Excerpts from Must Read Books & Articles on
Mental Health Topics
Articles- Part XIX
Children of Different Ordinal Positions
George Edington & Bradford Wilson
Most clinicians recognize the relevance of being a firstborn or only
child. Unfortunately, the significance of other ordinal positions
in child development continues to be ignored. Examining birth order
(as it is often called) offers the clinician a wide field for observation,
for theory building, and for research. One's birth order makes for
enduring attitudes about one's place in the scheme of things. Just
as the mother and father are the first woman and man that the child
knows, siblings are the child's first experience of competition, cooperation,
mutual dependence, and mutual defiance of authority. The child's rivalrous
tendencies can be modified by his recognition of siblings as a source
of affection and support.
A proliferation of research into ordinal
position over the past decade has been confined mainly to comparisons
of "firstborn" versus "later-born" populations.
Results are often ambiguous since "firstborn" constitutes
a homogeneous, easily defined group, whereas "later-born"
may refer to anything from the younger member in a twosibling family
to any child in a series of eight. The reader is referred to Sutton-Smith
and Rosenberg's superb review and evaluation of this formidable body
of data." They conclude that research findings on the younger
of two brothers and the younger of two sisters are the most consistent.
The few clinical studies in this area are represented by the pioneering
work of Koch, Toman and a handful of others.
The present authors have long collected
data from clinical practice, comparing them with data from others
in the field. We believe that most patients can be better understood
if their ordinal position and its various ramifications are given
appropriate weight within their clinical profile. Twinship is the
only major sibling constellation not included in this study since
its complexity and scope do not lend themselves to abbreviation.
Koch devised a simple code to designate
children in two-sibling configurations. The first letter of the code
indicates the sex of the sibling in question; the number indicates
whether the child is first- or second-born; and the second letter
indicates the sex of the other siblings. Thus:
Firstborn girl with a younger sister.
Second-born girl with an older sister.
Firstborn girl with a younger brother.
Second-born girl with an older brother.
Firstborn boy with a younger sister.
Second-born boy with an older sister.
Firstborn boy with a younger brother.
Second-born boy with an older brother.
Only children are commonly referred
to as singletons. By extention, Koch's code can be used for other
configurations. A firstborn may be designated as F-1 or M-1 without
reference to other siblings. In larger constellations, however, the
code would become unwieldly; the present authors have not attempted
to use it for other than the above categories.
The dynamics of two-sib combinations
are often sufficient to explain behavior within larger sibling constellations.
Thus, let us consider a patient who is the younger of two boys born
three years apart. This pair was followed eight years later by two
other siblings. In such an instance, the major dynamic constellation
is more likely to be that of "younger of two brothers" (M-2-M
in Koch's terminology) rather than "second-born of four."
The rule of thumb here is that an age-gap of six or more years demarcates
a new sibship.
The observations noted here are based
partly (although not entirely) on adult clinical populations, although
most research on birth order comes from nonclinical groups (such as
Koch's work with six-year-old school children). Our overall data constitutes
an amalgam of observations drawn from a number of sources in addition
to our own.
Firstborn: Only Child
Note that "firstborn oldest" and "firstborn only"
child (or singleton) are distinct categories-but with much in common.
The only child is often born of a mother who had difficulty conceiving,
or could not afford more than one child, or did not want any children,
but "got caught." The parents of these children are frequently
older than those of most firstborns (often being aged thirty and beyond)
at the time of the child's birth, so that the usual give-and-take
between young parents and their children may well be lacking.
During an only child's formative years,
sibling rivalry in the usual sense rarely exists unless the nurturant
household includes cousins or other contemporaries. This child is,
however, confronted with formidable competition in the persons of
the parents. Each of them is experienced as a rival for the other
parent's attention and affection. In such a situation the child feels
outclassed and outweighed by giants. If by chance the child is left
alone to be raised with one parent, there may be no competition at
all. But the guilt engendered by an unconscious "triumph"
over the absent parent (and undiluted by sharing with siblings) can
Only children have a difficult time
learning how to compete and how to share. Characteristically, they
remain diplomatically aloof from both modalities: partnerships present
extraordinary problems for them, and in emotionally competitive situations
they abdicate, covertly manipulate, or else show ill-concealed vindictiveness
and overdomination. We find the adult singleton to be the most intensely
jealous of all ordinal positions and the most prone to act it out.
Never having had to share parental praise
with other siblings, such individuals are inclined toward narcissism
and egocentricity. On the other hand, not having others with whom
to share blame renders them both perfectionistic and highly vulnerable
to criticism. Extremely orderly and tidy in their habits, their living
and work areas are usually immaculate and well-organized, with chores
done punctually and conscientiously. As Sutton-Smith and Rosenberg"
observe, this group is chiefly responsible for the traditional view
that "the early born are especially eminent."
Having only one child to center their
concern upon-a single link with posterity-the parents of singletons
are, quite often, unintentionally overintrusive, and this is especially
true of the longawaited child of older parents. Arriving as many as
ten or fifteen years late (possibly after one or more miscarriages),
this particular singleton is most likely of all ordinal positions
to be "killed with kindness"--i.e., parental smothering
Sutton-Smith and Rosenberg" observe
that mothers seem to favor the only boys more than the only girls,
and they describe the boys as more "feminine" and the girls
more "masculine" than their peers, adding that this leads
to "a greater tendency toward sex deviations consonant with these
tendencies." They note that as adults the only girls are more
aggressive and less anxious than the only boys. Unless raised to be
pathologically dependent on one or both parents, these girls are apt
to develop self-sufficiency at a very early age and to delight in
acquiring new and varied skills throughout life.
Another special category of singleton
is the youngest child who is separated from older siblings by ten
years or more, and thus grows up, as it were, with several "parents."
If the siblings are adolescent, they may abhor the newborn infant
for giving public evidence of parental fornication.
These difficulties are further compounded when the child arrives as
an unwelcome surprise to parents unprepared for late-in-life offspring.
Such a child is apt to develop depressed and confused responses to
the mixed messages arriving from the environment. He may develop a
life-style dedicated to pleasing everyone and not being a burden or
a disgrace. These children early learn to keep thoughts and feelings
to themselves and to avoid taking sides. While presenting a friendly
and socially outgoing facade, they are inwardly quite withdrawn.
Because all firstborns are privy to
"adult" information, singletons are almost invariably more
comfortable with adults or much older children than with peers. They
also display an exaggerated sense of responsibility and a well-developed,
premature self-sufficiency. At the same time, they may feel needlessly
isolated and lonely. We believe that frequent overnight (or longer)
visits between the only child and contemporaries can help to remedy
the disadvantages of this ordinal position.
Firstborn: The Oldest Child
What was said about the singleton can also hold true for the oldest
child. A singleton's birth can result from parental efforts to "prove"
sex-role adequacy, "cement" a failing marriage, etc. The
oldest child, on the other hand, is most often born at a time when
parental attraction and compatibility are at their height. Whatever
problems bedevil inexperienced parents, their firstborn receives considerable
and lifelong attention. His or her status as the family prince or
princess entails assets which are legendary: primogeniture (real or
implicit), parental support in every endeavor, inclusion in adult
counsels, respect (often grudging) from sibs, and a continuing sense
of intrinsic worthwhileness. In a poor family where "hand-me-downs"
are worn, the oldest child gets the most new clothes. The larger the
age gap between the oldest and the nextin-line, the more singleton
characteristics will predominate.
The liabilities, however, are considerable,
and poignant. Oldest children are the frightened pioneer offspring
of novice and anxious parents. Proud of their rove as strawbosses
and parental message bearers, they pay a price in overseriousness.
Dignified and sober, they are under a tacit injunction to "grow
up"--"you're older, you ought to know better" is never
said to the youngest child.
