Evaluation of the Results of Psycho-Analytic Treatment1

In order to evaluate any therapeutic method, it is necessary to compare it with other methods. But I know only one psychotherapeutic method, and that is psycho-analysis. Being thus deprived of the opportunity to compare, I should perhaps stop here. However, having consented to participate in this symposium, I had to find some kind of approach to this problem. It occurred to me that the only possible way to ascertain the value of changes brought about by psycho-analytic treatment is to scrutinize these changes in the framework of Freud's concepts. (I shall refrain here from referring to the many contributions by other psycho-analysts to this subject.)

In order to do so, one should first examine the problems of mental health and illness.

As to the first problem, we can be brief, because no one has been successful as yet in giving a clear-cut picture of the mentally healthy person. Whether a man is considered healthy or ill depends to a great extent on the milieu in which he is living. What, for example, would be considered as a heavenly revelation in a certain religious community, might be regarded as mental disorder in another community. When as a very young psychiatrist I discussed with my colleagues the problem of mental health or illness, we finally arrived at the conclusion that mental health ends at the gates of the mental hospital. Although definitions of mental health or illness are more refined nowadays, they are nevertheless no more precise.

How confusing mental illness may sometimes be for the observer may be illustrated by the following true story: A famous psychiatrist said after the examination of an insane man who had made an assault on the life of the Emperor William II, that at the end he did not know whether he was insane or the patient was. Not infrequently similar ideas enter our mind when we talk with our patients. Sometimes a patient seems so disturbed that we are reluctant to accept him for treatment. But if nevertheless we have taken