Even for those unacquainted with any of the tenets of psychoanalysis, it is common enough knowledge that people sometimes fall in love with the doctors or nurses who tend to their physical ills, thereby demonstrating the same proclivity as those patients who fall in love with their psychotherapists. In the movies, one thinks of (among others) Bette
Davis in Dark Victory. She plays the role of a very spoiled rich young woman, stricken with mysterious fainting spells. During the course of her medical treatment, she falls in love with the neurologist and, ultimately, he with her. In falling in love and struggling with what turns out to be an incurable brain tumor, Davis is transformed from a bratty immature woman into a mature, happy, and feeling one. Similarly in real life, many aging or ailing men fall in love with their nurses. The latest well-known figure to have done so is the novelist Joseph Heller, who fell in love with his nurse while recuperating from a neurological disease. Thomas Merton, while a cloistered monk, did the same with a nurse he met when he was ill. Some men have been known to disinherit their families in favor of their nurses, even when close to death and not likely to achieve a fully realized, mutual love. (Closely related are those love affairs between aging men and their housekeepers: among them one thinks of the example of Mr. J. Seward Johnson and the Polish-born housekeeper whom he married, much to the consternation of his disinherited children.) Reciprocally, many women are known to fantasize about nursing a man back to health or falling in love with an injured or mutilated man. The story of Jane Eyre is perhaps the ultimate nursing fantasy. And doctors, too, like the neurologist in Dark Victory, fall in love with their patients. In this context, one is also reminded of the pilot of a fatal airplane crash who afterwards fell in love with and married one of his passengers, the singer Jane Froman, who lost her legs in the crash. Indeed, rescuing or being rescued surely ranks as one of the great romantic themes.
Falling in love with one's doctor in psychoanalytic therapy is a common enough phenomenon that, as already noted, it has a special name—the erotic transference or transference love. This refers to some mixture of tender, erotic, and sexual feelings that the patient has towards the analyst, and, as such, it forms part of a positive transference (though like all positive transferences it necessarily contains some latent negative feelings). Sexual longing or sexual transference alone—without the elements of tender longing—represents a truncated erotic transference, one that has not been fully developed or experienced. In large part, the erotic transference is a component of the wish to be loved by the analyst. The analyst may occasionally experience reciprocal feelings for the patient—what would then be called an erotic countertransference— stoked by his response to both her admiration and need. (Generally speaking, the patient longs to be rescued, the therapist to rescue.)
Today with psychoanalysis so well established and knowledge (as well as folklore) about it so widespread, many people take it for granted that patients are "supposed to" fall in love with their analysts. But the fact that patients do fall in love with their doctors with some regularity is, when you think about it, astonishing. Of course, analysts call these feelings "transference," but the patient often experiences them as genuine feelings of love.
Freud was the first to describe the phenomenon of the erotic transference, to theorize its meaning in our developmental lives and in the process of psychoanalytic therapy, and to make a connection between transference love and romantic love. But an understanding of the erotic transference did not spring full-blown, even to Freud. His introduction to the phenomenon began with a strange series of events which he learned about through his mentor and collaborator, Josef Breuer.
The "talking cure," an early precursor of psychoanalysis, developed more or less by accident in the course of Breuer's therapy with Anna O, a woman with many hysterical symptoms. She had initiated the process of a kind of free association, in which her speaking of the origins of each symptom magically caused it to disappear. But this therapy was finally disrupted by events in the world outside the consulting room, and it was the disruption itself that led circuitously to the conceptualization of transference, specifically the erotic transference and its hazards to both patient and doctor.
Breuer, who had become increasingly fascinated with Anna O's treatment, is thought to have ignored his wife and thereby provoked her jealousy. Belatedly recognizing the nature of his wife's reaction, Breuer terminated Anna O's treatment. Shortly afterward, he was called back to find his patient in the throes of an hysterical childbirth. He calmed her down but, the next day, took his wife on a second honeymoon. Freud recounted the story in a letter to his own wife. According to Freud's biographer Ernest Jones, Martha "identified herself with Breuer's wife," and hoped the same thing would not ever happen to her, whereupon Freud reproved her vanity in supposing that other women would fall in love with her husband; "for that to happen one has to be a Breuer." Freud, then, denied even the possibility that such a phenomenon might occur in any of his patients, while Martha, rejecting the idea that the infatuation could be attributed solely to Breuer's personal prestige and charisma, seemed intuitively to understand the universal nature of the dynamic. (The mere possibility of triangulation can apparently sharpen one's intuitive abilities!) Only later did Freud come to see Anna O's reaction as the rule rather than the exception, thus enabling him to turn his attention to its central theoretical significance. (It may be of some interest that Anna O was in fact none other than Bertha Pappenheim, who went on to become an eminent social worker and a pioneer of the European women's movement.)