These children usually grow up feeling that ethers depend on them
and they mustn't betray that trust. This is particularly true of a
firstborn girl in a large family, who functions as surrogate mother
for her younger sibs. In poor or motherless families she is likely
to become the housewife, cook, and keeper-of-accounts as well. With
or without siblings, she seems to grow up with a single motto-"it's
all up to me"-and she devotes her life to setting the world straight,
never doubting that she alone knows what ails it.
In large families (especially in poor
neighborhoods) the oldest boy may assume the role of family protector,
obliged to defend his siblings even against heavy odds. He grows up
serious and filled with a sense of responsibility toward others.
Koch finds firstborns in general to
be especiially high in curiosity, planfulness, competitiveness, and
most self-confident in academics. She notes, surprisingly enough,
that firstborn male children show the highest verbal skills of any
ordinal position--even firstborn girls. This may be due, she hypothesizes,
to the fact that "they are very active and get around more on
their own." and that mothers show firstborn boys special devotion.
The resulting extra verbal stimulation then leads to accelerated language
development. In adulthood we find them relatively lacking in originality,
and their creativity tends toward synthesizing the traditional. Konig
points out that firstborns are par excellence the defenders of tradition,
laws, and the continuity of customs.
As regards this conforming tendency,
Smith and Goodchilds find that they rank relatively low on self-confidence
and in creative problem solving, where they function better when supported
by membership in groups. Social anxiety and ambivalence seem to be
lifelong characteristics of this ordinal position.
Above all, these firstborn oldest children
need to have areas in which they are free to be a child. Otherwise
they grow up robbed of a certain playfulness permitted to others.
For them, life is all too apt to be "real and earnest" at
the expense of the carefree romping of later-horn children. As for
their exaggerated strivings for primacy, Forer suggests that they
need to learn how to avoid biting off more than they can chew, and
adds that this holds particularly true for oldest girls.
The Middle Child
Alfred Adler first pointed to the middle child's difficulties, especially
in a three-sibling family. With neither the status of the oldest child,
nor the maternal deference of the youngest, he or she can feel left
out. Not every middle child, however, fits this pattern, and it cannot
be laid down as a general rule.
In a multi-sib family, any one of the
children may feel left out and feel like a fifth wheel in an already
completed family (such as the "traditional" father, mother,
son, and daughter). Any child resulting from an unwanted pregnancy
may be made to feel superfluous to family happiness. However, we discuss
these phenomena under the rubric of the "middle child" because
it is the middle child who most often responds in these ways to these
Siblings have a way of staking out territories
with firm, tacitly agreed-upon boundaries. Thus one child may become
"the musician," another "the athlete," and so
forth; or, pejoratively, "the black sheep," "the dumbell,"
etc. While two or more siblings may share a talent or interest in
common, characterological roles tend to be more exclusive-only one
child gets dubbed "the trustworthy one," another "the
Such sobriquets tend to be polar and
to cluster at either end of a sibling array. The middle child, often
passed over, feels left out. For example, if the oldest child is the
conformist and the youngest the rebel, the middle child, sizing up
the liabilities inherent in both roles, can refuse to play the game
altogether. And if this child reaches similar conclusions about other
domestic interactions, he or she may end up feeling superfluous, devoid
of any meaningful family role.
Caught in such a dilemma, the middle
child often abandons the family arena and turns to peers for affirmation,
preferring to "run with the pack" at school or in the larger
world while being enigmatic and "out of it" at home. For
these children what the "gang" thinks takes priority long
before the usual preteen and adolescent phases when greater peer-group
concerns normally develop.
Like the singleton, he or she early
acquires self-sufficiency and independence from family ties, but with
sophisticated peer-group skills which the former usually lack. A liability
of this birth order, however, can be a lifelong feeling that the doors
of intimate trust and confidentiality are pretty much closed; the
middle child knows and understands many other people but feels truly
known and/or understood by very few. In our opinion, much needless
isolation and loneliness can be forestalled by helping the middle
child to carve out a valid and significant niche within the family
at as early an age as possible.
The Youngest Child
Considered the most pampered, this "baby of the family"
is heir to many hidden liabilities. While the firstborn oldest child
must by definition suffer "replacement" by younger siblings
who make successive claims for parental attention, the youngest child
comes into a world where everybody else "was there first"
and seems to have been born knowing how to tie shoelaces and a host
of other prestigeous, praiseworthy skills. More often than not, older
sibs show off their skills at the younger's expense, thus confirming
the latter's fantasy that "the big people" never had to
learn all the things at which this child feels so woefully inept.
As a result, youngest children see two
options: either to become adept at getting other people to do things
for them, at the expense of developing a number of independent skills,
or to become a dedicated "do-it-yourselfer" who refuses
to be taught by anyone and feels compelled to "invent the wheel."
Hobbies, and even vocational skills, are often learned in secret,
by privately experimenting and covertly reading textbooks.
Although often retaining carefree attitudes
toward the more "serious" aspects of existence, the youngest
child may nevertheless carry a perpetual sense of unimportance and
"failure"; the world always seems to say "not yet;
there is still one more hurdle." Whereas the oldest child is
usually acclaimed for everything from teething to being awarded a
Ph.D., the youngest child's identical landmarks are apt to be "old
hat" when his turn comes around.
Ambivalent about yearned-for acceptance,
the youngest child may abandon projects in midstream, unconsciously
fearing retaliation by the "big people" for daring to aspire
to their rank, or by other "little people" for betraying
their camaraderie as outcasts and no-accounts. Or "big people"
may be courted in order to counterreject them--the youngest often
abandons his membership in clubs, professional organizations, and
other groups without warning or without apparent reason.
The youngest nevertheless has a lifelong yen to make a contribution,
to be needed and listened to. Forer finds that youngest children are
particularly vulnerable to the loss of a parent in early childhood,
and populations of hospitalized schizophrenics and alcoholics show
a significant preponderance of this group.
Finally, an unfortunate but inescapable
fact about the youngest child is that, of all ordinal positions, he
is the most likely to have been sired by a man other than the mother's
legitimate spouse. In such cases, the presence of guilt. resentment,
overprotectiveness, or rejection, etc., on the part of one or both
parents (not to mention siblings who are quick to respond to parental
cues) exerts a profound influence upon the subsequent development
of this child. In any event, the question needs to be asked: "Why
was this child the last?" Just as the firstborn is usually a
"love child," the last born is often an "accident,"
or a last-ditch effort to preserve parental eroticism, or (in poor
families) "another mouth to feed"; "the last straw,"
or whatever. Much of the proverbial "spoiling" of this child
may represent a compassionate reaction formation to parental consternation.
In child rearing it is important for the youngest child that genuine
accomplishments receive the same parental affirmation as those of
elder siblings: otherwise adulthood is likely to remain a mirage -always
beckoning and forever out of reach,
Older of Two Boys (M-1-M )
This particular firstborn is prone to acquire the role of "heavy"
quite early in life as he assumes the multiple burdens of trail blazer,
role model. and stand-in for paterfamilias-both for his sibling and
his mother. He tends to shoulder all responsibilities conscientiously,
stoically, and unquestioningly. Careful to maintain his "princely"
status, he is perpetually alert to maintain his defenses and to avoid
the unconventional. According to Forer, he absorbs parental values
at an early age and proceeds to apply them rigorously both to himself
and to others. Afraid of parental disappointment or of ridicule by
his brother (or worse, by his brother's cronies), his fears are confided
only to his closest (and usually only) friend.
Toman reports that the older of two
boys gets along well with other males and makes friends with both
males and females who themselves have older brothers. He delights
in exerting self-control, planning ahead in practical matters, and
keeping his house (financial and otherwise) in order. Toman adds that
this boy deals with male authority by either identifying with it or
subverting it via subtle invasion or erosion of the authority's prerogatives.
Koch and Sutton-Smith and Rosenberg
describe his childhood behavior as anxiously rivalrous over the mother's
attention, quarrelsome, teasing, insistent on his rights, and of all
ordinal positions the slowest to recover after upsets. These characteristics
tend to become modified after about age ten.
