EVALUATION OF THE RESULTS OF PSYCHOANALYTIC

THERAPY '
BY ROBERT P. KNIGHT, M.D.,TOPEKA,
KANSAS
A reproach frequently directed against in discussing the problems of reporting,
psychoanalysts is that they do not publish says : "The reasons why psychoanalysts at-
reports on the results of their therapy. This tach little value to therapeutic records in
criticism is in some degree valid, for to the the field of psychopathology are well known :
knowledge of the writer there is not a single the sharp distinction they make between
report in the literature on the therapeutic symptomatic improvement and modification
results of an analyst in private practice, or of the underlying disorder itself, the impos-
of any group of such analysts. However, sibility of using comparable criteria, and
there are brochure reports of the results of their far higher standards of what consti-
592 analyses conducted at the Berlin Psycho- tutes mental normality than those accepted
analytic Institute(1) from 1920 to 1930, 74 by other physicians." He goes on to make
cases at the London Clinic of Psychoanaly- the point that even in a ten year period, in-
s i s ( ~ )from 1gz6 to 1936, and 157 cases at .volving 738 patients presenting themselves
the Chicago Institute for Psychoanalysis(3) for consultation, an extremely small num-
from 1932 to 1937. Also, there are the im- ber of psychoanalytically treated cases in
portant reports by Hyman and Kessel(4) each diagnostic category developed-far too
in 1933 and later by Hyman(5) in 1936 of small a number to be of much significance
43 cases referred by them to psychoanalysts, statistically.
and the selective study by Jarneison and In the five year report of the Chicago
McNiel(6) in 1938 of 17 unsuccessful cases Institute (1932-37) Alexander discusses
which had to be hospitalized, It is the pur- inore fully the difficulties encountered in
pose of this paper to review and evaluate diagnosis, record-keeping and evaluation of
the valid and invalid factors which operate results. He mentions the well known fac-
against the reporting of results by psycho- tors of the long duration of psychoanalytic
analysts, to present a report on 100 cases treatment, the difficulty of recording data
treated by psychoanalysis at the Menninger and material derived from many hundreds
Clinic from 1932 to 1941, and to show a of hours with various patients, the less
composite table of all these reports, which tangible symptoms in psychopathology as
include almost I ,ooo cases. compared to organic pathology, and the fact
that even the intangible symptoms are often
of secondary importance as compared with
the still less tangible disturbances of the
The Berlin Institute report of 1930, com- whole personality. He points out that the
piled by Fenichel, does not discuss the spe- disappearance of manifest and well-defined
-cific difficulties encountered. Since this was symptoms can be used as a sign of cure in
the first published report of results, diag- only a limited number of cases, that any
noses were listed as simply as possible and -'criteria for judging therapeutic results are
more or less arbitrary and subjective criteria necessarily vague and abstract and require
of improvement were employed. In the next subtle and expert judgment, and states that
report, that of the London Clinic in 1936, standard criteria for such judgment are
written by Jones, there was no real attempt lacking. He reminds us that the conditions
at statistical reporting, and only a general treated by psychoanalysis are very complex
.semi-statistical summary was given. Jones, and diversified and often include combina-
tions of a number of different diagnostic
1 Read at the ninety-seventh annual meeting of
entities. Also cases within any particular
The American Psychiatric Association at a joint
session with the section on psychoanalysis, Rich- category may be of varying degrees of
mond, Va., May 5-9, 1941. severity. In evaluating the often rather
 19411 ROBERT P. KNIGHT 435
subtle changes in the personality which the subjective complexities of each patient
psychoanalysis seeks to effect, other difficul- by attempting to apply the psychoanalytic
ties are encountered. The analyst must re- technique. Hence any report of the thera-
member that the post hoe ergo Propter hoc peutic results of psychoanalysis as a treat-
fallacy must be avoided ; life situations that ment method is actually a composite of the
become altered may result in marked per- results of various individual analysts of
sonality changes and relief of symptoms, varying degrees of experience and skill with
and also spontaneous remissions are possible cases of varying degree of severity. While
in some cases. Relatives and friends of the these variables are present in some degree
patient also may have somewhat unreliable in all medical and surgical procedures as
opinions as to the value of the personality well, they are probably never present in
changes in the psychoanalytically treated anything like the degree of significance
patient. Individuals in close contact with found in psychoanalysis.
the patient usually stand in a special emo- The nosological categories in psychiatry
tional relationship to him, and, as a matter are at the present time unstandardized in
of fact, all psychiatrists are aware that rela- spite of continued attempts to achieve de-
tives of the patient may have reasons for finitive conceptions and labels for clinical
actually preferring that the patient remain conditions. Physicians strive for a single
in his neurotic state, so that valid progress diagnosis that includes all the symptoms and
in his mental functioning may arouse un- signs, but must often list also the complicat-
favorable comment or even actual antago- ing conditions. Psychiatrists and psycho-
nism toward the analysis and the analyst. analysts also strive for such a single clinical
Alexander concludes that the analyst and diagnosis, but are handicapped by a still
the patient are in the best position to judge present (although perhaps decreasing) non-'
the actual progress made and the weights to- unanimity of viewpoint as well as by diverse
be assigned to analytic insight and altered systems of nomenclature. The standard
life situation in evaluating the therapeutic nomenclature adopted by The American
result. Psychiatric Association is quite useful in
