by Ruth Snowden
This led Charcot to understand that a patient’s own ideas could affect the area of a paralysis. He realized that a person’s paralysis sometimes stopped at a neat line because the person thought that the limb began or ended at that line, whereas these neat lines did not correspond with the actual physiology of the nervous system. Charcot soon discovered that this type of paralysis could be cured, or even induced, by post-hypnotic suggestion. For example, he could give someone under hypnosis the suggestion that their arm would become paralysed when they woke up.
People who had received post-hypnotic suggestions like this were indistinguishable from others who were actually suffering from hysteria. Although they could not recall the suggestions made to them under hypnosis, they would show similar symptoms of pain, loss of memory, shaking, trembling or paralysis. Charcot was interested in experimenting with this, and gave fascinating demonstrations in front of impressed audiences. Freud took the whole idea a stage further, hoping that if he could unravel the mystery, these discoveries might bring him the fame and fortune he had failed to gain from his research into cocaine.
This was a risky area to get into because at that time hypnosis was better known as a fairground attraction, often preying upon gullible and credulous audiences. However, Freud was undeterred and began to ask questions that Charcot had not thought of. By looking at things in a fresh light he developed two new ideas that were to become very important in the therapeutic field:
To understand hysteria one needed to look at the patient’s psychology, rather than just neurology.
The unconscious mental processes that produce hysterical symptoms actually go on in the minds of all people at levels of which they are not fully aware. These processes can affect people’s behaviour. Freud realized that although a patient’s behaviour could be affected by hypnosis, they often did not recall what had happened during the session. This was the beginning of Freud’s development of psychoanalysis.
Freud’s new ideas may seem rather unstartling to us nowadays, but at the time people had very little understanding of mental illness. In the past, hysterics had been persecuted, often locked up, or burned as witches because their unusual and sometimes frightening behaviour was attributed to the presence of demons. Even Charcot thought that hysterics, and good hypnotic subjects, suffered from a genetic weakness in the brain. For him, the cause of hysteria had to be purely physical because he was a strict mechanist. He also thought that only hysterics could be hypnotized. Freud had other ideas and began to consider whether hypnosis could be used as a therapy.
Freud began his own private practice as a neuropathologist in 1886, concentrating on the use of hypnosis. His first patient, Frau Emmy von N, suffered from compulsive movements of her face and neck and uncontrollable urges to shout and make odd noises. Nowadays we would recognize these as classic symptoms of Tourette’s syndrome – an illness with a neurological basis.
Two main methods of treatment were currently in use with ‘neurotic’ patients: electrotherapy and hypnosis.
ELECTROTHERAPY
This involved local electrical stimulation of the skin and muscles. Freud considered this method to be useless and said that when it did seem to work it was only because of the power of suggestion. In other words, he was once again stating that mental processes could affect physical symptoms.
HYPNOSIS
New research was beginning to suggest that this could work on ‘normal’ people too. Being susceptible to hypnosis was no longer regarded as a sign of brain damage or genetic weakness. Hypnosis was the first method of treatment for patients with neurotic problems that held Freud’s interest.
Freud met Breuer at the Institute of Physiology in 1880, when Breuer was also carrying out research. They became close friends and Breuer helped him with advice and finances, and also passed some of his patients on to him. Unlike other people in the medical profession, who poured scorn on the idea, Breuer was already using hypnosis to help hysterical patients. Eventually, both Freud and Breuer were working mainly with hysterical patients. The two men exchanged ideas and eventually agreed to publish some of their findings together. This was the joint work Studies On Hysteria, of which Breuer was the main author.
This book explains how hysteria can be caused by psychological as well as physical events. When the cause was psychological the patient could not remember it at all, even if they tried to. Freud realized that banishing traumatic or threatening memories from the conscious mind in this way involved some sort of conflict within the mind between the part that wanted to express an unpleasant emotion and the part that wanted to shut it away because it was too awful to contemplate.
Freud suggested that this banishing process involved an active mechanism. He called this repression, and he saw it as being both compulsive and completely unconscious. The process that prevents the unconscious, repressed ideas from being released he called resistance.
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Insight
It is important to grasp the difference between repression, which is the process of banishing unpleasant or undesirable feelings and experiences to the unconscious mind, and resistance, which is the unconscious process that then prevents them from being released.
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Freud suggested that the repressed emotion was rather like a mental boil, unable to discharge its toxic contents, and so giving rise instead to neurotic symptoms. In the case of hysteria, these symptoms became physical and expressed the patient’s trauma in a symbolic physical form; hence the term conversion hysteria.
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Insight
Freud cited a case which provides an example of how repression can be expressed in a symbolic, physical form, where a boy’s hand froze when his mother asked him to sign a divorce document that denounced his father.
