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No one who has any experience of the rifts which so often divide a family will, if he is an analyst, be surprised to find that the patient's closest relatives sometimes betray less interest in his recovering than in his remaining as he is. When, as so often, the neurosis is related to conflicts between members of a family, the healthy party will not hesitate long in choosing between his own interest and the sick party's recovery. (Freud 1916–1917, p. 459. S.E. 16.)
Experience with families enables us to add other possibilities to Freud's scenario. The so-called sick party may find himself duty-bound to protect the so-called healthy party and may continue to carry a psychic burden which properly belongs elsewhere. Alternatively, the so-called sick party may apparently throw off symptomatic behaviour or neurotic character traits while plunging other members of his family into divorce, illness or suicide. Such phenomena are, of course, now recognized by psychoanalysts, but the theoretical implications have not been well worked through.
If relationships are sought and family life is arranged so as to stabilize, rationalize and socialize intrapsychic states, then successful psychoanalytic treatment should lead to alterations in an analysand's intimate and social relations. If, however, the appropriate alterations are blocked, then, as Freud emphasized, psychoanalysis will fail, because the psychoanalyst will have 'undertaken something which … was unrealizable' (p. 459). What is to be done? Does the analyst follow Freud's own 'rule of not taking on a patient for treatment unless he was sui juris, not dependent on anyone else in the essential relations of his life?' (p. 460). Psychoanalysts have rarely adopted this position, which would, in any case, represent an artificial divide of a person from his environment. Such an artificial divide is made theoretically in the conceptualization of a 'psyche'. If the divide does not hold up in practice, if there is no such