Forer points out that he needs to develop
more patience and playfulness. Care should be taken during his growing-up
years not to saddle him with so much work and so little play as to
make him the proverbial "dull boy." He is usually less serious
or more playful if one or both of his parents were younger children,
even more so if one or both of his parents were firstborn oldest or
Younger of Two Boys (M-2-M)
This child usually grows up blissfully unaware of the buffering role
of his sober elder brother. More gregarious and extroverted than his
sibling, he fails to see what all the fuss is about. To his thinking,
most things work themselves out eventually, so let others do the worrying
at which they seem to be so proficient.
The youngest child syndrome is ameliorated
for the younger of two boys by the fact that he has a single sib and
may receive a greater share of parental affirmation than the youngest
in a larger family. The smaller the age gap, the more likely he is
to be both playmate and pal to his elder brother-provided that one
of them being dubbed "Mother's Boy" and the other one "Father's
Boy" does not engender a special rivalry. If that does occur,
the ensuing competitiveness between samesex siblings is usually far
more bitter than that between parentally polarized boy and girl sibs.
This boy, generally easygoing and with
a sunny disposition, is least likely of all ordinals to generate incapacitating
psychiatric syndromes. He is often fonder of his brother than his
brother is of him, unaware that in his own upbringing his parents
relaxed many anxieties and strictures which had adversely affected
the psychic economy of his elder sib. The younger of two boys' chief
asset is his firm belief that the world stands ready to offer advice
and help whenever needed. He does have a distinct disadvantage in
the form of a certain reluctance to maintain a minority opinion against
great odds, or to enter uncharted territory.
According to Toman he is a "capricious
and willful" iconoclast who depends on (and feels lost without)
icons to react against. Irregular in his goal orientation, he either
concentrates intensely or else dawdles and procrastinates-half hoping,
half expecting that a magic rescuer will (as usual) relieve him of
any onerous tasks. Inclined to live in the moment, he spends lavishly,
disregarding the future. Childhood toys are likely to be soon lost,
broken, or discarded. He often responds well to opportunities, but
is not inclined to create them. Much depends upon his moods, which
are in turn a function of the amount of seconding which he receives
from his environment. Others (even his elders) can easily evoke his
empathy and understanding.
In Toman's view this boy gets along
best with boys who have younger brothers, girls with younger siblings,
and with singletons. Generally anti authoritarian, he prefers as allies
an elite group or at best a benign, paternalistic authority. During
childhood he often presents attention-seeking behavior problems.
Sutton-Smith and Rosenberg find that
as a preadolescent he is apt to display "a surge of emotional
dependence and submissiveness." Of all ordinal positions he is
likely to be lowest in conformity and affiliation, and highest in
"masculinity" and athleticism. Koch describes him as having
"more readiness to anger" than boys in other ordinal positions.
When the age gap is small he plays "follow the leader" to
his older brother in social situations. She notes, however, that with
a wider age gap he shows more aggressiveness, curiosity, originality,
enthusiasm and planfulness, and is apt to be socially expansive and
bouyant. Meanwhile, he recovers more readily than his brother from
emotional upsets. Forer feels that this boy needs to develop more
confidence and initiative, to strike a better balance between work
and play activities, and to develop more verbal skills.
Older Boy with Younger Sister (M-1-F )
When a firstborn child gets to be three years old or more, the birth
of a younger sibling may take on increasingly traumatic aspects. In
a way, the parents "can't win"-if the secondborn is of the
same sex as the firstborn, the (mute) complaint is "Why? Wasn't
I a good enough boy (or girl)? Why did they want a second one?"
And if the later-born is of the opposite sex, the complaint becomes
"Wasn't my sex good enough? Why did they have to invite this
kind of creature into the family?"
In the case of the older boy with a
younger sister, the loss of maternal attentiveness constitutes a serious
hurdle, and if he is aged four or older (a time when he is involved
in ambivalent struggles with his father), any pronounced paternal
involvement with the newborn girl can be devastating. Most commonly
the boy clings tenaciously to his prior status of crown prince-a role
which the younger sister (if not the parents) usually accepts completely.
The sister, however, may be treated with lofty disdain (as adults,
these males can go through forty or fifty psychotherapy sessions before
mentioning that they grew up with a younger sister).
Koch characterizes this child as highly
jealous but otherwise aggressive, self-confident, curious, and planful.
Toman finds him a pacifist and reluctant to take risks--usually not
"one of the boys" (although his relations with males are
cordial enough) and often on the lookout for good father figures;
"He wants his peace and his fun. That's what life is for."
In fights among other boys "he is for mediation and reason, even
if it earns him the reputation of a coward." Sutton-Smith and
Rosenberg remark that his "maleness is more in his posture than
his competence."" Like the younger brother with an elder
sister, he tends to ensconce himself in emotionally disbursed relationships
to male peers en masse, with no male confidants whatever. Relations
with females are distantly cordial although marked by an almost compulsive
and obligatory seductiveness. As adults, Wilson finds older boys with
younger sisters to be conventional and all-around good guys, while
close associates frequently observe that even after many years of
acquaintanceship, they really don't know him very well.
When the age gap is smaller (three years
or less) this boy is apt to be close and protective toward his younger
sister, resulting in an overtoleration of mistreatment by female peers.
Nevertheless, a certain emotional distance and detachment characterizes
his relationships to most people. Overt intensity seems to frighten
him, threatening to open up a Pandora's box of undealt with hostility
and/or ambivalence, and he rarely has any confidential friends of
Younger Boy with Older Sister (M-2-F )
Owing to the absentee role of fathers in Western culture, this boy
often feels that his behavior is constantly being monitored by his
older sister and his mother. By the time his father returns home from
work, he feels that the damage has been done. He has either been bossed
or wheedled into so many tiny concessions and thwartings of selfassertion
that he can no longer remember exactly what they were about and he
is likely to wind up being a "rebel without a cause." He
often finds himself feeling resentful, angry, and rebellious without
quite knowing why. Emotional detachment and rather ineffectual nay-saying
may persist well into adolescence when the companionship and support
of male peers finally exerts a calming and steadying effect.
He can achieve a kind of detente with
peers of both sexes, but feels that his personal freedom is left on
the doorstep when he enters the family circle. Rarely able to articulate
this deeply felt problem, he usually finds himself unable to appeal
to his father for sorely needed male support and thus runs the risk
of estrangement. Consequently the all-important father-son relationship
is seldom openly confidential, but is marked by quiet, nonverbal rapport.
Koch notes that in childhood the younger
boy with an older sister tends to be withdrawn and depressive ("sissyish,
hostile and not very friendly") and not a joiner of peer groups.
She finds him passive; low in ambition and initiative. Sutton-Smith
and Rosenberg see him as exhibitionistic, selfish, uncooperative with
peers, and given to teasing. At the same time they see his high self-esteem
as possibly explaining his apparently scant need for peer affirmation.
According to them, of all male ordinal positions, he ranks highest
on measures of "femininity." Toman finds him to be "low
on insight," hypothesizing that, owing to the attentions of his
women folk, he never had a need to develop it. Toman adds that this
ordinal tends to marry a woman whose sole career "is the background
management of his interests and welfare," adding that he is apt
to be unpopular with male peers, "who resent his taking help
and support for granted and leaving them to clean up after him."
Most researchers find him highly quarrelsome at all ages, and the
authors note that he is prone to violent temper tantrums during adolescence
and early adulthood. This seems particularly true when the division
of labor between mother and father is blurred--i.e., when the mother
seems to cut a more vibrant professional figure in the world such
that the father's prestige appears dim by comparison. Given a weak
or incapacitated (but not physically absent) father, this boy can
get into serious emotional difficulties. This ordinal prefers environments
that are gregarious but not intimate. As an adult he will most often
enter a field which is (so far as possible) closed to women.