The writer wishes to call attention to sev- making statistical studies, but it still awaits
eral other factors to be taken into account more refined and accurate category differ-
in any attempt to compile therapeutic re- entiation. It is extremely difficult to make
ports on pyschoanalytically treated cases. an all-inclusive case diagnosis-one that de-
Psychonanalysis can be (and is) utilized by scribes the psychopathological condition it-
analysts of varying degrees of experience self as well as the general psychodynamic
and proficiency. Theoretically, better results structure of the character of the patient.
should be obtained when well trained, ex- Thus, in compilinga statistical report, one
perienced analysts treat types of cases for is confronted constantly with the problem
which they are especially suited by tempera- of where to list many "mixed" cases; how
ment and by specific experience. In spite to classify a case (for example) of a person
of all references to psychoanalysis as a of rigid obsessional character who has strong
rnethod of treatment, or to orfhodo.r tech- paranoid trends, presents an anxiety state
~ t i q u e ,psychoanalysis remains a therapeutic as the clinical condition from which he seeks
procedure which, when compared to such a relief, and also has some psychogenic physi-
definite medical procedure as administering cal symptoms which he attributes to having
insulin to a diabetic on a calculated diet, or had jungle fever ten years before.* In gen-
such a surgical procedure as performing a eral medicine there is no comparable con-
gastro-enterostomy, is relatively unstandard- fusion, for there is not the same attempt to
ized. Just as every psychoanalytic patient diagnose the entire physio-chemical struc-
is a distinctly different case, so each psycho- ture of the patient, nor, furthermore, the
analyst, trained though he be in the standard same attempt to treat many other condi-
techniques of conducting an analysis, is still tions subordinate to the main illness. Hence,
an individual with certain talents and a cer- This is an actual case, finally listed in the card
tain temperament who attempts to cope with index as "Obsessional neurosis."
436 RESULTS OF PSYCHOANALYTIC THERAPY [ Nov.
in psychoanalytic reporting, there is a fac- THE AIMS OF PSYCHOANALYTIC THERAPY,
'tor of unavoidable error in listing diagnoses ITSLIMITATIONS, AND CRITERIA FOR
at all. EVALUATING THE RESULTS
The above cited difficulties may be re- ~ h ,ims
, of psychoandytic therapy and
spOnsible the fact that much the the psychodynamic theories regarding the
psychoanab'tic literature with case modus operan& of psychoanalysis were fully
reports is discovered to contain intensive discussed in a symposium on therapeutic
studies of case material, psychodynamic in- results at the International Congress at
ter~retationsand meta~s~chO1ogid cOnclu- Marienbad in 1936 by Glover, Fenichel,
sions, with the pa* played by the Strachey, Bibring, Bergler, Numberg and
and the therapeutic Outcome the others. (7) This excellent discussion will not
case frequently omitted entirely. The be reviewed here, nor did the symposium
pression is conveyed to the reader or listener discussions include any recommendations
that Some abstract, mysterious "process of for the &teria to be used in the
P ~ Y ~ Operates ~ ~ ~ produce ~ ~ the ~ Y ~ Any
results. ~ general
~ " statement of the aims
analytic material and bring about whatever of psychoanalytic therapy, however, in non-
success results. Such accounts justifiably technical language, would undoubtedly in-
arouse skepticism and criticism among non- clude the following:
analytic psychiatrists and physicians. I. Disappewance of the presenting symp-
A further reason of dubious validity oper- toms
ating against ~s~choanalytic reporting is the 2. Real improvement in mental func-
viewpoint held by some analysts that psycho- tiofling
analysis is not an instance of medical thera- a. The acquisition of insight, intellectual
peusis but a confidential personal matter be- a d emotional, into the childhood sources of
tween patient and analyst, which exempts conflict, the part played by precipitating and
the analyst from the usual medical obliga- other reality factors, and the methods of
tion to report methods and results. The defense against anxiety which have produced
writer believes, however, that if psycho- the type of personality and the specific char-
d y s i s is to attain its rightful place as a acter of the morbid process
valuable scientific therapy among the b. Development of tolerance, without anx-
d therapies, its exponents must recognize iety, of the instinctual dives
the necessity of reporting the technique used c. Development of ability to accept one's
and the results obtained. -The reporting of self objectively, with a good appraisal of
failures is d s o almost absent from the litera- elements of strength and weakness
ture, although medicine in general, contrary d. Attainment of relative freedom from
to the lay opinion that physicians "bury their enervating tensions and talentcrippling
failures," publishes failures of cure and inhibitions
deaths for the scientific value of such data e. Release of the aggressive energies
in the general body of medical literature. needed for self-preservation, achievement,
Much can be learned from such failures, competition and protection of one's rights
and no stigma can rationally be attached to 3. Improved ,-ea&tyadjustment
the physician doing the whether a. More consistent and loyal interper-
he be surgeon, internist, psychiatrist or sonal relationships with well-chosen objects
psychoanalyst. One further factor operat- b. Free functioning of abilities in pro-
ing against the making of therapeutic re- ductive work
pods by psychoanalysts is probably the rela- c. Improved sublimation in recreation and
tively much higher proportion of time, effort avocations
and study required per patient reported as d . Full heterosexual functioning with po-
compared to general medical reporting of tency and pleasure
cases treated. This element is, however, in- Certain limitations, however, are imposed
herent in the type of practice, and is insuf- on the attainment of these aims in spite of
ficient reason to refuse to attempt to com- the best application of the method of psycho-
pile therapeutic records. analytic therapy. ( I ) The intelligence level
19411 ROBERT P. KNIGHT 4.37

