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Most people think of psychoanalysis, as Freud did, as a method of treatment for a complaint. The complaint was regarded as similar to a physical ailment which, when you know what it is, has to be treated in accordance with the rules of medicine. The parallel with medicine was, and still is, useful. But as psychoanalysis has grown, so it has been seen to differ from physical medicine until the gap between them has passed from the obvious to the unbridgeable. For most purposes the similarity yields illuminating comparisons and models that facilitate discussion. But the more we see of psychoanalysis the more the models become inadequate to define, report, or apply psychoanalysis. Differentiation has meant that models which were illuminating have become opaque and often misleading even to psychoanalysts. Let us see why. We may start by discussing the obvious and simple reasons, though they will not remain either for long.
In physical medicine the patient may have a pain in his chest for which he can go to his doctor. To him he can explain its nature and its history and from him he can receive instructions to undergo further examination, say, by X-rays or microscopy, or certain forms of treatment. Or so it appears; later we may have reason to question this account. For the present it will serve to point the divergence of physical medicine and psychoanalysis.
Suppose the patient complained not of physical but of mental pain; no one doubts the existence of anxiety or sees any incongruity in seeking help to cure it. We find it necessary to differentiate between the pain of a broken leg and the pain, say, of bereavement; sometimes we prefer not to, but exchange mental for physical pain and vice versa. Physician and psychoanalyst are alike in considering that the disease should be recognized by the physician; in psychoanalysis
recognition must be by the sufferer too. The physician considers recognition of the pain subordinate to its cure; the psychoanalyst's view is expresse