Psychoanalysis is a set of psychological and psychotherapeutic theories and associated techniques, originally popularised by Austrian physician Sigmund Freud and stemming partly from the clinical work of Josef Breuer and others. Since then, psychoanalysis has expanded and been revised, reformed and developed in different directions. This was initially by Freud's colleagues and students, such as Alfred Adler and Carl Gustav Jung who went on to develop their own ideas independently from Freud. Later neo-Freudians included Erich Fromm, Karen Horney, Harry Stack Sullivan and Jacques Lacan.
The basic tenets of psychoanalysis include the following:
- besides the inherited constitution of personality, a person's development is determined by events in early childhood;
- human attitude, mannerism, experience, and thought is largely influenced by irrational drives;
- irrational drives are unconscious;
- attempts to bring these drives into awareness meet psychological resistance in the form of defense mechanisms;
- conflicts between conscious and unconscious, or repressed, material can materialise in the form of mental or emotional disturbances, for example: neurosis, neurotic traits, anxiety, depression etc.;
- the liberation from the effects of the unconscious material is achieved through bringing this material into the conscious mind (via e.g. skilled guidance, i.e. therapeutic intervention).
Under the broad umbrella of psychoanalysis there are at least 22 theoretical orientations regarding human mental development. The various approaches in treatment called "psychoanalysis" vary as much as the theories do. The term also refers to a method of analysing child development.
Freudian psychoanalysis refers to a specific type of treatment in which the "analysand" (analytic patient) verbally expresses his thoughts, including free associations, fantasies, and dreams, from which the analyst induces the unconscious conflicts causing the patient's symptoms and character problems, and interprets them for the patient to create insight for resolution of the problems. The analyst confronts and clarifies the patient's pathological defenses, wishes and guilt. Through the analysis of conflicts, including those contributing to resistance and those involving transference onto the analyst of distorted reactions, psychoanalytic treatment can hypothesize how patients unconsciously are their own worst enemies: how unconscious, symbolic reactions that have been stimulated by experience are causing symptoms.
History
1890s
The idea of psychoanalysis first started to receive serious attention under Sigmund Freud. Sigmund Freud formulated his own theory of psychoanalysis in Vienna in the 1890s. Freud was a neurologist trying to find an effective treatment for patients with neurotic orhysterical symptoms. Freud realised that there were mental processes that were not conscious, whilst he was employed as a neurological consultant at the Children's Hospital, where he noticed that many aphasic children had no apparent organic cause for their symptoms. He then wrote a monograph about this subject. In the late 1880s, Freud obtained a grant to study with Jean-Martin Charcot, a famed neurologist and syphilologist, at the Salpêtrière in Paris. Charcot had become interested in patients who had symptoms that mimicked general paresis (neuropsychiatric disorder affecting the brain and central nervous system, caused by syphilis infection).
Freud's first theory to explain hysterical symptoms was presented in Studies on Hysteria (1895), co-authored with his mentor the distinguished physician Josef Breuer, which was generally seen as the birth of psychoanalysis. The work was based on Breuer's treatment of "Anna O.", which the patient herself had dubbed the "talking cure". Breuer wrote that many factors that could result in such symptoms, including various types of emotional trauma, and he also credited work by others such as Pierre Janet; while Freud contended that at the root of hysterical symptoms were repressed memories of distressing occurrences, almost always having direct or indirect sexual associations.
Around the same time Freud attempted to develop a neuro-physiological theory of unconscious mental mechanisms, which he soon gave up. It remained unpublished in his lifetime.