The best way for parents to avoid the
pitfalls of this ordinal position is to initiate clearcut agreements
regarding his territorial rights. There must be a firm guarantee that
in such areas the mother and sister will respect his boundaries. The
father can help by making special "unsmothering" efforts
toward a personal level of rigorously private confidentiality that
under no circumstances should be shared with the mother or sister
without the boy's prior permission. For the younger boy with an older
sister, no greater crime exists than for one fellow to betray another's
Older Girl with Younger Brother (F-1-M )
This girl, like the older girl with a younger sister, may act out
an oedipal fantasy about being the mother in the family (i.e., her
father's wife) and copes with her resentment toward her newborn rival
by becoming his nursemaid, thus turning her jealousy into a compensatory
From mediating between her younger brother
and the outside world it is but a short step to being a go-between
and peacemaker in other family relationships-for example, bickering
parents or other relatives. Her first motto is "It's all up to
me." While she may disdain her male contemporaries, she is apt
to be more secure in male company, regarding other girls with suspicion
and distrust. As Toman puts it, she tends to patronize males while
still being nurturant and helpful toward their goals.
Accustomed from early childhood to taking
charge of things, she often acts "bossy" toward males without
realizing it, but is generally adept at smoothing ruffled feathers
and making necessary conciliatory gestures. In situations involving
competition with other females, she prefers to behave as though they
do not exist-much to their chagrin.
Koch found that in childhood this girl
is friendly with her teachers, socially expansive, and noted for leadership.
The authors' clinical observation is that the older girl with a younger
brother often seems to have brought herself up; she can astonish her
parents with an organization and precision not learned by precept
According to Sutton-Smith and Rosenberg
she ranked high on conformity and emotional dependency. As she grows
older, Sutton-Smith, Roberts, and Rosenberg assert that she is likely
to become "the most submissive, most dependent, most anxious,
but also the most competitive of the female groups studied."
It appears that when the age gap is
three years or more, this ordinal maintains her ascendancy by polishing
her verbal and intellectual skills. She does this in an effort to
maintain her father's respect and interest. As was noted earlier,
her brother then tends to stake out nonverbal territories, putting
him at a serious disadvantage, both socially and personally. The authors
consider adult older sisters with younger brothers to be the most
predictable of ordinal positions, displaying most of the following
1. She does not particularly like children. While not rejecting her
own children, she is apt to be more maternal as a teacher, child psychologist,
etc., to other people's children.
2. She is usually a career woman. However, she may regard her marriage
and homemaking activities as her "career." Her second motto
is "I'm from Missouri, show me." She takes nothing on faith,
and demands proof. In therapy, she is affable and acts promptly on
insights but makes it almost a point of honor never to acknowledge
the therapist's contribution to her life.
3. Her genuine love for her parents is tempered by a keen awareness
of their shortcomings so that her attitude toward them can be one
of almost loving contempt implemented more by filial obligation than
by genuine concern.
4. In her personal life the older sister with younger brother shows
an underlying disdain for emotionalism. She tends to become attached
to men who are intellectual, professional, who "believe in"
solving every problem rationally, but who are inept socially--almost
as though she seeks a man who will not compete with her in poise and
Collaborative childhood undertakings
carried out in the company of male and female peers with minimal adult
supervision can go a long way toward correcting the imbalances that
have been outlined.
Older Girl with One Younger Sister (F-1-F )
This child is more likely than her male counterpart (older boy with
younger brother) to be nursemaid for the younger sibling at an extremely
early age, perhaps because the transition from playing mommy to a
doll to that of parenting a younger sibling is easy to make. Unaware
of the pitfalls in such a role, parents may place a heavy burden of
responsibility on this elder daughter. Such a policy fails to take
into account the fact that the two children are siblings, and most
important, that this little mother is herself a child, and entitled
to the prerogatives of a bona fide childhood. Relinquishing these
prerogatives plays into the little girl's desire to be a woman like
her mother and makes it difficult for her to come to terms with the
resentment and anger that such a heavy sacrifice entails.
Toman finds her responsible, competent,
often bossy, highly competitive with other females, conscientious,
and inclined toward self-righteousness. He observes that while she
relates best to younger sisters of sisters, both boys and girls may
feel intimidated by her-which she doesn't seem to mind at all. Koch
notes that her childhood playmates are largely female and that in
family terms she tends to see herself as being closer to her father,
and her sister as closer to the mother. Toman likewise sees her as
being strongly attached to her father, in competition with her mother;
as father's helpmate or second-in-command. Sutton-Smith et al. find
her "the most independent of all girls at all ages."
Where a narrow (one- to three-year)
age gap exists, she may treat the younger sister more like a twin
and they may become inseparable-confidantes, the proverbial "sister
act." If the age gap is four years or more, rivalry usually takes
over and this girl then regards her sister as the recipient of numberless
parental favors, as being "spoiled" and unfairly indulged.
In this case she can be the most bitterly hostile toward her sibling
of all ordinal positions.
As with other two-sib configurations,
when the special advantages of each birth order are openly spelled
out to the child and consistently adhered to, many of these problems
are avoidable. In the meantime it is best if the caretaking duties
of this elder sister are held to a realistic minimum.
Younger Girl with an Older Sister (F-2-F )
Like the younger girl with older brother and the younger boy with
older sister, this girl is relatively rare in adult clinical caseloads.
An examination of her childhood personality profile may help to explain
why she so rarely seeks (needs?) psychotherapy.
While Koch finds the younger girl with
an older sister quite dependent on adult attention (especially the
mother's) and having difficulty making final decisions, she is also
described as being less moody, less fearful of physical activities,
and less vacillating than other children. Apparently the wider the
sibling age gap the better her social adjustment and the more self-confident,
cheerful, and less moody she is apt to be. SuttonSmith et al. find
her conforming and affiliative, high in emotional dependency, and
low in competitiveness. At the same time, they find her the "most
feminine and least masculine of the two child female sibling statuses."
As with the younger of two boys, Koch notes that with a narrow age
gap, this ordinal girl tends to be a hanger-on in social groups chosen
by her elder sister.
The relatively few younger girls with
older sisters whom the authors have encountered clinically are gregarious,
energetic, confident, ebullient (bordering on silliness), and breathtakingly
verbose. The social chatterbox and single swinger is most apt to be
such an ordinal.
Her rarity among patient populations
may be due either to a highly successful social repertoire which serves
to assuage and distract her from deeper internal concerns, or to the
sense of total erasure which could result from a too serious defeat
at the hands of a competitively successful older sister.
A problem met with in all two-sister
families is that one parent may have wanted a boy and demands that
one of the girls either fulfill this role or else do eternal penance
for having failed to do so.
Forer feels that a younger girl with
an older sister needs much reassurance as an adolescent and young
adult, and that it is "important for her to develop her own interests
and abilities rather than compete with the sister on the sister's
Younger Sister with an Older Brother (F-2-M )
In a study of thirty-five therapist caseloads, the oldest sister of
three or more siblings is the least likely ordinal position to seek
psychotherapeutic help. But this ordinal girl was the next rarest.
Clinical experience with her older brother has convinced the authors
that this girl frequently suffers serious and subtle childhood damage,
the nature of which her older brother (who scarcely acknowledges her
existence) is unable to elucidate. Combining limited clinical findings
with extraclinical sources, one may hypothesize that her development
proceeds as follows.
