by Ruth Snowden
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Insight
The cathartic method is a method of therapy involving the freeing of repressed emotions. The actual freeing of the emotions is called abreaction. This involves becoming conscious of, and often reliving, traumatic events in order to lessen their emotional impact.
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However, there was a snag, because eventually Anna became very dependent on Breuer and fell in love with him. She began telling people she was carrying his child and developed a phantom pregnancy. This was potentially very dangerous for Breuer – he was a married man and such a scandal could be very damaging to his career. He ended the therapy sessions with Anna and later on refused to accept Freud’s theories about hidden sexual problems underlying neurosis. Remarkably, Anna must have recovered eventually from her illness because she was later able to lead a fulfilling life as a social worker and feminist. Her real name was Bertha Pappenheim.
STUDIES ON HYSTERIA
In 1895, when Freud and Breuer together published Studies On Hysteria, their work presented some rather radical new ideas:
Negative mental processes can directly affect the physical body and lead to a diseased state. Any traumatic memory that is painful, frightening or shameful in some way can do this.
These negative memories remain active in the unconscious mind and can alter a person’s behaviour. We cannot get rid of them unless they are recalled, i.e. brought back into the conscious mind.
The banishment of unpleasant memories to the unconscious requires an active process operating at an unconscious level. This is the process that Freud called repression, the ‘first mechanism of defence’, and the idea is one of the cornerstones of psychoanalytic thinking.
The repressed emotional energy or affect is converted into hysterical symptoms. These can be permanently erased by abreaction, when the original trauma is relived and gone over in detail.
A symptom is often overdetermined, which means that it actually has more than one root cause. This makes therapy more difficult.
Symptoms often proved to be symbolic, for example a pain in the heart area when a person had a ‘broken heart’.
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Insight
The word ‘affect’ is used in psychology to suggest an emotion, especially an emotion attached to an idea. ‘Affective science’ studies emotion and ‘affective displays’ are such things as facial expression, body posture and so on.
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Early on, Freud thought that all repressed emotions were associated with traumatic events that the patient wanted to forget. Nowadays, the idea of uncovering the original trauma and allowing the patient to express the accompanying emotion is still used in the treatment of people suffering post-traumatic stress disorder, for example after an accident. Later, Freud extended his definition of repression to include suppression of instinctive impulses that the patient had been unable to express. For example, one of his female patients was unable to leave her room or even have a visitor without having to urinate several times. Freud linked this back to a trip to the theatre when she had experienced a high degree of sexual arousal when she was strongly attracted to a man.
Freud soon found that some of his patients were very resistant to all this unravelling, and he discovered that there was a constant theme underlying all their cases – one of sexual hang-ups. This was hardly surprising really, given that most of Freud’s patients were middle-class women, and women’s sexuality was so little understood at that time. But the link between all his cases led Freud to decide that practically all resistance was sexual in origin – the result of unconscious denial of a forbidden sexual wish. He put forward a thesis that at the bottom of every case of hysteria there lay buried sexual experiences. These were rooted in the earliest years of childhood, but they could be brought to light by psychoanalysis. Freud was so impressed by his own discovery that he described it as a caput Nili (source of the Nile) of neuropathology.
Freud decided that in many cases the trauma that had apparently caused a neurosis was too trivial to be the real underlying cause. In these cases he suggested that the unveiled trauma actually harked back to a still earlier trauma, which was invariably of a sexual nature. He did recognize that other emotions could come into play, for example a constriction in the throat could be caused by someone being unable to ‘swallow’ an insult. But for many years his emphasis was very strongly on the sexual theory. This was probably because sexual impulses are strongly tied in with measurable physiological responses as well as with strong emotional reactions, so this gave Freud a ‘scientific’ basis for his theories. Without this basis he suggested that he would feel uncomfortable in his explorations of the psyche.
Breuer disagreed with this huge sexual emphasis and there was soon a parting of the ways. This was probably partly because Breuer had been so embarrassed when Anna had developed such a strong sexual attachment to him. One can almost hear Freud saying, ‘I rest my case!’ But Breuer felt compelled to reject Freud’s ideas and so Freud had to continue his research on his own. He soon discovered more and more cases of repressed sexual memories, frequently involving childhood abuse by parents – most often involving fathers and daughters. Eventually, Freud came to realize that many of these cases were actually fantasies representing events that the patient had wished, or perhaps feared might happen. Such fantasies gradually became indistinguishable from reality in the person’s mind. There may also have been an element of people obligingly producing what the therapist wanted to hear.
