The psycho-analysis was the means of synthesizing the dissociated psychic groups, forcing the ego to bring the ideas into normal (albeit painful) association and realization. Here, as elsewhere, the destiny could not be changed, but the patient's attitude to it was altered, the hysterical reactions being replaced by normal emotions and ordinary sorrow.

* Papers on Hysteria, Freud.

In an analysis, points constantly arise which the physician notes as resistances. These occur at places which are important in the history of the illness, where the censor exerts an influence over the emerging unconscious thought. It is the physician's art to overcome these, because they conceal the unconscious pathological complexes which are causing the symptoms. In the process of solving the problem it is not uncommon to get the hysterical symptoms 'joining in the discussion.' From time to time such an exacerbation may indicate that an important point in the history has been reached. When all the resistances have been overcome the conduct of the analysis is complete.

During the therapeutic process there is usually a steady advance towards recovery, the patient's health and spirits improving. In a few instances the result is dramatic, in some unsuccessful. It is claimed that want of success does not lie in the therapy, but in failure of technique, in want of experience on the part of the physician, in failure of the patient to respond to treatment, either because he is past repair, or is wanting in the qualities that assist the cure, or too old, or too young, or because the illness has been misunderstood. It will be conceded that all these difficulties are found in every branch of medicine and surgery.

A partial success may be admitted, and a piece of educational work accomplished, if the unconscious has been made accessible in a measure to consciousness. Where resistances are overcome, re-education is possible, and a new mental condition may be brought about. If the treatment or cure is incomplete, the patient may yet be able to return to work with some of his more devastating affects released from their pathological fixations, and with an additional sum of energy serviceable for new and wholesome application.

It is perhaps hardly necessary to point out that, though certain patients submit themselves to a therapeutic regime, they do not necessarily wish for a cure. All who deal with neurotics recognize this class; they cannot be said to have the requisite amount of intelligence or good-will, and a practised analyst would not waste his energies over such persons.

Psycho-analysis should not be undertaken where an acute symptom presses for relief (as in hysterical anorexia), nor where, owing to the nature of the symptoms, the patient is unable, for their relief, to wait the many days or weeks that may elapse before reaching the buried complexes. Moreover, the general health should be sufficiently good to allow the patient to contribute a very large share of mental energy to the investigation.

Lastly, what has psycho-analysis to say to hypnotism? Must it stand in opposition to it, or by its side? The psycho-analysts have largely given up its use. Freud found he could not always hypnotize his patients, and preferred to put them into a state of concentration, which in his hands was more efficacious for reaching subconscious memories. His words on the subject are these: 'There are many ways and means of psycho-therapy. All methods are good which produce the aim of the therapy. We have developed the technique of hypnotic suggestion, of psychotherapy through diversion, through practice, and through the evocation of serviceable affects. I do not disdain any of them, and would practise them all under suitable conditions.' He compares hypnotism to the art of painting, and analysis to that of sculpture, and says that hypnotism' conceals from us the psychic play of forces, and does not permit us to recognize the resistance with which patients adhere to their malady,' etc.

Thus the methods are opposite, but it is not the first time that opposite methods have been successfully applied in the treatment of disease. We find an analogy in a localized tuberculous infection. It is our common experience that under suitable conditions healing may take place; the invading bacilli are overpowered by the phagocytes, and become encapsuled and rendered inert by the condensation of surrounding tissues. On the other hand, the invading army may cause death and devastation among the leucocytes. The dead cells then act as irritating foreign material, and in order to avoid further destruction of the tissues an incision is necessary to evacuate an abscess. So, also, an idea suggested in hypnotism may be strong enough to encapsule a phobia or hysterical pain, and render it inert; but should this be impossible owing to the nature of the trauma or the condition of the patient, psycho-analysis remains as an operative procedure which may be applied to the psychic focus. The longest way round (psycho-analysis) is sometimes the shortest way home, but that need not prevent us from using short-cuts (hypnotism) where available. In fact, psycho-analysis is not of very wide application, for various reasons.

It is laborious to the physician, and makes great demands of candour on the part of the patient; it occupies a great amount of time, and is therefore very expensive; it is generally inapplicable to people over fifty; it requires a certain amount of education on the part of patients, who should be persons of intelligence and good-will. Freud considers it fit only for those above a certain level of intelligence. Hence it is obvious we cannot afford to exclude hypnotism as in some instances the ' therapy of choice,' and it will always prove technically useful in investigating the unconscious from time to time in the hands of even the most skilled analyst.*

For an understanding of the human mind there is no method of equal value with psycho-analysis. Those who pretend to such an understanding would do well to take up one case and follow it out, devoting the leisure of months to the purpose, if necessary. Freud points out that the physician is limited by his own complexes and resistances, and that it is of primary importance to understand where they lie. He should at least analyze himself and his dreams. In this he is in the position of a poor art student who is forced to use himself as his own model; a fact to which we owe many portraits of great painters, which are not only interesting and valuable, but masterpieces of art.

* In the treatment of some of my cases I combine the use of psycho-analysis and hypnotism. While searching the unconscious and overcoming resistances it may be advantageous to treat the more pressing symptoms with hypnotism (such as insomnia, for instance), nor have I found this interfere with subsequent analysis.