Psycho-Analysis and the Concept of Health

Perhaps it would be true to say that we attach less importance in analytical circles to differentiating between healthy and pathological behaviour than is often done outside those circles. But the concepts of 'health' and 'illness' always exert a 'latent' influence, so to say, on our analytical habits of thought and it cannot but serve a useful purpose to clarify the implications of these terms. Moreover, it would be a mistake to suppose that the subject possesses no more than a theoretical interest, that it lacks any practical significance. For, when all is said and done, it often depends upon the analytical concept of health whether we recommend a course of analytical treatment—so that the matter is important as a factor in our judgement of the indications present—or what changes we should like to see effected in a patient, or when we may consider that an analysis is ripe for termination. Differences of outlook in this sphere must ultimately lead to corresponding differences in our therapeutic technique, as was clearly foreseen by Ernest Jones1 many years ago.

While psycho-analysis was still in its infancy, it seemed a relatively simple matter to define mental health and mental illness. At that period we became acquainted for the first time with the conflicts which give rise to neuroses and believed that we had thereby acquired the right to differentiate between health and illness. Subsequently the discovery was made that conflicts such as those we had come to regard as pathogenic could be shown to exist also in healthy people, it became apparent that the choice between health and illness was determined rather by temporal and quantitative factors. To a greater extent than any theoretical considerations our therapeutic experience has compelled us to recognize this truth. It has been found that our efforts have met with very variable success and we are not always able to accept the familiar explanations of the responsibility for this state of affairs. We are