Freud slowly abandoned hypnotism and developed a new technique called the ‘pressure technique’. The patient relaxed on a couch and the analyst pressed on his or her forehead, announcing that memories would now be recalled. This method made the analyst into rather an authoritative figure and Freud later abandoned this too.
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THINGS TO REMEMBER
Freud trained originally in medicine.
After working with Charcot he became interested in hysteria and hypnosis.
Freud began his own private practice as a neuropathologist in 1886, using electrotherapy and hypnosis to treat patients.
The commonly accepted scientific view at this time was the mechanistic view.
Many of Freud’s ideas were regarded with suspicion and cynicism by other scientists.
Freud became interested in the unconscious while working with Josef Breuer.
Working with his own patients Freud developed the idea that all neurotic symptoms were caused by repressed sexual experiences.
Freud’s work was gradually suggesting to him the existence of conflict between two parts of the mind. This conflict led to the process that Freud called resistance. It was ideas like this that gradually led Freud to his discoveries about the unconscious.
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3
The beginnings of psychoanalysis
In this chapter you will learn:
key features of Freud’s emerging theories of psychoanalysis
some basic elements of the psychoanalytical technique
the background to Freud’s first attempts at psychoanalysis.
The crucial decade
Freud’s theories about psychoanalysis had already begun to evolve during the time he worked with Breuer. During the decade centred around the turn of the nineteenth century, he developed most of the major ideas about the development and functioning of the human psyche that were to become psychoanalysis. Following Studies On Hysteria, Freud entered a period of huge intellectual activity during which he produced several more important works. In 1896 he wrote various papers outlining a new theory about how neuroses arose, which he called the ‘seduction theory’ (see below). This work was followed in 1900 by his important book The Interpretation of Dreams, and Three Essays on the Theory of Sexuality was published in 1905.
It was during this period that psychoanalysis really began to emerge as a way of studying the psyche, a clinical method and a developmental theory. All these aspects were interrelated and inspired by Freud�
��s experiences with his own patients and by an extensive analysis of his own psyche, based largely on dream analysis. He was gradually moving away from the strictly mechanistic, empirical science that he had been trained in, and his work took on a much more introspective slant. Many of the changes in his theoretical thinking reflect his significant struggle to understand himself. However, he always insisted that his work was scientifically based and got very defensive if anybody suggested otherwise. It is particularly interesting to read his letters to Fliess during this period, because they reflect many of the tensions that he must have been feeling.
The repression of sexual ideas
At first Freud thought that neurotic symptoms were always caused by traumatic events. Following his early determinist training, he hoped to prove that neuroses were always physical in origin. In an early study called Project for a Scientific Psychology, he even tried to link neurotic symptoms with actual anatomy and physiology. Eventually he abandoned this line of research however, when case studies such as that of Anna O led him to the important discovery that these symptoms can also be caused by repressed sexual urges. Freud still adhered firmly to scientific principles, saying that these sexual urges are instinctive and represent a basic biological drive. Because this drive is a form of energy it cannot be destroyed when it is repressed. It still exists intact, in a repressed form in the unconscious, from where it exerts an influence on the conscious mind and can give rise to dysfunctional behaviour and neurotic thinking.
Freud saw the human psyche as constantly striving towards a peaceful state. This meant that any strong emotions, either positive or negative, were seen as unpleasant and therefore needed to be got rid of in order to release tension. This idea was later named the ‘nirvana principle’. Nirvana is a Buddhist idea meaning ‘blowing out’, as in blowing out a candle. It refers to the idea that the goal of life is to enter a state of nothingness: in this empty state a person becomes one with the life force of the universe, or ‘prana’. Freud wasn’t really referring to this transcendental bliss state – he simply used the word nirvana to refer to a state where there is no psychic tension. He came to believe that the most potent and overriding source of negative feelings was the lack of a fulfilling sex life. The assumption was therefore that ‘normal’ people, without neurotic symptoms, must have a fantastic sex life that provided them with the necessary release of tension needed to attain the desired nirvana state.
Freud now claimed confidently that all neurotic symptoms are caused by traumatic sexual experiences, often in early childhood. Sexual satisfaction in adulthood was the key to happiness and emotional balance. This idea became central to psychoanalytic theory, and Freud remained adamant about it for a long time. We must remember that because of the times in which he lived there was a prevailing prudish attitude towards any mention of sex. Moreover, there was no proper means of birth control. This meant that once your family was complete you had to abstain, or furtively seek satisfaction elsewhere. It is likely that this social attitude led to more people having neurotic symptoms that were connected to sexual repression. Most of the patients who came to Freud were neurotic, middle-class women who suffered with problems of this sort.
