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In these days of steadily increasing emphasis on the promotion of positive mental health, dissatisfaction has been expressed with “a primary focus on sick behavior.”1 There has been a diagnosis made of a kind of professional neurosis in many psychiatrists and psychoanalysts which causes them to fix their attention upon the morbid and pathological and to disregard or underestimate the health potential, the constructive aspect of the patient.
I do not believe that this misorientation is due primarily to characteristics of the individual therapist. Occasionally, pride in a so-called scientific approach, is hidden fear of a full relationship with the patient, or as Otto Rank saw it, scorn for the neurotic in whom the therapist unconsciously sees his own destructive self, may lead to an emphasis on the sick in the patient. However, the deeper root of this phenomenon which results in an iatrogenic interference with effective therapy lies in the early history of psychoanalysis itself.
When psychoanalysis was born, pathology experienced its triumph in the whole field of medicine, and analysis provided new knowledge in physics and chemistry. Freud's image of man homo homini lupus was based on Hobbes and Darwin, but on an incomplete understanding of Darwin who described in animals evidence not only of destructive aggression but also of constructive cooperation. This was emphasized by Kropotkin and Julian Huxley. Freud's “unconscious” harbored only libido and destructive aggression.
Psychoanalysis, in the main, became an “analytical,” debunking and dissecting procedure. Insufficient distinction was made between unhealthy and healthy feelings, sadistic aggression and healthy self-assertion, morbid dependency and healthy love. Affection, friendship and love were misdiagnosed as aim-inhibited instinctual drives, moral values as a reaction formation against incestuous impulses. Thus, pathology often was considered primary and basic, health secondary and difficult to achieve.
The lack