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Today's discussion of the silent patient returns to a topic which has engaged analysts' attention repeatedly in the past. Both in 1927 and 1935, it was discussed in the Vienna Psychoanalytic Society, and the Hungarian Society considered the subject in 1934. Since we do not yet have a fully formulated understanding of this problem, nor very specific principles for the management of such cases, it is appropriate that we survey again a familiar terrain. This paper will review the literature and then offer some clinical experiences with silent patients.
In reporting on previous analytic research on this topic, no effort will be made fully to present the ideas of the authors selected. Rather it is proposed to excerpt certain highlights of the principal contributions in order to reflect how analytic thinking on the silent patient has broadened and to convey some impression of the multiple angles from which the subject has been considered.
One has only to advert to the essential role of speech in psychoanalytic therapy, to imagine that interruptions in this process would early engage attention. Ferenczi (5) in 1911 first wrote how the fear of uttering obscene words produced prolonged silence, while Freud (11) in 1912 identified transference difficulties as a cause of a breakdown of associations. In 1913, Ferenczi (6) discussed patients for whom there appears to be an equation of speech with action with an inevitable inhibiting consequence on verbalization. Freud (12) next widened his original observation