How did psychoanalysis arise?

Joseph Breuer and Bertha Pappenheim came up with the "cathartic method" as treatment. In that method. Breuer hypnotized Breuer Pappenheim and asked her to go back to the first times she had experienced a specific physical sensation (such as her symptoms). Hypnotizing made it easier to reach forgotten memories (but only high emotion memories, associated with symptoms). By recovering the forgotten memory, she can release the oppressed emotions. This way the symptoms could disappear.

Sigmund Freud (1856-1939), friends with Breuer, remembered the method years later tried it out. He found out that it works better than direct hypnosis. Together with Breuer, he wrote the book "Studies on Hysteria", which became the starting point for Freud's new field. He called this field psychoanalysis. Psychoanalysis played an important role in the history of the Mental Hygiene Movement and the Child Guidance Clinics. In the book, different cases they showed and brought on the general hypothesis that patients with hysteria suffered this because of their repressed memories. It was not about normal memories, but memories about emotion-laden experiences that were stored in the unconscious, which turned them into a disease ("pathogenic ideas"). Without access to normal consciousness, the emotional energy that accompanies the pathogenic ideas is not expressed in the normal way and thus cannot be released. The stimulus that normally aroused the memories was now used to the pinched emotional energy, causing the hysterical symptoms. The hysterical symptoms were conversions (the transition of emotional information into physical energy). With hypnosis, people can consciously gain access to the pathogenesis ideas, allowing the normal expression of their pinched energy to take place. This is because the cause of the symptoms is directly addressed. One downside is that the "cathartic method" is only applicable to people who can be deeply hypnotized.

Freud grew up as the oldest child in his family, but with half-brothers who were as old as his mother and a nephew (grandson of Freud's father) who was older than he. By this unusual family composition Freud may have become susceptible to family relationships, which he later emphasizes in his theories. When Freud studied at the University of Vienna, he met the philosopher Franz Brentano, who became his inspiration. In 1874, Brentano published a book, "Psychology from an Empirical Standpoint". In his book, he emphasized the Act psychology, in which he put the essential nature of the subjects within psychology and those within the physical sciences directly opposed to each other. The physical sciences studied objects, while for Brentano, the basic units of psychological analyses were previously actions, which always referred to the contents of an object. For example, where the basic unit of physical analysis was probably an atom, the psychological base unit was an action like thinking about an atom or believing it that a certain atom exists. So all mental phenomena have a component that indicates what they are "about", a way in which the object is involved or implied in the consciousness. This, Brentano called intentionality. 

Brentano also believed that each psychological theory must be dynamic, or able to take into account the influence of the motivational factors on thinking. He also made a distinction between the "objective reality" of physical objects and the “subjective reality” of private thinking. Brentano remained the inspiration for Freud, until he met Brucke. Together with Hermann Hemholtz, Emil Du Bois-Reymond and students of Johannes Muller, Ernest Brucke was the father of the productive new physiology. Vitalism was rejected, and they searched for mechanistic explanations for organic phenomena.

Freud came up with the printing technique, in which patients had to lie down on a couch with their eyes kept closed, as with hypnosis. Then the patient had to go back in thought to the moment that he had experienced the symptoms for the first time. When the patient the memories could no longer be recalled, then Freud pressed with his hand on their forehead. Often the memories came back again. This process was then repeated a number of times, and often it caused relief for the patients. Slowly Freud found out that it was not physical pressure which needed to stimulate their memory. All he had to do was to encourage his patients to let their thoughts go and to press them to heart that they could honestly to say what came to them, even though it seemed irrelevant. By asking for everything, Associations could be formed. This method of free association soon became the new standard treatment of Freud. By focussing his attention more on the associations of the patient and trying to establish a relationship between him and his patient, he made a number of important discoveries:

The pathogenic ideas that were evoked did not have a one-to-one relationship with certain specific symptoms. There was previously a series of pathogenic ideas behind an individual symptom. This was what Freud called "overdetermination". A patient with shivers, associated for example three different emotional memories with their symptoms. Unconscious pathogenic ideas are not forgotten, but rather deliberately suppressed ('repression'). As evidence for this hypothesis, Freud came with the observation that patients often first resisted against the free association process. The unconscious resistance is their complex attitudes towards their illness. On the one hand they suffer from the symptoms and they wanted to get rid of it, but on the other hand there was also the unconscious resistance that got in the way of getting better. Freud thus noted an intrapsychic conflict in the patients.