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In 1886, Freud gave a lecture on male hysteria to the Vienna Society of Physicians. He was already being looked upon with scorn because of his interest in Charcot’s ideas. This new outrage – the very idea that men could suffer from hysteria – met with a fresh wave of hostility. When he dared to describe some cases of hysteria in men there was outrage. One top surgeon remarked that because the word hysteria referred to the uterus, it was obviously impossible for a man to be hysterical. Interestingly, such irrational and extreme denial of Freud’s new ideas seems rather neatly to demonstrate repression at work: his ideas were disturbing and therefore both they and their perpetrator needed to be banished!
Freud began to realize that his ideas were always going to be unconventional and that he would have to get used to this type of reaction. It would certainly not be the only occasion on which his ideas were ridiculed. Gradually, he accepted that if he wanted to publish his findings he was bound to meet with hostile reactions.
The very idea that men could suffer from hysteria!
Nineteenth-century scientific and moral thinking
In order to avoid thinking that a lot of Freud’s ideas were rather ludicrous and obsessive, it is important to try and understand his work within the context of the times in which he lived.
The mechanistic view in science made it difficult to look at the way in which a person’s mind and ideas can affect their behaviour.
Great arguments were going on between scientists and religious thinkers, which largely began with the work of Charles Darwin.
The prudish attitude people had towards sex made it difficult to study or discuss anything sexual in a scientific way.
The system was patriarchal and men still tended to think they were naturally superior to women.
THE MECHANISTIC VIEW
Scientific thinking in Freud’s day followed the rules of positivism, an approach that limits knowledge to things which are directly observable. This goes hand in hand with the mechanistic and deterministic approaches that were so popular at the time – you describe the facts of what you can experience and observe. Anything else is not science. Positivists try to make general scientific laws about the ways in which phenomena are
related. This approach began in the natural sciences and spread into philosophy.
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Insight
Positivism is a philosophy which limits knowledge to that which is based on actual sense experience. It attempts to affirm theories by strict scientific investigation.
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Freud struggled with trying to apply positivism to the way the mind worked. This proved to be tricky, because thoughts, feelings, fantasies and moods are abstract in their nature rather than concrete. This means that they only exist in thought rather than in solid matter and are therefore hard to observe. Most psychologists took the positivist stance, but psychiatry – the study and treatment of mental illnesses – was also developing, as people became interested in the workings of the mind and what could go wrong with it. It was hard to explain these illnesses by means of conventional medicine and mechanistic thinking. People were beginning to understand that psychiatric problems might be rooted in events such as traumatic experiences, and were not always merely an indication of a malfunction in the physical body. This seems obvious to us today, but in Freud’s time it was a new way of thinking.
There are probably two main reasons for Freud’s insistence upon the positivist stance. Firstly, it was in keeping with the way he was trained as a scientist and the thinking of tutors whom he had admired and respected at university. Secondly, it protected him because it gave him academic respectability. Many of his ideas were so unusual that he needed this credibility in order to carry on with his work. Interestingly, the very name he chose to give his new ideas – psychoanalysis – shows that he wanted his work to be seen as scientific and painstaking.
CHARLES DARWIN
Charles Darwin was the official naturalist on board a ship called the HMS Beagle, which went on a world voyage from 1831 to 1836. During this voyage, he accumulated lots of scientific data that led to the formulation of a revolutionary new biological theory – the Theory of Evolution. This caused great uproar when his work On the Origin of Species was published in 1859. Darwin’s theory of evolution says that:
the animals and plants that we see today have all descended from an original, simple life form
this process depends on ‘natural selection’ – successful species tend to survive and therefore pass on their genes
accidental variations in the genes lead to new species gradually evolving, and unsuccessful variations die out.
Darwin’s ideas were shattering because they were a direct challenge to the traditional religious stories in the Bible, which said that God had created all the species fully formed from the beginning. Man occupied a privileged position in the natural order – he was different from all the animals, because God had given him an immortal soul. Darwin’s theories suggested that man had not been specially created by God – he had evolved as a result of a long, slow process, automatically following a natural law. He was different from other animals only in the degree of structural complexity. In addition, man was not a finished product, designed according to a perfect divine plan – he was capable of evolving further. This meant that man was a suitable subject for scientific study, and the huge range of complex human behaviour could be shown to follow scientific principles. Many people were strongly opposed to Darwin’s theory because it went against their religious convictions. Others used his ideas to support their own theories about man and his societies. Like Darwin, Freud challenged traditional thinking and met with great opposition.