Her feelings toward the older brother (and males in general) seem
marked by a lifelong ambivalence. She oscillates between anguished
yearnings for his love and support accompanied by a sense of resentment
and despair at feeling patronized, rejected, or totally ignored by
the family "prince." At the same time she feels that her
parents compare her unfavorably with her brother. A wish to be her
brother's devoted sychophant wars with an equally strong impulse to
compete with and defeat her lofty competitor. Her adult romantic relations
with men seem to be governed by an unconscious paradox: "I want
a strong, self-assertive, masculine man who will do exactly as I tell
Sexual experiments between siblings
are by no means rare. However, they can be traumatic for the younger
sister with an older brother. She feels "used" by the older
brother rather than loved, affirmed, or physically and emotionally
appreciated by him. He, meanwhile, represses, denies, or dismisses
such contacts as being mutually inconsequential. When the age gap
is small, however, this pair can also be genuinely close.
Kammeyer and Sutton-Smith and Rosenberg"
comment upon her "masculine" qualities, which are more pronounced
than for girls in any other ordinal position; she is most often involved
in entrepreneurial activities and in college is apt to be "overrepresented
among physical education majors." Rather than being "masculine"
in the traditional sense, she plays down her vulnerability so as to
avoid possible vanquishment either by males or by more dominant females.
Toman says that she collaborates well with males in work situations,
but that other females, without knowing why, do not trust her. He
further confirms that with a wide sibling age gap she often feels
that she runs a poor second to her brother and dreads anything resembling
failure in the eyes of the world.
Koch, adds that with the wider age gap,
the juvenile young sister with an older brother shows decreased cheerfulness,
self-confidence, finality of decision making, and speed of recovery
from emotional upsets: she is also less friendly toward adults. She
displays an increased tendancy to alibi, to be critical, to hid for
adult attention, and to be readily upset by defeats. Otherwise Koch
describes her as dynamic, highly observant, and tenacious, although
with a "tendency to procrastinate."
Sutton-Smith et al. find her to be low
on affiliation and conformity, more emotionally independent than other
girls, and "least powerful vis-a-vis siblings . . . a surprisingly
unmitigated record of the older male sibling's influence on the younger
girl." Toman notes that she doesn't seem to seek friendship with
females and Koch reports that at the six-year-old level this ordinal
girl is apt to display "tomboyish" qualities. Moreover,
compared to other girls she is apt to be more quarrelsome, tenacious,
resourceful, selfish, competitive, and confident as well as enthusiastic,
popular, and "high on leadership." Koch further points to
her "greater expressed desire to become the opposite-sex sibling
than any [other] group." More than any ordinal position (with
the single exception of the younger boy with an older sister), from
birth onward this child needs a great deal of love and affirmation
from her same-sex parent (or parental surrogates).
While the ramifications of birth order are manifold, appreciating
the significance of ordinal position provides information crucial
to understanding a given child. Knowing parental (and even grandparental)
ordinal positions can widen the scope of that understanding. An older
sister may see her own daughter as the embodiment of her younger sister
and "transfer" onto the child her resentment of that sister's
presumed privileges. Singleton parents become upset when their own
children squabble, while parents who come from large families consider
sibling quarrels to be run-of-the-mill. Finally, an eldest brother
may resent his own children because they, like his siblings, compete
for his wife's ("mother's") love and attention. As we have
pointed out, these matters are not cutand-dried, but are complicated
by many modifying factors. Considerably more clinical investigation
is called for in this largely neglected area, since the surface has
hardly been scratched.
1. ADLER, A., Understanding Human Nature, Premier Books
(Fawcett Publications), New York, 1959.
2. FORER, L. B., Birth Order and Life Roles, Charles C Thomas, Springfield,
3. KAMMEYER, K., "Birth Order and the Feminine Sex Role among
College Women," American Sociological Review, 31:508-515, 1966.
4. KOCH, H. L., "Some Emotional Attitudes of the Young Child
in Relation to Characteristics of His Sibling," Child Development,
5. ----------,"Childrens' Work Attitudes and Sibling Characteristics,"
Child Development, 27:289-310, 1956.
6. ----------, Some Personality Correlates of Sex, Sibling Position,
and Sex of Sibling among Five- and Six-Year-Old Children, Genetic
Psychology Monographs, vol. 52, pp. 3-50, 1955.
7. ----------, "The Relation of Certain Family Constellation
Characteristics and the Attitudes of Children towards Adults,"
Child Development, 26:13-40, 1955.
8. ----------, "The Relation of `Primary Mental Abilities' in
Five- and Six-Year-Olds to Sex of Child and Characteristics of His
Sibling," Child Development, 25:209-223, 1954.
9. KONIG, K., Brothers and Sisters, St. George Books, Blauvelt, N.Y.,
10. SMITH, E. E., and GOODCHILDS, J. D., "Some Personality and
Behavioral Factors Related to Birth Order," Journal of Applied
Psychology, 47:300-303, 1963.
11. SUTTON-SMITH, B., and ROSENBERG, B. G., The Sibling, Holt, Rinehart
and Winston, New York, 1970.
12. SUTTON-SMITH, B., ROBERTS, J. M., and ROSENBERG, B. G., "Sibling
Association and Role Involvement," Merrill-Palmer Quarterly,
13. TOMAN, W., Family Constellation, 2nd ed., Springer, New York,
14. WILSON, B., "A Clinical Portrait of M-1-F, the Elder Brother
with One Younger Sibling, a Sister," unpublished manuscript,
15. ----------, "The Personality of M-1-F as Seen in An Out-Patient
Population: A Pilot Study," unpublished manuscript, 1968.
Sigmund Freud, Introductory Lectures on Psychoanalysis- Lecture 28
Ladies & Gentleman, you know what we are going to talk about
today. You asked me why we do not make use of direct suggestion in
psycho-analytic therapy, when we admit that our influence rests essentially
on transference--that is, on suggestion; and you added a doubt whether,
in view of this predominance of suggestion, we are still able to claim
that our psychological discoveries are objective. I promised I would
give you a detailed reply.
Direct suggestion is suggestion aimed
against the manifestation of the symptoms; it is a struggle between
your authority and the motives for the illness. In this you do not
concern yourself with these motives; you merely request the patient
to suppress their manifestation in symptoms. It makes no difference
of principle whether you put the patient under hypnosis or not. Once
again Bernheim, with his characteristic perspicacity, maintained that
suggestion was the essential element in the phenomena of hypnotism,
that hypnosis itself was already a result of suggestion, a suggested
state; and he preferred to practise suggestion in a waking state,
which can achieve the same effects as suggestion under hypnosis.
Which would you rather hear first on
this question--what experience tells us or theoretical considerations?
Let us begin with the former. I was a pupil of Bernheim's, whom I
visited at Nancy in 1889 and whose book on suggestion I translated
into German. I practised hypnotic treatment for many years, at first
by prohibitory suggestion and later in combination with Breuer's method
of questioning the patient. I can therefore speak of the results
of hypnotic or suggestive therapy on the basis of a wide experience.
If, in the words of the old medical aphorism, an ideal therapy should
be rapid, reliable and not disagreeable for the patient [`cito,
tuto, jucunde'], Bernheim's method fulfilled at least two of these
requirements. It could be carried through much quicker--or, rather,
infinitely quicker--than analytic treatment and it caused the patient
neither trouble nor unpleasantness. For the doctor it became, in the
long run, monotonous: in each case, in the same way, with the same
ceremonial, forbidding the most variegated symptoms to exist, without
being able to learn anything of their sense and meaning. It was hackwork
and not a scientific activity, and it recalled magic, incantations
and hocus-pocus. That could not weigh, however, against the patient's
interest. But the third quality was lacking: the procedure was not
reliable in any respect. It could be used with one patient but not
with another; it achieved a great deal with one and very little with
another, and one never knew why. Worse than the capriciousness of
the procedure was the lack of permanence in its successes. If, after
a short time, one had news of the patient once more, the old ailment
was back again or its place had been taken by a new one. One might
hypnotize him again. But in the background there was the warning given
by experienced workers against robbing the patient of his self-reliance
by frequently repeated hypnosis and so making him an addict to this
kind of therapy as though it were a narcotic. Admittedly sometimes
things went entirely as one would wish: after a few efforts, success
was complete and permanent. But the conditions determining such a
favourable outcome remained unknown. On one occasion a severe condition
in a woman, which I had entirely got rid of by a short hypnotic treatment,
returned unchanged after the patient had, through no action on my
part, got annoyed with me; after a reconciliation, I removed the trouble
again and far more thoroughly; yet it returned once more after she
had fallen foul of me a second time. On another occasion a woman patient,
whom I had repeatedly helped out of neurotic states by hypnosis, suddenly,
during the treatment of a specially obstinate situation, threw her
arms round my neck. After this one could scarcely avoid, whether one
wanted to or not, investigating the question of the nature and origin
of one's authority in suggestive treatment.