Another hypothesis developed by Freud had to do with the many experiences that patients shared about sexual abuse in childhood. The hypothesis was that suppressed sexual experiences were necessary for hysteria to be able to develop, because experiences of sexual abuse form the pathogenic ideas. In the seduction theory of hysteria, Freud stated that all patients with nerve attacks were sexually abused as a child. As a child, they had not only experienced it directly as sexual, but as soon as sexual drive emerged in puberty, the memories of the experiences were still highly sexualised in the mind. The memories were emotionally charged, making the patient susceptible to suppressing those memories. Pathogenic ideas were thus replaced by hysterical conversion symptoms. Symptoms functioned as a defence against the psychologically dangerous pathogenic ideas. However, this theory was so badly received that Freud even began to doubt his own experiences. If the free associations are not real memories, what were they? Eventually, after he had researched the meaning and nature of dreams, he corrected his theory.

What is the meaning of dreams?

Freud began to analyse dreams with the help of free association. He distinguished between manifest content and latent content of dreams. He stated that dreams originated from a series of latent thoughts or ideas, which during sleep can be converted into manifest content with the help of three processes: The manifest content symbolizes the latent content. The process of replacement takes place because of psychic energy with a heavily charged latent content, is replaced by a related but emotionally neutral idea from the manifest content. Replacement ('displacement') has a protective function.

Different latent thoughts are symbolized by an image or element from the manifest content. He calls this process reinforcement. This is when two or more latent thoughts are merged into one manifested image. The manifest content reflects latent ideas through concrete experiences or sensations hallucinations. Dreams are not perceived subjectively as thoughts, but rather in the form of sensations. The latent dream thoughts receive concrete representations in the subjective sensations of the manifest content.

Freud felt that the three processes mentioned above were the opposite of the mental activity that is normally associated with logical and scientific thinking. This is because there is a form of thinking in which we use terms that explicitly use to refer to concepts instead of indirectly doing. We also use concepts that are limited in scope are, instead of widely applicable. In logical and scientific thinking, the processes are thus also deliberately available and to a certain extent voluntarily verifiable. When dreaming or creating symptoms, all processes are unconscious, just like symptoms or dreams appear involuntarily. Freud came with two forms (modes) of mental activity. First the unconscious fashion, or the primary process. This process is associated with dreams and it forms some symptoms. According to Freud, babies are born with a capacity for dreams, but they have to learn how to think rationally. Secondly, the conscious fashion, that is the secondary process. This process is responsible for rational thinking.

Freud saw the dreams and the hysterical symptoms in adults as a case involving the secondary thought process but where the primary process forced its way in. So there is a regression (relapse) to earlier and more primitive ways of thinking. Freud later found out that the primary thought process was not just limited to abnormal states, such as dreams and hysteria, but could also play a positive role in creative and artistic thinking. He noted that poets and artists used symbols to indirectly (via allusions) make a clear point ("displacement"), and that they produced work that could be interpreted in different ways ("overdetermination / condensaton"), and that they often symbolize abstract ideas, but in the form of concrete images ("concrete representation"). Also artists often report that they get inspiration for a work of art from scratch. The regression of the primary thinking process therefore has a positive and adaptive purpose. 

So, Freud discovered not the unconscious, but he did set specific rules for the unconscious in which he was sure of a scientific phenomenon. Freud concluded that all dreams contain a wish fulfilment component. So a dream can express a latent wish. Manifest dreams and hysterical symptoms seemed like a lot have in common. Both of them indirectly symbolize unconscious and fear-stopping ideas and both represent a number of unconscious ideas by means of a single image or symptom. Both were a concrete representation of ideas through subjective sensations, and both were created unconsciously and involuntarily. The only difference is the cause. Dream are stimulated by latent dreams, and symptoms by sexual memories. This discovery caused Freud to find an answer for his seduction theory. The sexual experiences that his patients so vividly remembered had never really taken place but were the effect of a dream. This led to the idea that dreams and symptoms both their origin as their structure share and that the sexual memories display a wish instead of actual experiences.

