Unconscious Insight: Some of its Manifestations1

From our studies of the neuroses and psychoses we know that the neurotic symptom represents a sort of solution of an insoluble problem, and that the whole process of untanglement took place in the unconscious. For a long time the patient struggles with his conscious difficulties. There is seemingly no way out of these until unconsciously the compromise forms which results in the symptom. The patient then is neurotic or ill. He is more or less incapacitated, but he gains something thereby, even if it be a morbid gain. If we study the case after the neurosis has existed for many years, we are struck by the ingenious elaboration of the whole structure. Everything seems to dovetail, the façade looks massive and the machinery works perfectly. The patient is so well adjusted, or rather maladjusted, to it that at best it is hard to change him, and often very little can be done, not-withstanding his apparent willingness. This state of affairs is still worse in the psychoses wherein the patient loses all association with reality and lives in a world of his own. He is in a dereistic state2 and, as a rule, inaccessible to treatment. But even here, when we get an occasional glimpse behind the scenes, we find the same mechanism as in a neurosis, albeit more complex in elaboration and more resistive to any approach. Both the neuroses and psychoses may be designated as fortresses erected to protect the patient from pain or displeasure. For 'the dominating tendency of psychic life, perhaps of nerve life in general', as Freud words it, 'is the striving for reduction, keeping at a constant level, or for a removal of the inner stimulus of tension (the Nirvana principle of Barbara Low) as it manifests itself in the pleasure principle'.3 When the individual finds himself blocked in his struggle with the outer world so that he cannot keep up, an unconscious adjustment takes place in one way or another so as to enable him to live with