Healthcare Based on Life or Death?

This blog is part of a series; its original title was Heilkunst Basics : University, 3rd Year (Healthcare Based on Life or Death?)

Studying the relationship between Freud and Reich, and their concepts, is a very fruitful area of meditation and study in terms of understanding the true basis of healthcare. A very important point of divergence between them came out of their differing views on the source of masochism. On the surface, it is a strange phenomenon to understand — why, after all, would someone intentionally seek out ways of inflicting pain and harm to themselves?

Freud’s answer to the problem of masochism was to posit the concept of ‘the death instinct’ (thanatos). That is, he concluded that at our base, we all are ultimately programmed to self-destruct, and without having control mechanisms, such as the neurotic patterns within our own personalities, or external controls such as the government and police, we would end up ripping our selves and each other to shreds. Therapy, within this world view, really can’t aim at a higher goal than “helping people to cope”, or to be “well-adjusted”.

Reich came to a radically different conclusion than Freud. Ultimately, he saw that at our core, we are driven by the principles of life, rather than principles of death. The problem of masochism as seen according to his research, emerged from what he called the “secondary layer”. Below the surface or persona, which is the mask we mostly wear in public, exists this secondary layer full of all the conflicts and neurotic and psychotic patterns which we have not successfully processed and discharged. Every so often, under stress, or a triggering event, some content from this secondary layer will erupt in public, as in the example of someone suddenly having an unexpected emotional outburst disproportionate to what is actually going on around them.

This is the type of content which people will typically bring to their therapy sessions, to try to gain perspective of. In Freud’s model, as I mentioned, the therapeutic goal is to help people better “manage” these issues, or learn how to temporarily express them in the treatment room. What Reich saw (and Freud didn’t), was that this is not our core layer of functioning — a successful therapeutic technique (see yesterday’s blog on “from Psychoanalysis to Character Analysis”) is actually able to penetrate down through this secondary layer, and make real contact with the patient’s core, or essential self.

The function of masochism, then, does not come from our core, but rather from this deeply conflicted secondary layer. Rather than positing and accepting thanatos (death) as our basis, Reich instead saw and defended the basis of life as our healthy functioning, and the actual goal of therapy. This also parallels the fundamental difference between the outlook of conventional medicine (think of how the doctors are trained by studying cadavers, ie the function of death) and Heilkunst medicine, whose training is focussed around understanding life and living functions from many different perspectives.

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