How did Freud think about sexuality in childhood?

Around 1900, childhood was seen as an innocent phase that is disturbed by the physiological developments of puberty. Sexual instinct would only begin to appear in puberty. After the instinct had stabilized, the individual should procreate through means of the genital heterosexual community. Freud's ideas about this were therefore shocking that time. Freud claimed that sexuality is a mental development that affects every child. Freud was also the 'inventor' of the Oedipus complex: the childish desire to obtain sensual pleasure from the parent of the opposite sex, and the wish that the parent of the same sex disappears because that person is the main rival for attention.

Freud proposed a generalized form of the human sexual drive, which is already present from the moment of birth. The goal is physical and sensual pleasure. According to his new theory a baby born in a "polymorphous perversity", is capable of sexual pleasure from stimulation of to get all kinds of body parts. During the baby’s development, number of body parts become erogenous zones, areas where the baby can experience sexual pleasure. 

There will be a number of stages to distinguish. The first phase starts with the mouth, or the oral phase. Once the child starts to be potty trained, the child finds pleasure in the voluntary monitoring of the body functions. This is called the anal phase. Later, when the child has developed complete control over his body, the stimulation of the genital area can become a source of sexual pleasure. Social factors to interact with these developments within the family.

Freud soon discovered deviant character types as a result of fixations in the different phases. Individuals with the oral character type remain interested in oral for the rest of their lives activities such as eating, drinking, smoking and talking. If the child has been spoiled too much, then it can be like adult are very optimistic. If the child was not spoiled, then it can later become pessimistic to be. The phallic or genital character type is characterized by characteristics such as curiosity, exhibitionism and being very competitive.

What is psychoanalytic therapy?

The only thing Freud had to do as a therapist was to encourage free association until the suppressed pathogenic ideas came within consciousness and the symptoms disappeared. But Freud noticed that the patients unconsciously resisted. He argued that the complications in therapy could be due to transference of feelings. Patients were inclined to transform attributions from the past to Freud. The therapy required that as much attention was paid to the transference relationship as to the symptoms. Freud found individual symptoms less important. He saw them as relatively superficial manifestations of an underlying emotional conflict. Every conflict could express itself in different ways, partly through dreams, transference feelings or specific symptoms. Symptoms are therefore not independent entities. The disappearance of a symptom in itself means little, because the conflict occurs can express itself in a different way, until the underlying conflict is discovered and analysed. 

Eventually, psychoanalysis developed, a long and difficult process of self-exploration for relief of symptoms caused by insight into the unconscious mental life of what creates an individual. "Dora" is a case study by Sigmund Freud, that assesses and describes the condition and treatment of Ida Bauer, a woman diagnosed with hysteria who was assigned the pseudonym "Dora". It is one of the most famous works by Freud and is praised for the scientific empiricism of Freud's method, and because of the identification of, among other things, the phenomenon known as transfer ("transference feelings").

Freud focused on discovering the general characteristics of the individual's mind that create symptoms, dreams and 'transferences', together with the normal and everyday mental phenomena. He called the development of a general model for the mind metapsychology. In his book 'The Ego and the Id', Freud states that the mind deals with three demands that come with a conflict. The three requirements are presented by the Id, the Ego and the Superego. The task of the mind is to solve these conflicts as well as possible. First there are the biological and primal needs, such as care, warmth and sexual satisfaction. These are presented by the Id. Freud called these internal biological requirements ‘instincts’. Second come the demands from the outside world. To survive, a person must learn to use and to manipulate his environment, to avoid physical dangers and to satisfy his instincts. Then third, the mind has to deal with moral demands. People do not always act according to all their impulses, because they think that's wrong, even if there is nothing that can stop them. These requirements are presented by the superego. The Ego is the mediator of the spirit. Everything an individual does, according to Freud, it is a compromise of conflicting demands, solved by the Ego.

What are the defence mechanisms?

Defensive mechanisms are a form of compromise of the mind, shaped by the ego.  These are the defence mechanisms:

'Displacement' occurs when someone focuses on a replacement target that is slightly like the original problem but is a safer solution.

Projection occurs when someone is not aware of the internal origin of the unacceptable momentum and the burden reduced by attributing it to someone else.

In 'intellectualization', a number of impulse and emotion-laden objects are directly approached, but then in an intellectual way without emotions being involved.

