Freud In A Week

by Ruth Snowden

Today we will learn about how Freud first developed his revolutionary ideas about the treatment of neurological disorders and the birth of the group of techniques that together became known as ‘psychotherapy’.

  Freud began his career in medical research. When he began private practice as a doctor, he used hypnosis as a treatment for his neurotic patients. He dismissed another popular treatment, electrotherapy, saying that apparent successes could be explained by the power of suggestion – in other words, he was arguing that mental processes were affecting patients’ physical symptoms. This was a radical idea, but Freud was never afraid to go against mainstream thinking. His pioneering work set out to cure neurotic symptoms by releasing suppressed traumatic memories.

  At first Freud thought that neurotic symptoms are always caused by traumatic events, but eventually he decided that they could also be caused by repressed sexual urges.

  In 1896 Freud went through a period of depression and carried out extensive self-analysis, largely through dream work. He coined the term ‘psychoanalysis’ in 1896. One of the earliest recorded case histories in psychoanalysis is the analysis of ‘Dora’, which was published in 1905 in a specialist journal.

  FREUD’S MEDICAL TRAINING

  Freud entered the University of Vienna in 1873 to study medicine. He did not finish until 1881, so the course took him three years longer than was normal. This was because he really enjoyed research and his interest lay more in this direction than in actually becoming a doctor. He specialized in histology (a branch of anatomy dealing with the structure and function of tissues) as well as neurology. The scientific method he was taught involved systematic observation, measuring and experimentation. This suited Freud’s orderly, methodical way of thinking.

  SCIENTIFIC RESEARCH

  After graduating as a doctor of medicine in 1881, Freud went on to work in the research laboratory at the university. Here he was given an assignment to investigate the sex organs of eels, about which nothing was known at the time. He also studied the nervous system of lampreys (a kind of fish) and his first published article was on this subject. He wrote 20 or so neurology papers between 1887 and 1897.

  The mechanistic scientific view insisted that the mind of a human being and an animal such as a frog differed only in their complexity. Even ideas were held to be merely the result of a complicated neurological process. This deterministic view was to remain with Freud throughout his life. He believed that all psychological phenomena, even fantasies and feelings, rigidly followed the principle of cause and effect.

  Freud would have happily stayed in medical research, but he realized that he would not have enough money to support a wife and family. He decided that he would have to go into medical practice and spent the next three years gaining practical medical experience at Vienna General Hospital. In 1885 he was appointed as a lecturer in neuropathology at Vienna University. In the same year he wrote an essay about scientific psychology. He was already beginning to embark on his lifelong quest to bridge the gap between the exact science of neurology and psychology, which was still a very poorly understood discipline.

  HYSTERIA AND HYPNOSIS

  The time that Freud spent working with Jean-Martin Charcot in Paris was to have a profound effect upon his thinking. Charcot was working with cases of paralysis, trying to discover a way of distinguishing between when they were the result of organic disease in the nervous system (i.e. disease relating to particular body structures or functions) and when they were ‘hysterical’, or neurotic, in origin.

  Doctors found hysteria interesting for several reasons:

  • The symptoms were very varied. They included memory loss, hallucinations, loss of speech, sleepwalking, paralysis, fits and loss of sensation.

  • Only women were supposed to suffer from it. In fact, the word hysteria is derived from a Greek word hustera, meaning ‘womb’. Charcot disagreed with this and said that men could have hysteria too.

  • It baffled doctors because it did not fit in with the anatomy of the nervous system. For example an arm might be paralysed exactly up to the shoulder, even though the nerves do not stop precisely there.

  Charcot realized that a patient’s own ideas could affect the area of the paralysis. A person’s paralysis could stop at a neat line because the person thought that the limb began or ended at that line. Charcot discovered that this type of paralysis could be cured, or even induced, by hypnosis. This led Freud to two very important new ideas:

  1 To understand hysteria, one needed to look at the patient’s psychology, rather than just his or her neurology.

  2 Unconscious mental processes can affect behaviour. Although a patient’s behaviour could be affected by hypnosis, he or she often did not recall what had happened during the session.

  Freud’s new ideas may seem rather unstartling to us nowadays, but in the past people had very little understanding of mental illness. Hysterics were persecuted, often locked up or burned as witches, because the unusual and sometimes frightening way they behaved was attributed to the presence of demons. Even Charcot thought that hysterics 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 think about whether hypnosis could be used as a therapy.

  Hysteria was usually understood as a neurological disorder suffered uniquely by women.

  Freud began his own private practice as a neuropathologist in 1886. Two main methods of treatment were then in use with neurotic patients:

  • 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. So being susceptible to hypnosis might no longer be regarded as a sign of brain damage or genetic weakness.

  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. 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 was certainly not to be the only occasion when his ideas were to be ridiculed.

  NINETEENTH-CENTURY SCIENTIFIC AND MORAL THINKING

  It is very important to try to understand Freud’s work within the context of the times in which he lived. Prevailing views and ideas included the following:

  • The mechanistic view in science, which made it difficult to look at the way in which a person’s mind and ideas can affect their behaviour.

  • Divisive arguments between scientists and religious thinkers, stemming from the work of Charles Darwin.

  • A prudish attitude towards sex, making it difficult to study or discuss anything sexual in a scientific way.

  • A patriarchal system, in which men still tended to think they were naturally superior to women.

