A Metapsychological Description of the Process of Cure1

The object of the present paper is to describe in metapsychological terms the alteration in the mental systems which we seek to effect by means of psycho-analytical treatment. The change in question is the result of a process whereby an original condition of psycho-neurosis is terminated by recovery of health. Before going further, however, some orientation of a general kind is necessary. Throughout this metapsychological analysis of the ego-changes aimed at during treatment, I am guided by Freud's topographical-dynamic doctrine concerning the structure of the mental apparatus, which doctrine I regard as the ultimate result of our collective clinical experience. In attempting to refer these conclusions once more to their empirical substratum, I propose to retrace the difficult path traversed by the founder of this theory during its gradual formulation. In speaking of changes during treatment, I imply of course treatment in accordance with the technique as laid down by Freud himself; as opportunity occurs I shall examine from the metapsychological point of view recent suggestions and advances in technique.

Taking as a starting-point for our investigation the neurotic state as observed at the beginning of treatment, let us see if we can find a general formula which will be valid for all neuroses. We select this starting-point not because it comes first chronologically, but because experience shows that it is easier to understand the normal from a study of pathological states than vice-versâ. Disease supplies a dynamic motive power for research; accurate understanding is a prerequisite of successful treatment. Pre-analytic psychology was really a hobby or pastime; it lacked the dynamic factor which has aided us in our deeper investigations, namely, the ultimate aim of effecting cure of disease. It was only the pressure of necessity encountered in pursuing this aim that enabled the investigator of the mind to overcome the obstacle of those states of resistance w