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(Accepted for publication 10 May 2014)
With this fine, sophisticated, intellectually challenging and elegantly written article, Pontalis brings to our attention some of the issues that have both theoretically and clinically occupied a central place in analytic thinking and practice - and still do.
Pontalis first traces the development of the concept of ‘negative therapeutic reaction’ (NTR) in Freud, making some important points. He addresses Freud's notion of the NTR as a “force” that is “defending itself by every possible means against recovery and which is absolutely resolved to hold on to illness and suffering” (Freud, 1937, p. 242). His point is that Freud talks about NTR as if it was a war, using a military metaphor that appears to allude to an admission of defeat.
Pontalis then presents us with a brief survey, where he looks at the ‘arms’ and instruments used by psychoanalysis to understand and tame this force that he defines, and which can be summarized as: (1) the libidinal satisfaction found in the symptom involving the primary and secondary gains of the disease, which Pontalis describes as the ‘secret jousissance’ behind the symptom or the bonus of pleasure that accompanies it, as well as the suspicion brought by a possible ‘flight into health'; (2) Freud's development of the second topography (structural model), with the notions of the sense of guilt ('unpleasure for the ego, gratification for the superego'). An important point Pontalis notes is Freud's claim that the sense of guilt can be unconscious, “dumb” (Freud, 1923, pp. 49-50). He describes Freud's economic perspective regarding the issues surrounding masochism and the patient's need to maintain a certain “amount of suffering”, a need for punishment that was “inscribed in the register of the drives” and connected to the death drive in Beyond the Pleasure Principle (Freud, 1920); in this work, Freud places the emphasis on repetition and the death drive, what Pontalis calls “an agony principle of jouiss