It's been suggested that it was perhaps inevitable that the theoretical observations of the phenomenon were originally made by someone other than the therapist involved. In other words, because Anna O was Breuer's patient, not Freud's, it was easier for Freud to assume an observing role toward her sexual and erotic communications than if they had been directed at him. But even then it wasn't so easy. Simply being a fellow analyst seems to have brought Freud too close to the phenomenon for comfort, and he only appreciated gradually what his wife intuited immediately. Freud's reluctance to acknowledge the phenomena may be some measure of the power—and threat—residing in it.
Nonetheless, by 1905, Freud had formulated fairly explicit concepts about transference, linking the patient's reactions to the therapist to previous reactions the patient had experienced to one or more significant figures from his childhood. Freud described transference reaction as new editions or facsimiles of the impulses and phantasies which are aroused and made conscious during the progress of the analysis; but they have this peculiarity, which is characteristic for their species, that they replace some earlier person by the person of the physician.
In this formulation, emphasis is placed on the repetition inherent in transference and not on its subjective reality for the patient. According to one present-day analyst, "Freud's stress on repetition was in part a response to real and threatened public disapproval of the erotic transferences that female analysands developed in relation to their male analysts." (And here we have an implicit acknowledgment of the fact that this supposedly universal phenomenon is in practice much more common between women patients and men doctors.) But whatever Freud's reason for stressing that transference feelings are "merely" a re-edition of earlier feelings, the truth is that the patient experiences "transference" as a very powerful reality in the present tense. In fact, even a patient who has fallen in love with two therapists in a row finds it hard to accept the idea that her feelings are nothing more than transference. Only the doctor can view the patient's feelings from such an Olympian distance—and, as already discussed, doctors aren't always successful either, hence the phenomenon of the countertransference. Usually, however, the therapist keeps such feelings at bay, in part by invoking the theory of the transference, which thus becomes not only an aid to understanding the patient, but also a defense against a situation which threatens the analyst.
Freud himself was not unaware of the fact that transference looked different to the patient and the doctor. By 1915 he had begun to formulate a theory about the relationship between the erotic transference and the state of being in love. At that time, though, he still maintained his belief that the erotic transference was solely an impediment to therapy and advised that the therapist demonstrate to the patient that she fell in love with him only in the service of resistance to the analysis, as a means of avoiding the painful discoveries about to be made. Even so, Freud acknowledged that transference love and love had certain shared qualities in common.
I think we have told the patient the truth, but not the whole truth regardless of the consequences The part played by resistance in transference-love is unquestionable and very considerable. Nevertheless the resistance did not, after all, create this love; it finds it ready to hand, makes use of it and aggravates its manifestations. Nor is the genuineness of the phenomenon disproved by the resistance It is true that the love consists of new editions of old traits and that it repeats infantile reactions. But this is the essential character of every state of being in love. There is no such state which does not reproduce infantile prototypes. It is precisely from this infantile determination that it receives its compulsive character, verging as it does on the pathological. Transference-love has perhaps a degree less of freedom than the love which appears in ordinary life and is called normal; it displays its dependence on the infantile pattern more clearly and is less adaptable and capable of modification; but that is all, and not what is essential.
According to Freud, then, all love is a re-finding, and repeats infantile reactions; but transference love, for reasons he did not specify, was said to be even more dominated by the strait jacket of repetition than was romantic love. (One present-day analyst, Martin Bergmann, has suggested the reverse—that in real life the lover simply displaces or suppresses his negative feelings about the beloved, making it likely that they will eventually wend their way back into the relationship and corrode it, whereas in psychoanalysis the negative feelings can be both experienced and worked through so that what began as a compulsive repetition can end by becoming a freeing experience.)
Knowledge of the erotic transference was crucial to Freud's formulation of the phenomenon of re-finding in love. His observations in the consulting room enabled him to see that the object of both transference and romantic love is a re-edition of the original love object of childhood. But insight into the erotic transference is important to our understanding of love in several other interrelated ways as well. Transference can be demonstrated to be an imaginative act, an idealizing one, and, perhaps most importantly, an act—a process that the patient causes to happen and participates in, not something that happens to him, and in all these ways it confirms certain of our assumptions about romantic love.
Transference also sheds light on love as an agent of change, because transference, too, can be a major catalyst for personal change and growth. In fact, as already mentioned, analysts no longer fear transference as an impediment to analytic process, but rather look to it as the very vehicle of that process. Nonetheless the erotic transference, like love itself, can sometimes prove disruptive rather than constructive.
Perhaps even more important than the similarities between transference love and romantic love is one enormous difference. Transference love is far more predictable than love, such a regular feature of so many analyses that it almost appears to be promiscuous, whereas love in "real" life is much more selective. For insight into the whys and wherefores of falling in love, we must try to understand the frequency of transference love (at least for women patients in treatment with men) compared to the less predictable, more erratic inception of romantic love in everyday life.
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