The seduction theory
As a result of early case studies, Freud focused more and more on the influence of sexual experience. He claimed that the key to all neuroses was, in fact, the suppressed memory of an early childhood seduction by an adult. But he realized that not everyone who had experienced sexual abuse in childhood later developed neurotic symptoms. His explanation for this was that the experience only led to a neurosis if it was suppressed. It then festered in the unconscious, only to re-emerge at puberty as a neurosis. If, on the other hand, a person retained full conscious awareness of what had happened, then no neurosis would develop.
After a while Freud abandoned this theory for several reasons. The whole picture was suspiciously common – could it be that some of his patients were inventing the whole thing to fit in with their doctor’s theory? He also realized that some of his siblings showed neurotic symptoms – surely his own father was not guilty of incest? Freud’s letters to Fliess at this time show that he really agonized over this and eventually concluded that it could not possibly be the case. Eventually, he had a better idea and decided that some of the ‘memories’ that patients came up with were in fact fantasies. These arose in order to fulfil hidden desires.
This was an important breakthrough – it had dawned on Freud that fantasies could actually be more important than real events in our struggle to understand the human psyche. During analysis, people were coming up with fantasies that were based on instinctive urges. Freud described an incident in his own childhood when he had glimpsed his mother naked and had felt the first stirrings of sexual desire. Perhaps some of the seduction scenes that his patients were describing to him could actually be fantasies based on similar early erotic experiences? This new idea gradually led Freud to develop his theories about infantile sexuality and dreams. Until then people had tended to think that children were totally devoid of sexual urges. Once again Freud was producing new and uncomfortable ideas.
From this time onwards psychoanalysis became more about exploring this secret inner world than trying to unravel a neat causal chain of actual events that had led to the formation of neurotic problems. Freud developed these new ideas in two main ways – through extensive studies of dreams, and in theories about how sexuality develops throughout childhood.
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Insight
Later on Freud said that dreams were often overdetermined, being influenced by recent events, past traumas and unconscious wishes.
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The pressure technique
Freud seems to have given up using hypnosis completely before he really began to develop his theories of psychoanalysis. For quite a while after this he used the pressure technique. He would sit behind his patient, who was lying on a couch, and when the patient encountered a resistance to talking about something, he would apply pressure either to the forehead or to either side of the head. This pressure, he explained, would overcome the resistance. Freud became very keen on this method for a while, and declared that it could unblock resistance in every case. Interestingly, it often gave rise to visual images rather than a fresh flow of words, and frequently patients would recall past scenes that they had previously completely forgotten. These scenes would then unblock a fresh flow of words about what had happened.
Sometimes these scenes, or isolated words that the patient came up with, would lead to fresh insights into the problem he and his patient were working on. But sometimes nothing happened, or the scenes and words that came up would seem to be irrelevant. Usually Freud would then apply pressure again, and try to get the patient to come up with more images and words. In this way he helped people to build up chains of related ideas which sometimes did seem to make sense and help a person to understand what was bothering them.
For example, one patient came up with a single word, concierge, which made no sense to her at all. By pressing repeatedly Freud got her to say ‘night-gown’, ‘bed’, ‘town’ and ‘farm-cart’. When they put all this together the patient recalled an entire incident from when she was ten years old and her 12-year-old sister had gone completely mad one night. She had been overpowered by a concierge, tied up and taken into town in a hand-cart to an asylum. After further probing, Freud discovered that she and this sister had shared not only a bed, but also sexual abuse from the same man.
Freud gradually began to understand that, as with hypnosis, there was a snag to using the pressure method. In both cases the analyst was put in a position of authority and the patient was not in control. Soon he realized that using the pressure method also meant that the analyst’s voice could interrupt the patient’s flow of thought. Even worse, he recognized a tendency for the analyst actually to plant ideas that might not have been there to begin with.
You will remember!
The free-association technique
Freud therefore developed a modified version of the pressure technique. The patient was encouraged to relax on the couch and then simply feel free to voice whatever thoughts drifted into his or her mind without censorship. The role of the analyst had now changed – ideally he was there simply to guide the patient. In practice it was not always easy to retain this passive role. This new method – one of the keystones of psychoanalysis – is called the free-association technique. The idea behind it was that only the patient could really discover the key to the neurosis – this method put the patient back in control of what went on. However, Freud discovered that when the patient got close to the root cause of the neurosis resistance was likely to occur.
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Insight
The free-association technique is still used today by analysts. The idea is not to have any pre-planned conversation, or to look for specific answers, but rather to explore in an unstructured, intuitive kind of way. This can often lead to unearthing things which are meaningful and important to the patient.