of your medical tendencies in your dream was of great personal interest to me. This need to help is lacking in me, and I now see why, because I did not lose anyone whom I loved in my early years. I found this same personal motivation in Fliess. What is both strong and pathological in him comes from this. The conviction that his father, who died from erysipelas after many years of nasal suppuration, could have been saved made him into a doctor, indeed, even turned his attention to the nose. . . . This piece of analysis, unwanted by him, was the inner cause of our break, which he effected in such a pathological (paranoid) manner.
Freud’s own clinical work paints a different picture, of course. In retrospect, some of these departures seem like indulgences, like his habit of gossiping with patients. Yet even more significant are the moments that betray an unconscious, or at least unacknowledged, concept of what is curative. In these moments, he was directly emotionally engaged, claiming the transferences he preferred: correcting patients and passionately seeking a cure, even as it remained unclear to him at times what that cure would constitute; at other times, he would decide, without the patient’s input, what would constitute a cure and drive toward that. He was also supportive, often complimenting or empathizing with patients, although at times he would argue when he felt patients were resisting in some way.
Above all, Freud seemed to grant himself an exemption, a sovereignty—similar to his sovereign position of being the only analyst to not have been analyzed—to be permitted both the desire to cure (non-neutrality) and to act out that desire (non-abstinence). This could be missed entirely if one read only Freud’s own reports of his analyses, but depart from what he said about himself and turn to the recollections of some of his patients, and it is clear. Even with patients Freud did not particularly like, his wish to cure, including the free rein he gave this wish, is evident: from his overt empathy with Abram Kardiner to his passionate concern for H.D. (his banging on his chair in frustration when he felt she was suffering needlessly stands out) to his frustrated and occasionally ornery attempts to get John Dorsey to simply freely associate. It is well-known that Freud’s clinical method was nothing like what he prescribes in his technical papers. Nevertheless, too often people simply take him at his word when it comes to the difference between theory and practice. Nothing in his reports points to a lack of interest in effecting a cure, or a prioritization of research over therapy; instead, Freud seems much more interested in making his patients better than he allows for in his prescribed technique. He was more open, that is, to the therapeutic.
For everyone else, especially his disciples who had slept with their patients, the desire to cure was strongly discouraged, because it was felt to be too close to the sexual urge and its enactment. But, for this admonishment, repression was required. Freud could neither advertise his exempt status, nor, seemingly, acknowledge its importance to him. The desire to cure was tied with a technique that was designed to recreate the patient’s illness in relation to the analyst, and the results were tied to the maintenance of abstinence. This abstinent position was perhaps unpleasant at moments, yet there was a pull toward something more helpful. One wonders, then, whether the desire to cure had to be repressed; perhaps it needed to be simply deferred. In any case, in the clinical picture that began to emerge in the 1910s, these practical connections between technique and wish began to fray. A full acknowledgment of the ambiguity of the cure, one imagines, would have opened the door to enactments of care that Freud clearly feared.
Freud wanted to help his patients, but when his theory no longer pointed to abstinence as the absolute sine qua non of helpfulness, he faced an impossible choice: either jettison the only theory that could stop analysts from sleeping with their patients or hold on to a theory that no longer pointed so directly at the cure as it once had (and that might even have seemed cruel to him at moments). Accordingly, the concept of abstinence became uncoupled from its history, a “desymbolization” as psychoanalyst Alfred Lorenzer would have it, in which abstinence of action and abstinence of feeling became understood as curative in and of themselves. Having been disconnected from practice, theory would eventually regroup and reintegrate this development under the banner of neutrality, often in ways that would have been incomprehensible to Freud. Ultimately, the through line was broken, and neutrality, as a clinical positive, became a fundamentally different theoretical concept from its ancestor, abstinence.
*
If “neutrality” originally stood as an affective bulwark against a wish to cure that was felt to be too dangerously close to love, later development of the term erased the tension. While Freud leaves the word “neutrality” aside after its one use, and “abstinence” becomes less prominent in his writing as well, “neutrality” did anything but fade after Freud’s death. Neutrality carries none of abstinence’s associations to the state that created the illness (sexual repression), nor to the original clinical meaning of recreating the circumstances of the illness, so it became a useful term with varied meanings for later analysts. For ego psychologists, it eventually stands in for the analytic stance that creates a transference neurosis, though the sense of “indifference,” so clear in Freud’s original German, is lost here. For others “neutrality” comes to mean precisely the opposite of the original abstinence, a stance that is by itself curative for the patient.
Neutrality stands at the site of a wound to analytic practice—the moment when the certainty of a cure, and of a concrete definition of the cure, was lost.
Coming from different traditions, and in different ways, these formulations are all brilliant and useful. But in their generative misreadings of Freud, and in the confusion they entail, the original problem is lost or evaded. Neutrality becomes completely detached from its reference, by which abstinence is still associated with sickness and neutrality turns into healing on a separate axis from transference and, in the stronger formulations, a part of the cure. There is no through line between then and now. Instead, there is only a concept, however useful, lost in time and only partially available to thinking.
In his clinical diary, Ferenczi writes: “Occasionally one gets the impression that a part of what we call the transference situation is actually not a spontaneous manifestation of feelings in the patient, but is created by the analytically produced situation, that is, artificially created by the analytic technique . . . This appears to be an all too literal repetition of the child-parent relationship.” How well Ferenczi understands Freud! (Perhaps better than Freud understands himself at this moment.) Ferenczi sees the hole in the theory. Without the old theory of cure, he sees the senselessness of causing the suffering one seeks to alleviate. One might argue that the difference between Ferenczi’s and Freud’s conceptions of transference lies in Freud’s belief that the transference is always a re-creation, while Ferenczi sees it as seductive and even traumatogenic regardless of history, but the fact that the suffering is no longer definitively curative remains. The neurotic in treatment suffers from the treatment regardless, and more importantly, neither theory can offer a full justification for the torment. Ferenczi, delivering a milder version of this critique in 1932, would lose his reputation for decades as a result.
Neutrality stands at the site of a wound to analytic practice—the moment when the certainty of a cure, and of a concrete definition of the cure, was lost. Yet new possibilities abound. Acknowledging the loss of what analytic healing once was, we can perhaps start to shake loose that concept, and goodness knows what falls out of that. That is not to say that Freud’s original notion of care was the only thing that stood between the wish to cure and major boundary violations. Clearly that is not the case. But Freud was wrestling with a problem he could not solve. By reopening the history of that problem, over a century later, we can see what can be done with these questions. The wish to cure is dangerous, not simply because of Freud’s worry about sexual boundary violations, which are now at least fairly well managed with legal and professional consequences. This wish is dangerous because it creates turmoil within the analyst, who honestly ac-knowledges that our field has had no concrete and definite concept of cure for over a century. Neither rigid orthodoxy nor wild heterodoxy, fetishization of boundaries, or reckless acting out will obviate the need to truly and terrifyingly not know if and how we can help each new patient who passes through our doors.
[1] See, e.g.: “The anxiety neurosis, too, has a sexual origin as far as I can see, but it does not attach itself to ideas taken from sexual life; properly speaking, it has no psychical mechanism. Its specific cause is the accumulation of sexual tension, produced by abstinence or by unconsummated sexual excitation (using the term as a general formula for the effects of coitus reservatus, of relative impotence in the husband, of excitation without satisfaction in engaged couples, of enforced abstinence, etc.).”
[2] See, e.g.: “Hysterical symptoms hardly ever appear so long as children are masturbating, but only afterwards, when a period of abstinence has set in.”