of the patient is a limiting factor. It may possible situation like a super-man. Yet
apparently be raised in some cases by lift- psychoanalytic therapy is often judged by
ing conflicts which interfere with intelli- these very criteria. One might as well ex-
gence functioning, but the native intelligence pect that psychoanalysis would also cure his
endowment cannot be increased. ( 2 ) Like- freckles, his bad golf swing and his aver-
wise there are definite limitations in respect sion to turnips. No, the patient will remain
to native ability. Talents cannot be instilled. essentially the same person after the best
Occasionally some new abilities may blossom analysis-rid of his disabling symptoms,
forth in a patient when his instinctual energy perhaps, or able to handle what ones are
is freed from the shackles of anxiety and still left, more adaptable, more productive,
inhibition, but it cannot be a regular ex- happier in his relationships, but still the
pectation that psychoanalyzed patients will same person as to native endowment, ap-
come to possess talents which they did not pearance and basic temperament. Another
have before. ( 3 ) There are also limitations invalid criterion for judging therapeutic suc-
imposed by physical factors of size, muscu- cess was advanced by Hyman and Kessel in
lar and skeletal development, personal at- their report-a criterion which the editors
tractiveness and specific handicaps of physi- of the J.A.M.A. saw fit to refute in an edi-
cal anomalies, sequelae of previous disease torial(8). This was that a patient who was
or injury, etc., which will affect in many having difficulty adjusting to an unsuitable
ways the patient's full attainment of suc- marital partner should, after being analyzed,
cess in life. (4) Many emotional disorders be able to make a happy adjustment to this
are so deep-rooted, so early in their onset, same marital partner. The editorial pointed
that any improvement, even by the most
out that the neurotic choice of a marital part-
thoroughgoing and successful psychoanaly-
sis, can be only relative. The ego, or func- ner might well be a part of the neurosis, and
tioning, executive part of the psyche may improvement in the neurosis might lead in-
be said to be crippled, just as the skeletal evitably and logically to a changed marital
structure may be crippled .by rickets or in- status. Also, the expectations and require-
jury, the muscular structure by anterior ments of the patient or referring physician
poliomyelitis, or the organ integrity by rheu- at the beginning of treatment could not be
matic fever or malignant growth. ( 5 ) And a fair criterion of the success of the treat-
finally, life and reality impose frustrations, ment, since the patient's expectations and
stresses, kivations and all sorts of difficul- demands might also be elements of his erne
ties against which the patient must do battle tional disorder. Actually, however, as the
in spite of all he learns in psychoanalysis. editorial pointed out, divorce following an
The best analyzed patient might still relapse analysis is an exception, and cases where
under a special stress, just as might any ap- it has occurred have been cited by critics to
parently quite normal person who had never the exclusion of the many patients who
had a neurosis nor been analyzed. ( 6 ) It achieve a much better marital status with
probably goes without saying that the eco- the same partner through psychoanalysis.
nomic status of the patient imposes definite Psychoanalysts and psychiatrists undoubt-
limitations on what he may accomplish- edly should establish reasonable standard
whether there be too little or too much criteria for improvement in patients treated
money. by various psychiatric therapies. Since the
One might conclude from a consideration aims in psychoanalysis are considerably
of these and other limitations that it is an higher than in psychiatric hospital therapy,
entirely illogical and unfair expectation for for example, it is reasonable that the criteria
the patient, his friends, relatives or referring for judging such a long and intensive mode
physician to anticipate that after being of therapy as psychoanalysis should be more
treated by the method of psychoanalysis he exacting. The writer wishes to suggest five
will become a paragon of all the virtues and such reasonable criteria for measuring the
accomplishments, without flaw, defect or success of an analysis, the patient's own limi-
anxiety and capable of behaving in every tations, the severity of his illness and the
418 RESULTS O F PSYCHCIANALYTIC THERAPY [ NOV.