In 1896 Freud published his so-called seduction theory which proposed that the preconditions for hysterical symptoms are sexual excitations in infancy, and he claimed to have uncovered repressed memories of incidents of sexual abuse for all his current patients.However by 1898 he had privately acknowledged to his friend and colleague Wilhelm Fliess that he no longer believed in his theory, though he did not state this publicly until 1906. Though in 1896 he had reported that his patients "had no feeling of remembering the [infantile sexual] scenes", and assured him "emphatically of their unbelief" in later accounts he claimed that they had told him that they had been sexually abused in infancy. This became the received historical account until challenged by several Freud scholars in the latter part of the 20th century who argued that he had imposed his preconceived notions on his patients.However, building on his claims that the patients reported infantile sexual abuse experiences, Freud subsequently contended that his clinical findings in the mid-1890s provided evidence of the occurrence of unconscious fantasies, supposedly to cover up memories of infantile masturbation.Only much later did he claim the same findings as evidence for Oedipal desires.
1900–1940s
By 1900, Freud had theorised that dreams had symbolic significance, and generally were specific to the dreamer. Freud formulated his second psychological theory— which hypothesises that the unconscious has or is a "primary process" consisting of symbolic and condensed thoughts, and a "secondary process" of logical, conscious thoughts. This theory was published in his 1900 book, The Interpretation of Dreams. Chapter VII was a re-working of the earlier "Project" and Freud outlined his "Topographic Theory." In this theory, which was mostly later supplanted by the Structural Theory, unacceptable sexual wishes were repressed into the "System Unconscious," unconscious due to society's condemnation of premarital sexual activity, and this repression created anxiety.
This "topographic theory" is still popular in much of Europe, although it has fallen out of favour in much of North America.In 1905, Freud published Three Essays on the Theory of Sexuality in which he laid out his discovery of so-called psychosexual phases: oral (ages 0–2), anal (2–4), phallic-oedipal (today called 1st genita) (3–6), latency (6-puberty), and mature genital (puberty-onward). His early formulation included the idea that because of societal restrictions, sexual wishes were repressed into an unconscious state, and that the energy of these unconscious wishes could be turned into anxiety or physical symptoms. Therefore the early treatment techniques, including hypnotism and abreaction, were designed to make the unconscious conscious in order to relieve the pressure and the apparently resulting symptoms.
In On Narcissism (1915) Freud turned his attention to the subject of narcissism. Still using an energic system, Freud characterized the difference between energy directed at the self versus energy directed at others, called cathexis. By 1917, In "Mourning and Melancholia," he suggested that certain depressions were caused by turning guilt-ridden anger on the self. In 1919 in "A Child is Being Beaten" he began to address the problems of self-destructive behavior (moral masochism) and frank sexual masochism.Based on his experience with depressed and self-destructive patients, and pondering the carnage of World War I, Freud became dissatisfied with considering only oral and sexual motivations for behavior. By 1920, Freud addressed the power of identification (with the leader and with other members) in groups as a motivation for behavior (Group Psychology and Analysis of the Ego). In that same year (1920) Freud suggested his "dual drive" theory of sexuality and aggression in Beyond the Pleasure Principle, to try to begin to explain human destructiveness. Also, it was the first appearance of his "structural theory" consisting three new concepts id, ego, and superego.
Three years later, he summarised the ideas of id, ego, and superego in a book entitled, The Ego and the Id. In the book, he revised the whole theory of mental functioning, now considering that repression was only one of many defense mechanisms, and that it occurred to reduce anxiety. Hence, Freud characterised repression as both a cause and a result of anxiety. In 1926, in Inhibitions, Symptoms and Anxiety, Freud characterised how intrapsychic conflict among drive and superego (wishes and guilt) caused anxiety, and how that anxiety could lead to an inhibition of mental functions, such as intellect and speech. Inhibitions, Symptoms and Anxiety was written in response to Otto Rank, who, in 1924, published Das Trauma der Geburt (translated into English in 1929 as The Trauma of Birth), analysing how art, myth, religion, philosophy and therapy were illuminated by separation anxiety in the "phase before the development of the Oedipus complex" (p. 216). Freud's theories, however, characterized no such phase. According to Freud, the Oedipus complex, was at the centre of neurosis, and was the foundational source of all art, myth, religion, philosophy, therapy—indeed of all human culture and civilization. It was the first time that anyone in the inner circle had had characterised something other than the Oedipus complex as contributing to intrapsychic development, a notion that was rejected by Freud and his followers at the time.