So much for experiences. They show
us that in renouncing direct suggestion we are not giving up anything
of irreplaceable value. Now let us add a few reflections to this.
The practice of hypnotic therapy makes very small demands on either
the patient or the doctor. It agrees most beautifully with the estimate
in which neuroses are still held by the majority of doctors. The doctor
says to the neurotic patient: `There's nothing wrong with you, it's
only a question of nerves; so I can blow away your trouble in two
or three minutes with just a few words.' But our views on the laws
of energy are offended by the notion of its being possible to move
a great weight by a tiny application of force, attacking it directly,
without the outside help of any appropriate appliances. In so far
as the conditions are comparable, experience shows that this feat
is not successfully accomplished in the case of the neuroses either.
But I am aware that this argument is not unimpeachable. There is such
a thing as a 'trigger-action'.
In the light of the knowledge we have
gained from psychoanalysis we can describe the difference between
hypnotic and psycho-analytic suggestion as follows. Hypnotic treatment
seeks to cover up and gloss over something in mental life; analytic
treatment seeks to expose and get rid of something. The former acts
like a cosmetic, the latter like surgery. The former makes use of
suggestion in order to forbid the symptoms; it strengthens the repressions,
but, apart from that, leaves all the processes that have led to the
formation of the symptoms unaltered. Analytic treatment makes its
impact further back towards the roots, where the conflicts are which
gave rise to the symptoms, and uses suggestion in order to alter the
outcome of those conflicts. Hypnotic treatment leaves the patient
inert and unchanged, and for that reason, too, equally unable to resist
any fresh occasion for falling ill. An analytic treatment demands
from both doctor and patient the accomplishment of serious work, which
is employed in lifting internal resistances. Through the overcoming
of these resistances the patient's mental life is permanently changed,
is raised to a high level of development and remains protected against
fresh possibilities of falling ill. This work of overcoming resistances
is the essential function of analytic treatment; the patient has to
accomplish it and the doctor makes this possible for him with the
help of suggestion operating in an educative sense. For that reason
psychoanalytic treatment has justly been described as a kind of after-education.
I hope I have now made it clear to you
in what way our method of employing suggestion therapeutically differs
from the only method possible in hypnotic treatment. You will understand
too, from the fact that suggestion can be traced back to transference,
the capriciousness which struck us in hypnotic. therapy, while analytic
treatment remains calculable within its limits. In using hypnosis
we are dependent on the state of the patient's capacity for transference
without being able to influence it itself. The transference of a person
who is to be hypnotized may be negative or, as most frequently, ambivalent,
or he may have protected himself against his transference by adopting
special attitudes; of that we learn nothing. In psychoanalysis we
act upon the transference itself, resolve what opposes it, adjust
the instrument with which we wish to make our impact. Thus it becomes
possible for us to derive an entirely fresh advantage from the power
of suggestion; we get it into our hands. The patient does not suggest
to himself whatever he pleases: we guide his suggestion so far as
he is in any way accessible to its influence.
But you will now tell me that, no matter
whether we call the motive force of our analysis transference or suggestion,
there is a risk that the influencing of our patient may make the objective
certainty of our findings doubtful. What is advantageous to our therapy
is damaging to our researches. This is the objection that is most
often raised against psycho-analysis, and it must be admitted that,
though it is groundless, it cannot be rejected as unreasonable. If
it were justified, psycho-analysis would be nothing more than a particularly
well-disguised and particularly effective form of suggestive treatment
and we should have to attach little weight to all that it tells us
about what influences our lives, the dynamics of the mind or the unconscious.
That is what our opponents believe; and in especial they think that
we have `talked' the patients into everything relating to the importance
of sexual experiences--or even into those experiences themselves--after
such notions have grown up in our own depraved imagination. These
accusations are contradicted more easily by an appeal to experience
than by the help of theory. Anyone who has himself carried out psycho-analyses
will have been able to convince himself on countless occasions that
it is impossible to make suggestions to a patient in that way. The
doctor has no difficulty, of course, in making him a supporter of
some particular theory and in thus making him share some possible
error of his own. In this respect the patient is behaving like anyone
else--like a pupil--but this only affects his intelligence, not his
illness. After all, his conflicts will only be successfully solved
and his resistances overcome if the anticipatory ideas he is given
tally with what is real in him. Whatever in the doctor's conjectures
is inaccurate drops out in the course of the analysis; it has to be
withdrawn and replaced by something more correct. We endeavour by
a careful technique to avoid the occurrence of premature successes
due to suggestion; but no harm is done even if they do occur, for
we are not satisfied by a first success. We do not regard an analysis
as at an end until all the obscurities of the case are cleared up,
the gaps in the patient's memory filled in, the precipitating causes
of the repressions discovered. We look upon successes that set in
too soon as obstacles rather than as a help to the work of analysis;
and we put an end to such successes by constantly resolving the transference
on which they are based. It is this last characteristic which is the
fundamental distinction between analytic and purely suggestive therapy,
and which frees the results of analysis from the suspicion of being
successes due to suggestion. In every other kind of suggestive treatment
the transference is carefully preserved and left untouched; in analysis
it is itself subjected to treatment and is dissected in all the shapes
in which it appears. At the end of an analytic treatment the transference
must itself be cleared away; and if success is then obtained or continues,
it rests, not on suggestion, but on the achievement by its means of
an overcoming of internal resistances, on the internal change that
has been brought about in the patient.
The acceptance of suggestions on individual
points is no doubt discouraged by the fact that during the treatment
we are struggling unceasingly against resistances which are able to
transform themselves into negative (hostile) transferences. Nor must
we fail to point out that a large number of the individual findings
of analysis, which might otherwise be suspected of being products
of suggestion, are confirmed from another and irreproachable source.
Our guarantors in this case are the sufferers from dementia praecox
and paranoia, who are of course far above any suspicion of being influenced
by suggestion. The translations of symbols and the phantasies, which
these patients produce for us and which in them have forced their
way through into consciousness, coincide faithfully with the results
of our investigations into the unconscious of transference neurotics
and thus confirm the objective correctness of our interpretations,
on which doubt is so often thrown. You will not, I think, be going
astray if you trust analysis on these points.
I will now complete my picture of the
mechanism of cure by clothing it in the formulas of the libido theory.
A neurotic is incapable of enjoyment and of efficiency--the former
because his libido is not directed on to any real object and the latter
because he is obliged to employ a great deal of his available energy
on keeping his libido under repression and on warding off its assaults.
He would become healthy if the conflict between his ego and his libido
came to an end and if his ego had his libido again at its disposal.
The therapeutic task consists, therefore, in freeing the libido from
its present attachments, which are withdrawn from the ego, and in
making it once more serviceable to the ego. Where, then, is the neurotic's
libido situated? It is easily found: it is attached to the symptoms,
which yield it the only substitutive satisfaction possible at the
time. We must therefore make ourselves masters of the symptoms and
resolve them--which is precisely the same thing that the patient requires
of us. In order to resolve the symptoms, we must go back as far as
their origin, we must renew the conflict from which they arose, and,
with the help of motive forces which were not at the patient's disposal
in the past, we must guide it to a different outcome. This revision
of the process of repression can be accomplished only in part in connection
with the memory traces of the processes which led to repression. The
decisive part of the work is achieved by creating in the patient's
relation to the doctor--in the 'transference'--new editions of the
old conflicts; in these the patient would like to behave in the same
way as he did in the past, while we, by summoning up every available
mental force [in the patient], compel him to come to a fresh decision.