duration of the analysis always being taken The diagnostic categories employed are
into account also : common ones used by all psychiatrists and
I. Symptomatic recovery; i.e., relative are not special psychoanalytic terms. Cases
freedom from or significant diminution of reported in the studies mentioned are listed
disabling fears, distress, inhibitions, dys- as the authors of these studies listed them.
functions, etc. Cases reported from the Menninger Clinic
2. Increased productiveness, with im- are fitted into the diagnostic category most
proved disposition of his aggressive energies nearly applicable. The categories on the
in his work charts are so arranged that the less severe
3. Improved adjustment to and pleasure cases (psychoneuroses) are placed at the
in his sexual life top and the more severe cases-alcoholism,
4. Improved, less ambivalent, more con- psychopathies and psychoses appear at the
sistent and loyal interpersonal relationships bottom. The usual medical criteria regard-
5. Achievement of sufficient insight to ing outcome of treatment are employed-
handle ordinary psychological conflicts and apparently cured, much improved, improved
reasonable reality stresses and unchanged or worse. The first group,
The writer would like to propose that "apparently cured" is reserved for cases in
these, or some modification of these criteria which a definite and complete recovery oc-
become the subject of further discussion by curred which could be attributed only to
psychiatrists and psychoanalysts, to the end psychoanalytic therapy. The second group,
that after comparable standardization of "much improved," includes those cases in
diagnostic categories is effected, psycho- which im~rovement was considerable and
analysts in private practice might pool their was attribkable to the analysis, but in which
therapeutic results for publication, and thus the analyst felt that a cokplete cure was
permit significant contributions to the litera- lacking in some respects. These two groups
ture of therapeutic successes and failures are combined to provide the number re-
with various clinical conditions. garded as successful results of psychoanaly-
tic therapy. The third category, "improved"
includes those patients who were slightly or
Since standardized and entirely acceptable only moderately better at the end of the
diagnostic categories and therapeutic criteria treatment, but in whom the improvement
have not been established, and since, in order was of lesser degree and might be at-
to present the statistics available, the cate- tributable to other factors than the treat-
gories and criteria employed must be util- ment. The fourth category, "no change or
ized, the following reports will use a com- worse" is self-explanatory. These two
bination of the categories and criteria de- groups are combined to furnish the total
'

vised by the Berlin and Chicago Institutes. number regarded as the unsuccessful.
The individual cases reported by the London Wherever sufficiently large numbers of
Clinic and by Hyman and Kessel which cases are found, percentages based on the
could be identified as to diagnosis and re- number treated for at least six months are
sult have been included. sixteen children calculated for the successful and unsuccess-
and several other cases reported generally ful result^.^ Because of the relatively small
from the London Clinic had to be omitted In the Berlin, London and Chicago reports, only
for lack of information, as did 3 behavior those cases were included in the calculation of per-
problem cases in adolescents reported by centages which had been under treatment at least
Hyman and Kessel, and 10 subsequent six months. In order to promote uniformity, this
same selection was used in the study of the Men-
cases referred for analysis and reported by ninger Clinic cases and, of course, in the composite
Hyman. The 47 cases of unsuccessful re- table. However, the writer is well aware that the
sults of psychoanalytic therapy reported by excluded cases, i. e., those treated less than six
Jameison and McNiel, while a valuable months, represent an important group of "failures."
It is emphasized here again that this group deserves
study, could not fairly be included since special study, statistical analysis and evaluation of
these cases were selected from a certain the failure factors. Such a study of the Menninger
viewpoint. Clinic cases is in prospect.
1941I ROBERT P. K N I G H T 439