Other defence mechanisms work on the memory. Examples are:

Denial occurs when a person believes and behaves as if instinct-driven action never occurred.

Rationalization takes place when people act according to impulse A, but explain their behaviour based on a more acceptable impulse B.

Identification, the Oedipus complex disappears, and the latency begins when a child is identifies with the parent of the same sex and with that the prohibition of that parent internalize children's sexuality. Then the moral demands for restraint come from within, instead of from the outside world. The part of the psyche that the internalized parent is the superego.

The superego is the product of the internalization of the obstructing aspects produced by the parent of the same sex. On the basis of free associations, Freud concluded that there are important differences between the typical male and female oedipal conflict. During this phase, little boys and girls become aware of the clear anatomical differences: the presence or absence of the penis. Castration complex can be used by boys and girls take different shape. In boys, the reaction is often fear: they often think something is wrong with them is because they have a penis and others do not. Girls have in fact already been 'castrated' and often respond with jealousy because they also want a penis. Because of this difference Freud came to the conclusion that boys have a greater oedipal fear, and therefore require stronger internalization. So boys have a stronger superego than girls.

Karen Horney (1855-1952) was of the opinion that the penis only has a symbolic role. They also emphasized the role of women in pregnancy and childbirth and suggested that men do get jealous of this feminine experience. Both Horney and Thompson disputed the position that Freud had given to women. Clara Thompson (1893-1958) emphasized that it negative perspective that people had about female sexuality and female sexual organs, was responsible for the feeling of inferiority. She also considered that the Freud's theory about the psychology of women the product was of the kind of feminine patients who had Freud and their cultural and historical position. People are sometimes driven by an aggressive death instinct, which Freud called Thanatos. The ID or life, called Eros. Thanatos and Eros are constantly struggling for power. The death instinct can express itself through the superego; sometimes this happens by producing self-destructive feelings of guilt and sometimes the aggressive impulses on the external world to focus. Different actions were approved in the name of moral values ​​and be executed by the superego.

What did Freud leave behind?

A number of therapists accepted parts of Freud's theory. The school of object relationship, which Melanie Klein (1882-1960), W.R.D. Fairbairn (1889-1964) and D.W. Winnicott (1896-1971) joined,  involved and emphasized the details of relationships, rather than the role of instincts like Freud did. Erik Erikson (1902-1994) came up with a number of psychosocial phases of the development of the child, parallel to the psychosexual phases of Freud. He also added phases for later in the life cycle.

Who is Alfred Adler?

Adler (1870-1937) started his career as an eye doctor. Adler, however, became interested in Freud after reading ‘The Interpretation of Dreams’. Adler was especially interested in the feelings of inferiority during childhood. He claimed that every child has a unique inferiority complex. In 1911, he broke with the psychoanalytic group and created his own school of individual psychology. Adler focused on the therapy in his therapy’s social context, he saw people as social by nature, with an innate capacity that he called social interest. Adler also focused on the effect of birth order. He claimed that different inferiority feelings are typical for children depending on their birth order. His ideas were written down and developed in the Journal of Individual Psychology.

Who was Carl Jung?

Jung (1875-1961) grew up in Switzerland. During his life he was fascinated by his own inner experiences. He wrote a book with the title ‘Memories, Dreams and Reflections’. Jung became an excellent student and started working with the famous psychiatrist Eugen Bleuler. Here, Jung gained experience with schizophrenic patients. Jung also became interested in Freud after reading ‘Interpretation of Dreams’. He developed the word-association test. Jung visited Freud personally, and made a big impression on him and his family. However, he was not always in agreement with Freud. Jung also broke with the psychoanalytic group and started his own movement, called analytical psychology. According to Jung, there are archetypes that do not originate from personal experience but from an innate collective subconscious. Balance was important his theory. He proposed the personality dimension of extroversion introversion. The ideal, according to him, psychological condition was a balance between extroversion and introversion. He developed a model of the psyche, in which the 'self' was central. According to Jung, the self is getting bigger as someone becomes older. Jung especially attracted the attention of people with interest cultural history and art.

ExamTips

• How are Freud's theries about dreams and the unconcious similar?
• How would Freud's theory of the psyche influence our everyday decisions?