Thus the transference becomes the battlefield on which all the mutually
struggling forces should meet one another.
All the libido, as well as everything
opposing it, is made to converge solely on the relation with the doctor.
In this process the symptoms are inevitably divested of libido. In
place of the patient's true illness there appears the artificially
constructed transference illness, in place of the various unreal objects
of his libido there appears a single, and once more imaginary, object
in the person of the doctor. But, by the help of the doctor's suggestion,
the new struggle around this object is lifted to the highest psychical
level: it takes place as a normal mental conflict. Since a fresh repression
is avoided, the alienation between ego and libido is brought to an
end and the subject's mental unity is restored. When the libido is
released once more from its temporary object in the person of the
doctor, it cannot return to its earlier objects, but is at the disposal
of the ego. The forces against which we have been struggling during
our work of therapy are, on the one hand, the ego's antipathy to certain
trends of the libido--an antipathy expressed in a tendency to repression--and,
on the other hand, the tenacity or adhesiveness of the libido, which
dislikes leaving objects that it has once cathected.
Thus our therapeutic work falls into
two phases. In the first, all the libido is forced from the symptoms
into the transference and concentrated there; in the second, the struggle
is waged around this new object and the libido is liberated from it.
The change which is decisive for a favourable outcome is the elimination
of repression in this renewed conflict, so that the libido cannot
withdraw once more from the ego by flight into the unconscious. This
is made possible by the alteration of the ego which is accomplished
under the influence of the doctor's suggestion. By means of the work
of interpretation, which transforms what is unconscious into what
is conscious, the ego is enlarged at the cost of this unconscious;
by means of instruction, it is made conciliatory towards the libido
and inclined to grant it some satisfaction, and its repugnance to
the claims of the libido is diminished by the possibility of disposing
of a portion of it by sublimation. The more closely events in the
treatment coincide with this ideal description, the greater will be
the success of the psycho-analytic therapy. It finds its limits in
the lack of mobility of the libido, which may refuse to leave its
objects, and the rigidity of narcissism, which will not allow transference
on to objects to increase beyond certain bounds. Further light may
perhaps be thrown on the dynamics of the process of cure if I say
that we get hold of the whole of the libido which has been withdrawn
from the dominance of the ego by attracting a portion of it on to
ourselves by means of the transference.
It will not be out of place to give
a warning that we can draw no direct conclusion from the distribution
of the libido during and resulting from the treatment as to how it
was distributed during the illness. Suppose we succeeded in bringing
a case to a favourable conclusion by setting up and then resolving
a strong father-transference to the doctor. It would not be correct
to conclude that the patient had suffered previously from a similar
unconscious attachment of his libido to his father. His father-transference
was merely the battlefield on which we gained control of his libido;
the patient's libido was directed to it from other positions. A battlefield
need not necessarily coincide with one of the enemy's key fortresses.
The defence of a hostile capital need not take place just in front
of its gates. Not until after the transference has once more been
resolved can we reconstruct in our thoughts the distribution of libido
which had prevailed during the illness.
From the standpoint of the libido theory,
too, we may say a last word on dreams. A neurotic's dreams help us,
like his parapraxes and his free associations to them, to discover
the sense of his symptoms and to reveal the way in which his libido
is allocated. They show us, in the form of a wish-fulfilment, what
wishful impulses have been subjected to repression and to what objects
the libido withdrawn from the ego has become attached. For this reason
the interpretation of dreams plays a large part in a psycho-analytic
treatment, and in some cases it is over long periods the most important
instrument of our work. We already know that the state of sleep in
itself leads to a certain relaxation of the repressions. A repressed
impulse, owing to this reduction in the pressure weighing down upon
it, becomes able to express itself far more clearly in a dream than
it can be allowed to be expressed by a symptom during the day. The
study of dreams therefore becomes the most convenient means of access
to a knowledge of the repressed unconscious, of which the libido withdrawn
from the ego forms a part.
But the dreams of neurotics do not differ
in any important respect from those of normal people; it is possible,
indeed, that they cannot be distinguished from them at all. It would
be absurd to give an account of the dreams of neurotics which could
not also apply to the dreams of normal people. We must therefore say
that the difference between neurosis and health holds only during
the day; it is not prolonged into dream-life. We are obliged to carry
over to healthy people a number of hypotheses which arise in connection
with neurotics as a result of the link between the latter's dreams
and their symptoms. We cannot deny that healthy people as well possess
in their mental life what alone makes possible the formation both
of dreams and of symptoms, and we must conclude that they too have
carried out repressions, that they expend a certain amount of energy
in order to maintain them, that their unconscious system conceals
repressed impulses which are still cathected with energy, and that
a portion of their libido is withdrawn from their ego's disposal.
Thus a healthy person, too, is virtually a neurotic; but dreams appear
to be the only symptoms which he is capable of forming. It is true
that if one subjects his waking life to a closer examination one discovers
something that contradicts this appearance--namely that this ostensibly
healthy life is interspersed with a great number of trivial and in
practice unimportant symptoms.
The distinction between nervous health
and neurosis is thus reduced to a practical question and is decided
by the outcome -- by whether the subject is left with a sufficient
amount of capacity for enjoyment and of efficiency. It probably goes
back to the relative sizes of the quota of energy that remains free
and of that which is bound by repression, and is of a quantitative
not of a qualitative nature. I need not tell you that this discovery
is the theoretical justification for our conviction that neuroses
are in principle curable in spite of their being based on constitutional
The identity of the dreams of healthy and neurotic people enables
us to infer thus much in regard to defining the characteristics of
health. But in regard to dreams themselves we can make a further inference:
we must not detach them from their connection with neurotic symptoms,
we must not suppose that their essential nature is exhausted by the
formula that describes them as a translation of thoughts into an archaic
form of expression, but we must suppose that they exhibit to us allocations
of the libido and object-cathexes that are really present.
We shall soon have reached the end.
You are perhaps disappointed that on the topic of the psycho-analytic
method of therapy I have only spoken to you about theory and not about
the conditions which determine whether a treatment is to be undertaken
or about the results it produces. I shall discuss neither: the former
because it is not my intention to give you practical instructions
on how to carry out a psycho-analysis, and the latter because several
reasons deter me from it. At the beginning of our talks, I emphasized
the fact that under favourable conditions we achieve successes which
are second to none of the finest in the field of internal medicine;
and I can now add something further--namely that they could not have
been achieved by any other procedure. If I were to say more than this
I should be suspected of trying to drown the loudly raised voices
of depreciation by self-advertisement. The threat has repeatedly been
made against psycho-analysts by our medical 'colleagues'--even at
public congresses--that a collection of the failures and damaging
results of analysis would be published which would open the suffering
public's eyes to the worthlessness of this method of treatment. But,
apart from the malicious, denunciatory character of such a measure,
it would not even be calculated to make it possible to form a correct
judgement of the therapeutic effectiveness of analysis. Analytic therapy,
as you know, is in its youth; it has taken a long time to establish
its technique, and that could only be done in the course of working
and under the influence of increasing experience. In consequence of
the difficulties in giving instruction, the doctor who is a beginner
in psycho-analysis is thrown back to a greater extent than other specialists
on his own capacity for further development, and the results of his
first years will never make it possible to judge the efficacy of analytic
Many attempts at treatment miscarried
during the early period of analysis because they were undertaken in
cases which were altogether unsuited to the procedure and which we
should exclude today on the basis of our present view of the indications
for treatment. But these indications, too, could only be arrived at
by experiment. In those days we did not know a priori that paranoia
and dementia praecox in strongly marked forms are inaccessible, and
we had a right to make trial of the method on all kinds of disorders.