  THE MECHANISTIC VIEW

  The normal way of thinking in science in Freud’s day followed the rules of positivism. Positivism limits knowledge to things which are directly observable. This goes hand in hand with mechanistic and deterministic approaches. The goal of this way of thinking is simple – you simply 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.

  Freud struggled 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 and are therefore hard to observe. Most psychologists took t
he positivist stance, but in the developing discipline of psychiatry (the study and treatment of mental illnesses) it was hard to explain these illnesses by means of conventional medicine and mechanistic thinking.

  CHARLES DARWIN

  Darwin caused great uproar in the nineteenth century with his revolutionary ideas about evolution. Darwin’s theory of evolution said that the animals and plants that we see today had all descended from an original simple life form. This process depended on ‘natural selection’, whereby successful species tended to survive and could therefore hand on their genes. Accidental variations in the genes led to new species gradually evolving, while unsuccessful variations died out.

  Darwin’s ideas were a direct challenge to the traditional religious view that God had created all the species fully formed from the beginning. Like Darwin, Freud challenged traditional thinking and met with great opposition.

  PRUDISH ATTITUDES TO SEX

  Sex was almost totally unmentionable in the late nineteenth century. Freud himself said that it was something improper that one ought not to talk about. In such an atmosphere it is hardly surprising that many of Freud’s patients had sexual hang-ups.

  PATRIARCHY

  Some of Freud’s ideas seem sexist today, but we have to remember that at this time it was very much the norm for women to defer to men. The man was the undisputed boss within the family and women tended to lead very restricted, boring lives. This, in combination with the strong taboos about sex, meant that women’s psychology was as yet very poorly understood.

  In the late nineteenth century, sex was something that was rarely discussed in public discourse.

  FREUD’S FIRST IDEAS ABOUT THE UNCONSCIOUS

  During the 1890s Freud worked closely with a friend and colleague, Josef Breuer (1842–1925). Breuer told Freud about an interesting case history, the case of ‘Anna O.’. 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 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 been nursing her father night and day until his death. This traumatic experience seemed to have triggered her illness. Breuer found that if he repeated her trance words then she would describe her hallucinations to him. This made her a little better for a brief time, but then fresh symptoms seemed to arise. Breuer discovered that when each symptom was traced back to its origin it 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 itself is called ‘abreaction’. He stopped treating Anna when she became very dependent on him and fell in love with him. Anna was eventually able to lead a fulfilling life as a social worker and feminist. Her real name was Bertha Pappenheim.

  In 1895 Freud and Breuer together published Studies in Hysteria. This 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. Freud called this repression process 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 examined in detail.

  • A symptom is often ‘overdetermined’, which means that it is actually caused by several separate events. This makes therapy more difficult.

  • Symptoms often prove to be symbolic – for example, a pain in the heart area when a person had a ‘broken heart’.

  Freud soon found that some of his patients were very resistant to all this unravelling, and he decided that the resistance was sexual in origin. Breuer disagreed with him and there was soon a parting of the ways. 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. Later on, Freud was to modify this technique again, realizing that it made the analyst too much a figure of authority.

  Freud’s work was gradually moving towards the idea that there was conflict between two parts of the mind. One part wanted to release a blocked-up emotion but another part found the release unacceptable and refused to acknowledge it. This conflict led to a process that Freud called ‘resistance’, whereby unconscious ideas are prevented from being released. It was ideas like this that gradually led Freud to his discoveries about the unconscious.

  THE REPRESSION OF SEXUAL IDEAS

  Freud’s theories about psychoanalysis had already begun to evolve during his time working with Breuer. The rift between the two friends came in 1894.

  At first, Freud thought that neurotic symptoms were always caused by traumatic events, but case studies eventually led him to the discovery that they can also be caused by repressed sexual urges. He 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’.

  Freud now claimed confidently that all neurotic symptoms are caused by sexual experiences, often in early childhood. Sexual satisfaction was therefore the key to happiness and emotional balance. This idea became central to psychoanalytic theory, and Freud remained obstinately adamant about it for a long time. However, we must remember the times in which Freud lived and the prevailing attitude towards sex. Moreover, there was no proper means of birth control. This meant that, once your family was complete, you had to either abstain or, if you were a man, furtively seek satisfaction elsewhere.

  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. This 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.

  After a while Freud abandoned this theory, for several reasons. The experience, he noted, was suspiciously common – could it be that some of his patients were inventing the whole thing to fit in with their doctor’s theory? Furthermore, some of his own siblings showed neurotic symptoms – surely his own father was not guilty of incest? Freud now had a better idea and argued that some of the ‘memories’ were in fact fantasies that 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. People had fantasies that were based on instinctive urges. This 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.

  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. When
the patient encountered a resistance to talking about something, Freud 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 helped a person to understand what was bothering them.

  THE FREE ASSOCIATION TECHNIQUE

  Freud gradually began to realize that there was a difficulty with both the hypnosis and the pressure method that he had been using to help his patients. In both cases, the analyst was put in a position of authority and the client was not in control. Using the pressure method also meant that the analyst’s voice could interrupt the patient’s flow of thought. Even worse, Freud recognized a tendency for the analyst actually to plant ideas that might not have been there to begin with.

  Freud therefore developed a modified version of the pressure technique. The patient was encouraged to relax on the couch and to voice whatever thought drifted into his or her mind. 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 was 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, as the patient got close to the root cause of the neurosis, resistance was likely to occur.