numbers of cases in specific diagnostic cate- especially interesting because of the larger
gories, computations are made for the number of organ neuroses and organic con-
groups of psychoneuroses, of sexual dis- ditions treated than in any other report. Of
orders, or organ neuroses, and of psychoses. 43 cases, 27 were in analysis a minimum of
The last chart is a composite of all the identi- six months with 77.7 per cent successful
fiable cases reported including the IOO cases results. The other categories provide num-
from the Menninger Clinic, reported for bers too small for significant statistical
the first time in this paper. evaluation.
5. Menninger Clinic report.--Of IOO con-
secutive cases, none of which is still in
analysis, 31 were cases of psychoneurosis
I. Berlin Institute report.-423 out of or sexual disorder. All but one were treated
592 cases were cases of psychoneurosis or at least six months with about 80 per cent
sexual disorders. Only 89 cases or 15 per successful outcome. Eleven more were char-
cent were alcoholics and psychotics. In the acter disorders and stammering ( I case).
former group of 423 cases 149 or 35 per Of these 11, 8 were in analysis six months
cent broke off the treatment under six or longer and 5 or 62.5 per cent had suc-
months. Of the remaining 274, whose treat- cessful outcomes. This report is distin-
ment lasted six months or longer, 62 per guished from the others by the larger num-
cent had successful outcome. ber of cases of chronic alcoholism and psy-
2. H y m n and Kesse1.-21 out of 29 pa- chosis treated by psychoanalysis. Many
tients were cases of psychoneurosis or sexual cases of alcoholism and 38 cases of psychosis
disorder. Of these 21 all but 3 hypo- (58 per cent of the total) were treated with
chondriacs remained under treatment six combined sanitarium care and psychoanaly-
months or longer and 88.8 per cent success- sis. Of the 15 alcoholics treated at least six
ful outcomes resulted. The 8 psychotic months, one third had successful outcomes.
cases were all treated over six months and The writer has previously reported 20 cases
all were failures. It might be pointed out personally treated (9) but several of these
that analysis of such cases in private prac- cases were not treated by psychoanalysis.
tice offers much less chance of success than Of the 38 cases of psychosis 30 remained
combined psychoanalysis and sanitarium in analysis for at least 6 months and 40 per
care. cent had successful outcomes.
3. London Clinic report.-Here again a 6. Composite report.-The figures from
charity outpatient clinic shows a preponder- all of the previous reports are combined and
ance of cases of psychoneurosis and sexual shown on this chart. The highest per-
disorders-gg out of 74 or about 80 per cent. centage of success 78.1 per cent is shown
The original report did not use the criteria for organ neuroses and organic conditions.
of results employed in the present chart, but Psychoneuroses follow with 63.2 per cent
as nearly as could be determined, the results successful cases, character disorders next
showed that slightly less than half of the with 56.6 per cent success, then sexual dis-
cases were successfully treated. Of the 15 orders with 48.5 per cent successful out-
cases of psychoses, all treated as outpatients, come and psychoses last with 25 per cent
all but one were failures. success.
4. Chicago Institute report.-47 of the
157 cases reported (21 per cent) were diag-
nosed psychoneurosis or sexual disorder. In this study, the writer has attempted to
Of these 35 were treated six months or discuss and summarize the difficulties in-
longer and 62.9 per cent of the psychoneu- volved in reporting results of psychoanalytic
roses and 50 per cent of the sexual disor- therapy, presenting the valid and invalid
ders were treated successfully. Of 52 cases reasons usually involved in preventing the
of character disorder 39 were treated six publication of therapeutic results, and has
months or longer and 71.8 per cent had suc- made a plea for and suggestions regarding,
cessful outcomes. The Chicago report is standard diagnostic criteria and standard
440 RESULTS O F PSYCHOANALYTIC T H E R A P Y [Nov.

