Discussion

Dr. Siirala's paper seems to me to offer a very specific sort of challenge to those of us who may feel too complacent about our understanding of the labyrinthine puzzles presented to us when we are required to trace our patients’ symptoms to their hidden sources. Essentially, it would appear that Dr. Siirala is making the plea of a devout believer who, under the terms of his religious convictions, must see himself as the sinner and the sick one, and his patient both as a fellow sinner and as one who comes to the physician out of desperation, prepared to challenge the physician's claim that he can undo the evils suffered as the consequence of his involuntary exposure to an unfamiliar and hostile environment. The central theme of his paper, it seems to me, is the hypothesis that he has to cross the Styx with his patient, realizing the while that though the patient never knows it he holds a commutation ticket for the return journey.

It must seem obvious to any thoughtful and experienced person that no form of psychotherapy holds the precise answer for everyone. We are all familiar with the partisanship shown in our analytic societies for one approach or another, and the hostility and contempt expressed for the viewpoints of some other group, yet each and every member of each and every group calls himself and considers himself a qualified psychoanalyst. It is, however, quite another story when members of two psychoanalytic groups holding divergent views get together to discuss an actual case. Under these circumstances they usually are able to agree on the fundamental dynamics involved and on the points which still seem to be obscure. What does this mean? Do the analysts gang up on the patient, so to speak? Must they always be the ones in the know, while the poor patient is the outsider who, at least, has been wise enough to come to the source of all wisdom to hear what the oracle has to say?

Dr. Siirala says no. He exhibits in his enthusiastic protocol the humility of the