This 1966 article, The Pathogenic Secret and Its Therapeutics, by Henri F. Ellenberger may explain why psychotherapists are bounded by strict confidentiality in their work.
Ellenberger highlights what he calls the “pathogenic secret”. This is a secret of what has happened to us, or what we have witnessed first hand, or what we have been told, that is so “heavily-disturbing”, thus unbearable for us to come to terms with. This is the secret that we keep to ourselves. Sometimes it is a secret that we keep from ourselves, out of our consciousness. Oftentimes belongs to an an event that had occurred in early childhood.
Under certain circumstances, the confession of the pathogenic secret has been known for time in memorial to have healing qualities.
The Concept of the Pathogenic Secret
Pathogenic secret manifests itself as chronic neurosis resulting in symptoms like “melancholia, neurasthenia, hysteria, or even psychosis”, i.e. what we know today as psychopathology.
“The nature of the pathogenic secret can also differ widely. In certain patients, it is the matter of secret thwarted love or some other suppressed passion, such as jealousy, hatred, or ambition. Sometimes it is a matter of physical illness or infirmity, of which the patient feels ashamed. Frequently the secret is related to some kind of moral offence which can range from petty theft to murder, but frequently also it is of a sexual nature (adultery, incest, abortion, infanticide, etc.). The secret can also be the painful remembrance of some traumatic event, sometimes connected with a secret of another person (for instance a young girl discovering her mother’s adultery).” There is often experience of shame involved in the pathogenic secret. The type of the pathogenic secret can differ widely, and it’s effect varies with how the individual attaches meaning to it.
Healing Power of the Confession
Working with confessions is not a new concept. It is observed within ancient healing practices. Confessions of sins or taboos have been documented as healing methods in ancient civilizations in places like Mexico and Mesopotamia.
In the Roman Catholic religion, confessions are practiced, as a form of the self reconciling with the social world. In Catholicism, confessions are sealed in secrecy to the point that under no circumstances is the confession revealed. Once absolved from sins revealed in the confession, the confession is free from his/her sin.
In the Protestant religion, the concept of “Seelsorge” or “cure of souls” as the result of being in the presence of another in a dialogue that can be an exchange and containing of a secret.
The Pathogenic Secret in Literature
Ellenberger also cites examples of the destructiveness of the pathogenic secret and it the healing effect of the secret’s revelation in literature like Nathaniel Hawthorne’s The Scarlet Letter, Jeremias Gotthelf’s Wie Anne Babi Jowager haushaltet und es ihm mit den Doktorn ergeht, Ibsen’s The Lady from the Sea, Marcel Prévost’s L’Automne d’une Femme (The Autumn of a Woman), Heinrich Jung-Stilling’s Theobald oder die Schwarmer.
The Pathogenic Secret in Criminology
Then there is the confessions of the pathogenic secret in criminology. The author cites 19th century literature, Philosophie Pénale, published in 1880 by Gabriel Tarde, documenting the effect that the confession of the crime has on the person who committed it.
“A problem which seems to have attracted less attention is that of the long range effects of the burden of the secret upon the criminal, should his crime not be discovered. It would seem that the secret exerts a permanent and profoundly disturbing effect on certain criminals.”
Another literature cited was that of Austrian criminologist, Hanns Gross, in his textbook of criminal psychology in 1898.
C. G. Jung (12) tells the story of a woman, unknown to him, who came to hisoffice, refusing to divulge her name, and told him how twenty years earlier she had poisoned her best friend in order to marry her husband. But the husband died soon after she married him, the daughter of this marriage disappeared in turn; even animals turned away from her so that she could no longer ride horses nor own dogs and finally she fell into an unspeakable loneliness; this was the reason why she felt that she must make a professional man share the knowledge of her crime. Jung never saw that woman again and wondered what happened to her. Actually the long-range disturbances caused by a secret of that kind in the mind of an undetected criminal are one of the least-known chapters of criminology.
Hypnosis & Pre-psychotherapy
The notion of the burdening secret became known to magnetists very soon after the discovery by Puységur of the state of “magnetic sleep”, now known as hypnosis.
Moritz Benedikt (1835-1920) in the late 19th Century was already able to explain how symptoms like hysteria was cured with revelation of a pathogenic secret in the individual’s “second life” and thus “inner life”.
Freud’s Psychoanalysis and Psychotherapy Today
Freud’s earliest publications illustrate the curative process of revealing of innermost difficult-to-bear secret to a trustworthy professional in a therapeutic dialogue, or “talking cure”. In psychotherapy, this pathogenic secret is something in the unconscious that is revealed in the course of therapy. This revelation is the curative change that occurs in therapy.
With the further development of psychoanalysis, the concept of the pathogenic secret became gradually absorbed into the wider frame of reference of traumatic reminiscences and of repression, and later in the concept of neurotic guilt feelings.
Psychotherapy Law of Confidentiality
It is law in Europe that psychotherapists are committed to confidentiality in their work with clients. This means that whatever the client tells his/her therapist is bounded to confidentiality. The therapist has duty and also the right to maintain this secrecy. The therapist cannot be forced or tricked by anybody– regardless of power or authority– to reveal information given to him/her by his/her client.
This professional code of conduct (in German) for psychotherapists in Austria can be downloaded here: Berufskodex für Psychotherapeutinnen und Psychotherapeuten
The only consideration to break confidentiality is when it concerns the welfare of children and if lives are at risk. Even so, the therapist would consult their counsel of psychotherapists for advice and support.
Being trained in Austria, I am not sure at this point if this rule is applicable to other parts of the world. However, in this article, I would like to highlight the importance of confidentiality for the effectiveness of psychotherapy itself. The wish is that there is a worldwide recognition of the special role of psychotherapy as a profession, and respect for the autonomy of psychotherapists in keeping confidential the material obtained from their clients. As a therapist in Austria, I am committed by the license and by the law to keep all information of my clients secure. Documents are locked up, and information are encrypted so that no client information is compromised. When doing research or case studies, the information that is provided is altered in such a way that no person can be remotely identified in the work. All this is monitored by ethics commissions and peer groups.
This code of the psychotherapeutic profession, it’s protection by law of the therapists and clients, in countries like Austria, creates an environment safe for people to use psychotherapy as a means of healing.
Ellenberger, H. F. (1966). The pathogenic secret and its therapeutics. Journal of the History of the Behavioral Sciences, 2(1), 29-42.