BERLIN INSTITUTE 1920-30

Six Much No
No. of Broken months Apgar- Per cent Im- change Per cent
g! casa, off or AC+MI proved or I+NC
-'Anxiety hysteria. ..... ---- -----
6
longer

'
worn

m 57 25 32 I4 10 2 \
Conversionhysteria . . . 105 31 74 25 21 22 6
state. . . . . . . . . . . .................. ........
S Anxiety
Cornpubion neurosis.. . 106 35 71 21 26 18 6
Depression ........... 37 I3 24 7 5 , 62 38
. . . . . . . .,
10 2
a
Hypochondria. ....... 4 4 o ........
8 Inhibitions.. .........
Traumatic neurosis.. ..
e~ Neurasthenia and
80
3
24
o
56
3
21
I
I5
....
15
I :
,
anxiety neurosis. .... 10 7 3 .... I , 2 .....
8 3 5 2 I I
...... 8 4 4 2
...........................
.............................. ........
............ 5 3 2 2 .... ........
CHA~ACTERDISORDERS49 12 37 7 8 17 5
'Peptic ulcer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' ........
g Gastric neurosis.. . . . . . . . . . . . . . . . . . . . . . . . . . ........
g Colitis.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........
f: Chronic constipation.. . . . . . . . . . . . . . . . . . . . . . ........
8 o Bronchial asthma. .... 2 I I ........ I ....
Hay fever.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 ........ 20
$u 'Skin conqitions. . . . . . . . . . . . . . . . . . . . . . . . . . . ........
84 Female disorders.. . . . . . . . . . . . . . . . . . . . . . . . . ........
Endocrine disorders. . . 3 3 o ........ ........
3 8 l+ential
TICS..
hypertension
............... 4
80 ,Unclaseified.
....................
2 2 2 .... ........
........
......... 3 I 2 I I , ........
EPILEPSIES ........... 6 5 I . . . . . . ....... ... I
MIGRAINE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S T A M ~ I U.........
NG. I3 3 10 3 I .... 3 3
CHRONICALCOHOLISM. . 5 3 2 I ........ I ....

-
Paychopathies ........
Manic depressive. .....
Paranoia .............
........... -
Totals. ..........
23
I4

45
2

592
-
18
5
I

26
229
5
9
I

I9 -
363
I
I
....
I
-
101
....
2

2
I )
--
90
23.4
....
4

..; --
52.6
4

115
.:.I
76.6

51 47.4
19411 ROBERT P. KNIGHT 44I

HYMAN AND KESSEL

I

No
yn?;-
No. of
cases
Broken
off
S
ix
months Im-
proved
change Per cent
or I+NC
- ----
lo:;, cur* worse
--
(Anxiety hysteria.. .... I .... I .... ....
Ln
Conversion hysteria. . . . . . . . . . . ........ ....
Anxiety state.. . . . . . . . 5 .... I
EZ Compulsion neurosis.. . . . . . . . . . . .5. . . . .2. ....
$ ' Depression.. ................. ........ ....
Hypochondria. ....... 3 3 0 .... ....
Inhibitions ........... .... ....
g 7
Turnatic n e i s . . . . . . . . .
7
........
2
....
11.2
a
.
Neurasthenia and
anxiety neurosis.. ... 3 .... 3 .... I

Unclassified . . . . . . . . . . I .... I .... ....

....... I .... I I ....
............... ........ ....
.................. ........ ....
.................... . . . . . . . . ....
........
'Peptic ulcer. . . . . . . . . . . . . .
Gastric Neurosis. . . . . . . . . .
g
2 g Colitis.. . . . . . . . . . . .. .. .. .. .....
t: Chronic constipation.
$o Bronchial asthma. . . . . . . . .
' Hay fever.. . . . . . . . , . . . . . .
gu Skin conditions. . . . . . . . . . .
Z !! Female disorders.. . . . . . . . .
2 Endocrine disorders. . . . . . .
2 8 Essential hypertension ....
Tics.. . . . . . ................. .. .. .. .. ..
80 \Unclassified.
EPILEPSIES. ..............
MIGRAINE.. . . . . . . . . . . . . . .
STAMMERING. .............
CHRONICALCOHOLISM.. ....
Psychopathies . . . . . . . . I
Manic depressive. ..... 4
...............
............ 3
( Totals ........... I 29
4-4* RESULTS OF PSYCHOANALYTIC THERAPY [ Nov.

LONDON CLINIC 1926-36

No. of
cases
Bmk"
off
/ .;~
I longer
Appar-
ently
cured
Much
lm-
proved
Per cent
AC+MI
Im-
proved
No

worse
-
* 'Anxiety hysteria. . . . .
Conversion hysteria. .
Anxiety state.. . . . . . . . . . . .
Compulsion neurosis.. . 17
N
' ~Depression.. .............
~ ~ o c h o n d r. i. a. .. . . . . . . .
Inhibitions. . . . . . . . . . . . . . .
Traumatic neurosis.. . . . . . .
a Neurasthenia and
, anxiety neurosis.. . . . . . . .