HELMHOLTZ
There had been huge advances in the field of physics as well as biology. One very important development during the nineteenth century was the formulation of the principle of conservation of energy, put forward by Helmholtz. This principle states that the total amount of energy in any physical system is always constant. Matter can be changed, but never destroyed, so that when energy is moved from one place it must always reappear in another. The Helmholtz principle was applied to various branches of physics, such as thermodynamics and electromagnetism, which began to change the world in all kinds of hugely important ways, for example in the introduction of electrical technology. Biology was quick to take on board the new idea as well, and in 1874 Brücke wrote a book which explained that all living organisms, including human beings, are essentially energy systems, to which the principle of the conservation of energy applies. Because Freud admired Brücke so much he took on board this new ‘dynamic physiology’ and arrived at the idea that the human personality is also an energy system and that we therefore have ‘psychic energy’. The role of the psychologist was therefore to study how this energy works within the psyche. This is really the main basis for Freud’s theories of psychoanalysis and he applied the idea in various ways, such as in his theory about sexual repression (see Chapter 3).
PRUDISH ATTITUDES TO SEX
Sex was almost totally unmentionable in the late nineteenth century throughout most of Europe, and it certainly wasn’t a topic for discussion in genteel circles. Young girls were not usually taught the facts of life and frequently their first menstruation was a very traumatic event. It seems hardly surprising, therefore, that a lot of Freud’s patients, particularly the women, had sexual hang-ups.
Nevertheless, people were naturally interested in sex, and so a sort of duality of attitude existed. This can be seen, for example, in contemporary novels that tended to discuss sexual issues in evasive, coded ways. Cheap newspaper scandals involving sexual exploits were also highly popular, and prostitution was a thriving business.
PATRIARCHY
Everyone is familiar with the traditional image of the stern nineteenth-century patriarch. He ruled his family with a rod of iron, beating the children mercilessly and throwing the servants out on the street when they tiresomely got pregnant by him. Obviously, these images are exaggerated stereotypes, but the man was certainly always the undisputed boss within the family and men held all the most important positions in society – all Freud’s tutors and all the people he looked up to were men. Even in the history books and the myths and legends he was taught at school practically all the heroic figures were male. By contrast, women tended to lead very restricted, boring lives, revolving around childrearing and domestic affairs. This, in combination with the strong taboos about sex, meant that women’s psychology was as yet very poorly understood.
Some of Freud’s ideas seem very sexist to modern people, but we have to remember that this type of attitude was prevalent at the time, and to his credit Freud was one of the pioneers in encouraging people to think about women in a new light. Women were normally seen as intellectually inferior, but Freud developed a very close relationship with his youngest daughter Anna and greatly encouraged her intellectual development and what he saw to be masculine traits in her personality. Obviously he regarded her as an interesting and intelligent human being, but he couldn’t quite make the leap to accepting that the positive traits he admired in her could equally well be feminine ones.
Freud’s first ideas about the unconscious
THE CASE OF ANNA O
While they were working closely together, Breuer told Freud about the interesting case history of a patient of his – the case of ‘Anna O’. This was to be another hugely important step in the development of Freud’s theories that led to the idea of psychoanalysis. Anna was a young woman of 21 who suffered from a bewildering variety of symptoms. She had a nervous cough, speech problems, paralysis of her right arm and neck and also had hallucinations. Her hallucinations would gradually get worse through the day until in the evening she fell into a strange trance. While in this state she would mumble odd words.
Anna had recently nursed her father night and day until he died. This traumatic experience seemed to have triggered her illness and she began to refuse food. She also had strange fantasies and mood swings and several times attempted to kill herself. No physical cause could be found for all these strange symptoms and Breuer made a diagnosis of hysteria.
When Anna fell into her evening trance state she would begin to e
xplain her daytime fantasies to Breuer. She called these sessions ‘chimney sweeping’ or ‘the talking cure’. Breuer found that if he repeated words back to her in this trance state then she would describe her hallucinations to him. This made her a little better briefly, but then fresh symptoms would arise.
Sometimes Anna would recall an emotional event that shed light on a particular symptom. For example, after she had been refusing to drink for some time, she spontaneously recalled seeing a woman drink from a glass that a dog had just drunk from. Recalling her feeling of disgust at seeing this incident allowed her to start drinking again. Breuer discovered that when each symptom was traced back to its origin and Anna could describe the original incident to him in as much detail as possible, the symptom would then disappear. The origin of each symptom would turn out to be a forgotten traumatic event. While Anna was actually discussing the trauma her symptoms became very severe.
Breuer also used hypnosis to gain further insights into Anna’s problems. His method of curing symptoms by releasing suppressed traumatic memories became known as the cathartic method, and the release of repressed emotions was called abreaction. So, instead of using hypnosis simply to implant suggestions, hypnosis was being used to unearth past traumas that would then shed light on, and hopefully cure, hysterical symptoms. Freud and Breuer hoped that eventually they could show that all neurotic symptoms could be treated in this way.