But most of the failures of those early years were due not to the
doctor's fault or an unsuitable choice of patients but to unfavourable
external conditions. Here we have only dealt with internal resistances,
those of the patient, which are inevitable and can be overcome. The
external resistances which arise from the patient's circumstances,
from his environment, are of small theoretical interest but of the
greatest practical importance.
Psycho-analytic treatment may be compared
with a surgical operation and may similarly claim to be carried out
under arrangements that will be the most favourable for its success.
You know the precautionary measures adopted by a surgeon: a suitable
room, good lighting, assistants, exclusion of the patient's relatives,
and so on. Ask yourselves now how many of these operations would turn
out successfully if they had to take place in the presence of all
the members of the patient's family, who would stick their noses into
the field of the operation and exclaim aloud at every incision. In
psychoanalytic treatments the intervention of relatives is a positive
danger and a danger one does not know how to meet. One is armed against
the patient's internal resistances, which one knows are inevitable,
but how can one ward off these external resistances? No kind of explanations
make any impression on the patient's relatives; they cannot be induced
to keep at a distance from the whole business, and one cannot make
common cause with them because of the risk of losing the confidence
of the patient, who quite rightly, moreover--expects the person in
whom he has put his trust to take his side. 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. It is not
to be wondered at, indeed, if a husband looks with disfavour on a
treatment in which, as he may rightly suspect, the whole catalogue
of his sins will be brought to light. Nor do we wonder at it; but
we cannot in that case blame ourselves if our efforts remain unsuccessful
and the treatment is broken off prematurely because the husband's
resistance is added to that of his sick wife. We had in fact undertaken
something which in the prevailing circumstances was unrealizable.
Instead of reporting a number of cases,
I will tell you the story of a single one, in which, from considerations
of medical discretion, I was condemned to play a long-suffering part.
I undertook the analytic treatment--it was many years ago--of a girl
who had for some time been unable, owing to anxiety, to go out in
the street or to stay at home by herself. The patient slowly brought
out an admission that her imagination had been seized by chance observations
of the affectionate relations between her mother and a well-to-do
friend of the family. But she was so clumsy--or so subtle--that she
gave her mother a hint of what was being talked about in the analytic
sessions. She brought this about by changing her behaviour towards
her mother, by insisting on being protected by no one but her mother
from her anxiety at being alone and by barring the door to her in
her anxiety if she tried to leave the house. Her mother had herself
been very neurotic in the past, but had been cured years before in
a hydropathic establishment. Or rather, she had there made the acquaintance
of the man with whom she was able to enter into a relation that was
in every way satisfying to her. The girl's passionate demands took
her aback, and she suddenly understood the meaning of her daughter's
anxiety: the girl had made herself ill in order to keep her mother
prisoner and to rob her of the freedom of movement that her relations
with her lover required. The mother quickly made up her mind and brought
the obnoxious treatment to an end. The girl was taken to a sanatorium
for nervous diseases and was demonstrated for many years as `a poor
victim of psycho-analysis'. All this time, too, I was pursued by the
calumny of responsibility for the unhappy end of the treatment. I
kept silence, for I thought I was bound by the duty of medical discretion.
Long afterwards I learnt from one of my colleagues, who visited the
sanatorium and had seen the agoraphobic girl there, that the liaison
between her mother and the well-to-do friend of the family was common
knowledge in the city and that it was probably connived at by the
husband and father. Thus it was to this `secret' that the treatment
had been sacrificed.
In the years before the war, when arrivals
from many foreign countries made me independent of the favour or disfavour
of my own city, I followed a 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. This is not possible, however, for every psycho-analyst.
Perhaps you may conclude from my warning against relatives that patients
designed for psychoanalysis should be removed from their families
and that this kind of treatment should accordingly be restricted to
inmates of hospitals for nervous diseases. I could not, however, follow
you in that. It is much more advantageous for patients (in so far
as they are not in a phase of severe exhaustion) to remain during
the treatment in the conditions in which they have to struggle with
the tasks that face them. But the patients' relatives ought not to
cancel out this advantage by their conduct and should not offer any
hostile opposition to the doctor's efforts. But how do you propose
to influence in that direction factors like these which are inaccessible
to us? And you will guess, of course, how much the prospects of a
treatment are determined by the patient's social milieu and the cultural
level of his family.
This presents a gloomy prospect for
the effectiveness of psycho-analysis as a therapy--does it not?--even
though we are able to explain the great majority of our failures by
attributing them to interfering external factors. Friends of analysis
have advised us to meet the threatened publication of our failures
with statistics of our successes drawn up by ourselves. I did not
agree to this. I pointed out that statistics are worthless if the
items assembled in them are too heterogeneous; and the cases of neurotic
illness which we had taken into treatment were in fact incomparable
in a great variety of respects. Moreover, the period of time that
could be covered was too short to make it possible to judge the durability
of the cures. And it was altogether impossible to report on many of
the cases: they concerned people who had kept both their illness and
its treatment secret, and their recovery had equally to be kept secret.
But the strongest reason for holding back lay in the realization that
in matters of therapy people behave highly irrationally, so that one
has no prospect of accomplishing anything with them by rational means.
A therapeutic novelty is either received with delirious enthusiasm--as,
for instance, when Koch introduced his first tuberculin against tuberculosis
to the public--or it is treated with abysmal distrust--like Jenner's
vaccination, which was in fact a blessing and which even today has
its irreconcilable opponents. There was obviously a prejudice against
psycho-analysis. If one had cured a severe case, one might hear people
say: `That proves nothing. He would have recovered on his own account
by this time.' And when a woman patient, who had already passed through
four cycles of depression and mania, came to be treated by me during
an interval after an attack of melancholia and three weeks later started
on a phase of mania, all the members of her family--and a high medical
authority, too, who was called in for consultation--were convinced
that the fresh attack could only be the result of my attempted analysis.
Nothing can be done against prejudices. You can see it again today
in the prejudices which each group of nations at war has developed
against the other. The most sensible thing to do is to wait, and to
leave such prejudices to the eroding effects of time. One day the
same people begin to think about the same things in quite a different
way from before; why they did not think so earlier remains a dark
It is possible that the prejudice against analytic treatment is already
diminishing. The constant spread of analytic teachings, the increasing
number of doctors practising analysis in a number of countries seems
to vouch for this. When I was a young doctor, I found myself in a
similar storm of indignation on the doctors' part against treatment
by hypnotic suggestion, which is now held up in contrast to analysis
by people of `moderate' views.' Hypnotism, however, has not fulfilled
its original promise as a therapeutic agent. We psycho-analysts may
claim to be its legitimate heirs and we do not forget how much encouragement
and theoretical clarification we owe to it. The damaging results attributed
to psycho-analysis are restricted essentially to passing manifestations
of increased conflict if an analysis is clumsily carried out or if
it is broken off in the middle. You have heard an account of what
we do with our patients and can form your own judgement as to whether
our efforts are calculated to lead to any lasting damage. Abuse of
analysis is possible in various directions; in particular, the transference
is a dangerous instrument in the hands of an unconscientious doctor.
But no medical
instrument or procedure is guaranteed against abuse; if a knife does
not cut, it cannot be used for healing either.
I have finished, Ladies and Gentlemen.
It is more than a conventional form of words if I admit that I myself
am profoundly aware of the many defects in the lectures I have given
you. I regret above all that I have so often promised to return later
to a topic I have lightly touched on and have then found no opportunity
of redeeming my promise. I undertook to give you an account of a subject
which is still incomplete and in process of development, and my condensed
summary has itself turned out to be an incomplete one. At some points
I have set out the material on which to draw a conclusion and have
then myself not drawn it. But I could not pretend to make you into
experts; I have only tried to stimulate and enlighten you.