Chapter 7 Envy and the Negative Therapeutic Reaction

In a well-known passage, Freud writes:

There are certain people who behave in a quite peculiar fashion during the work of analysis. When one speaks hopefully to them or expresses satisfaction with the progress of the treatment, they show signs of discontent and their condition invariably worsens. One begins by regarding this as defiance and as an attempt to prove their superiority to the physician, but later one comes to take a deeper and juster view … They exhibit what is known as a ‘negative therapeutic reaction’.

Freud argued that we were dealing in these cases with an unconscious sense of guilt, ‘which is finding its satisfaction in the illness and refuses to give up the punishment of suffering’ (1923a: 49).

Freud goes on, in an interesting passage, to refer to the situation in which the sense of guilt is the product of an identification with someone who was once the object of an erotic cathexis.

A sense of guilt that has been adopted in this way is often the sole remaining trace of the abandoned love-relation and not at all easy to recognise as such. (The likeness between this process and what happens in melancholia is unmistakable).

Here, Freud is clearly referring to what we would now term guilt in relation to a damaged internal object.

While in Freud’s terminology it is the unconscious sense of guilt,

‘which is finding its satisfaction in the illness and refuses to give up the punishment of suffering’, in the clinical material I will give later in this chapter, one can see the extent to which it is the patient who is ‘finding satisfaction in the illness’, and being attached to an object relation that involves the punishment of suffering. I am suggesting that in the patient I will describe, the pain evoked by the (unconscious) experience of envy gives rise to a withholding and tormenting relationship with his object, which manifests itself as a form of negative therapeutic reaction.

Joan Riviere, in her 1936 paper, elaborates w