'Peptic ulcer. . . . . . . . . .
&2 Gastric neurosis.. . . . . .
4 p Colitis.. . . . . . . . . . . . . .
Chronic constipation.. .
I; asthma. . . . .
* o Bronchial
Hay fever.. . . . . . . . . . .
$ 0 'Skin conditions. . . . . . .
Z 2 Female disorders.. . . . .
Endocrine disorders. . .
5 8 Essential hypertension
80 Tics. . . . . . . ...................
,Unclassified.
EPILEPSIES.. . . . . . . . . .
MIGRAINE.. . . . . . . . . . .
STAMMERING. .........
CHRONICALCOHOLISM..
* Psychopathim.. . . . . . .

g
a
I
i
Manic depressive. .....
Paranoia.. . . . . . . . . . . .
Schizophrenia and
schizoid ...........
Totals ...........
I
19411 ROBERT P. KNIGHT 443

CHICAGO INSTITUTE 1932-37

'Anxiety hysteria. . . . .)
m
Conversion hysteria. . J
g Anxiety state.. . . . . . . .
Compulsion neurosis.. .
' Depression.. . . . . . . . . .
Hypochondria. . . . . . . .
Inhibitions . . . . . . . . . . .
Traumatic neurosis.. . .
Q,
I
Neurasthenia and
anxiety neurosis . . . .

CHARACTER
DISORDERS
'Peptic ulcer. . . . . . . . . .
2g Gastric neurosis.. . . . . .
4 2 Colitis.. . . . . . . . . . . . . .
i Chronic constipation.. .
I; @ Bronchial asthma. ....
* o Hay fever.. . . . . . . . . . .
ZU 'Skin conditions. . . . . . .
Z 1l Female disorders. . . . . .
3 Endocrine disorders. . .
2 2 Essential hypertension
0 0 Tica. . . . . . . . .. .. .. .. .. .. .. .. ..
,Unclassified.
..........
EPLLEPSIES.
...........
MIGRAINE.
.........
STAMMERING.
ALCOHOLISM. .
CHRONIC
Psychopathies . . . . . . . .
....
...........
............
1 Totals . . . . . . . . . . .
444 RESULTS OF PSYCHOANALYTIC THERAPY I NOV.

MENNINGER CLINIC 193241

No. of
aws
Broken
off
si.
rnontbs
or Azz! ysh
cured
Per c a t
AC+MI
Im-
proved
No
change P a cent
or I +NC
- .---
longer
----- worse
'Anxiety hysteria. ..... 5 .... 5 3 I > I ....
m
Conversion hysteria. .. I .... I .... I ........
~ n x i e t ystate.. ....... I .... I ........ I ....
Compulsion neurosis.. . ....
8.
7 I 6 I 3 2
Depression ........... 4 .... 4 .... 4 79.3 ........, 20.7
~ypxhondria........ I .... I I .... ........
Inhibitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........
g Traumatic neurosis.. . . . . . . . . . . . . . . . . . . . . . . ........
.
p, Neurasthenia and
anxiety neurosis.. ... 11 .... 11 2 7 ,
nclassi6e-d .
.............................................
..........................................
....... I .... I .... I ................
..............................................
Enuresis.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CHARACTER DISORDERS10 3 7 I 3 .... 2 2 ....
'Peptic ulcer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
neurosis.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
!0 Gastric
Colitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
constipation... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E Chronic
Bronchial asthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I;
o Hayfever.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............
zu . skin conditions.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Female disorders.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Endocrine didem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 3 Essential
o2 hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60 iUndassi6ed. .............................................
EPILEPSIES. ..............................................
MIGRAINE.. ..............................................
STAMMERING .......... I .... I .... I ................
C ~ O N ALCOHOLISM.
IC . 20 5 I5 2 3 33.3 5 5 66.7
........
.... I47
I 6 ........ 4 2
2 I2 2 5
........... 3 .... 3 .... 40 60

- ............ 14 5 9 2 :]
4 -- ..: --
Totals ........... IOO 17 83 14 32 55.4 22 16 44.6
19411 ROBERT P. KNIGHT 445

COMPOSITE
S
ix No
No. of
Casee
Broken
05
months
22;
cued
y~~ Per cent
AC+MI
Im-
proved
change
or
Per cent
I+NC
10E;er worse
- ---------
'Anxiety hysteria. .... 11
m
Conversion hysteria. . 49
Anxiety state.. ....... 6 .... 6 2 2 I I
Compulsion neurosis.. . 138 37 IOI 27 36 29 9
Depression ........... 5 1 13 , 63.2 36.8
. . . . . . . .,
I4 37 10 12 2
'Hypochondria. ....... 8 7 I I ....
Inhibitions . . . . . . . . . . . 87 24 63 23 20 I5 5
Traumatic neurosis.. . . 3 o 3 I o I I
ag Neurasthenia and
, anxiety neurosis.. ... 25 7 18 2 , 3

.I
11 2 )

......... 21 7 I4 5 3 3 3
...... 12 4 8 2 o 5
....... I .... I .... 48.5 .... 51.5
......... 8 o 8 3 0
Enuresis.. ........... 5 3 2 2 oI ] ........
CHARACTERDISORDERS 111 28 83 13 34 56.6 25 11 43.4
'Peptic ulcer. ......... 7 4 3 I I \ I ....
Gastric neurosis.. ..... 4 2 2 I I , ........
4 g Colitis.. .............. 7 2 5 4 I ........
a t: Chronlc constipation.. .
Bronchial asthma. ....
6 I 5
6
2
I
I 2
2
....
....
13 7 3
* o Hay fever.. .......... I o I I .... 78.1 ........ 21.9
g U 'skin conditions. ...... 2 o 2 I .... .... I
Female disofders.. .... 2 o 2 I I ........
4 Endocrine d~sorders ... 3 3 o ........ ........
3 Essential hypertension 3 I 2 o I I ....
8, ~ i c s................
.
,Unclassified. .........
4
3
2
I
2
2
2
I
....
I ,
........
........
EPILEPSIES........... 10 5 5 I I .... o 3 ....
MIGRAINE............ I o I I ....................
STAMMERING.. ........ 15 3 12 3 3 .... 3 3 ....
CHRONICALCOHOLISM. . 28 9 19 3 4 .... 7 5 ....
Psychopathies.. ...... 31 I9 12 I o 4
Manic depressive.. .... 7 6
Paranoia. ............ 'Y I
37
5 o

- ............ -70 -32 -38 - 3 - 6

-- 18 11
- -
Totals ........... 952 292 660 183 186 55.9 201 90 44.1
446 RESULTS OF PSYCHOANALYTIC THERAPY INov.
criteria for evaluating the outcome of treat- 3. Alexander, Franz: Five-year report of the
ment. A total of 952 cases in which analysis Chicago Institute for Psychoanalysis, 1932-37 and
supplement to the five-year report. Critical evalua-
was attempted are listed by diagnosis and tion of therapeutic results, pp. 3e43.
therapeutic result. These figures demon- q. Kessel and Hyman: The value of psycho-
strate, the writer believes, that psycho- analysis as a therapeutic procedure. J. A. M. A.,
analysis must be adjudged an effective lor : 1612-15,Nw. 18, 1933.
5. Hyman, H. T.: The value of psychoanalysis
therapy for the psychoneuroses, sexual dis- as a therapeutic procedure. J. A. M. A., 107 :3a6-
orders and organ neuroses, and a therapy 29, Aug. 1, 1936.
of some promise in the more difficult field 6. Jameison and McNiel : Some unsuccessful re-
of addictions and psychoses. actions with psychoanalytic therapy. Am. J. Psy-
chiat., 95 : 1421-1448,May 1939.
7. Glover, Fenichel, Strachey, Bergler, Numberg,
BIBLIOGRAPHY and Bibring: Symposium on the theory of the
therapeutic results of psychoanalysis. Internat. J.
I. Fenichel, Otto: Ten years of the Berlin Psy- Psycho-Analysis, 18 : 125-189,April-July 1937.
choanalytic Institute, IW-30. Report of therapeutic 8. An evaluation of psychoanalysis. Editorial.
results, pp. 2&40. J. A. M. A., 101 : 1643-44, Nov. 18, 1933.
2. Jones, Ernest : Decennial report of the London g. Knight, Robert P.: The psychoanalytic treat-
Clinic of Psychoanalysis, May 1926-May 1936. ment in a sanatorium of chronic addiction to alcohol.
Results of treatment, pp. 12-14. J. A. M.A., I I I : I ~ ~ ~ -Oct.
4 6 ,15, 1938.