By 1936, the "Principle of Multiple Function" was clarified by Robert Waelder. He widened the formulation that psychological symptoms were caused by and relieved conflict simultaneously. Moreover, symptoms (such as phobias and compulsions) each represented elements of some drive wish (sexual and/or aggressive), superego, anxiety, reality, and defenses. Also in 1936, Anna Freud, Sigmund's famous daughter, published her seminal book, The Ego and the Mechanisms of Defense, outlining numerous ways the mind could shut upsetting things out of consciousness.
1940s–2000s
Following the death of Freud, a new group of psychoanalysts began to explore the function of the ego. Led by Heinz Hartmann, Kris, Rappaport and Lowenstein, the group built upon understandings of the synthetic function of the ego as a mediator in psychic functioning. Hartmann in particular distinguished between autonomous ego functions (such as memory and intellect which could be secondarily affected by conflict) and synthetic functions which were a result of compromise formation. These "Ego Psychologists" of the '50s paved a way to focus analytic work by attending to the defenses (mediated by the ego) before exploring the deeper roots to the unconscious conflicts. In addition there was burgeoning interest in child psychoanalysis. Although criticized since its inception, psychoanalysis has been used as a research tool into childhood development, and is still used to treat certain mental disturbances. In the 1960s, Freud's early thoughts on the childhood development of female sexuality were challenged; this challenge led to the development of a variety of understandings of female sexual development, many of which modified the timing and normality of several of Freud's theories (which had been gleaned from the treatment of women with mental disturbances). Several researchers followed Karen Horney's studies of societal pressures that influence the development of women. Most contemporary North American psychoanalysts employ theories that, while based on those of Sigmund Freud, include many modifications of theory and practice developed since his death in 1939.
In the first decade of the 21st century there are approximately 35 training institutes for psychoanalysis in the United States accredited by the American Psychoanalytic Association (APsaA), which is a component organization of the International Psychoanalytical Association (IPA), and there are over 3000 graduated psychoanalysts practicing in the United States. The IPA accredits psychoanalytic training centers through such "component organisations" throughout the rest of the world, including countries such as Serbia, France, Germany, Austria, Italy, Switzerland, and many others, as well as about six institutes directly in the U.S.
Theories
The predominant psychoanalytic theories can be organised into several theoretical "schools." Although these theoretical "schools" differ, most of them continue to emphasise the strong influence of unconscious elements affecting people's mental lives. There has also been considerable work done on consolidating elements of conflicting theory (cf. the work of Theodore Dorpat, B. Killingmo, and S. Akhtar). As in all fields of healthcare, there are some persistent conflicts regarding specific causes of some syndromes, and disputes regarding the best treatment techniques. In the 21st century, psychoanalytic ideas are embedded in Western culture, especially in fields such as childcare, education, literary criticism, cultural studies, and mental health, particularly psychotherapy. Though there is a mainstream of evolved analytic ideas, there are groups who follow the precepts of one or more of the later theoreticians. Psychoanalytic ideas also play roles in some types of literary analysis such as Archetypal literary criticism.
Topographic theory
Topographic theory was named and first described by Freud in The Interpretation of Dreams (1900). The theory hypothesises that the mental apparatus can be divided into the systems Conscious, Pre-conscious and Unconscious. These systems are not anatomical structures of the brain but, rather, mental processes. Although Freud retained this theory throughout his life he largely replaced it with the Structural theory. The Topographic theory remains as one of the metapsychological points of view for describing how the mind functions in classical psychoanalytic theory.
Structural theory
Structural theory divides the psyche into the id, the ego, and the super-ego. The id is present at birth as the repository of basic instincts, which Freud called "Triebe" ("drives"): unorganised and unconscious, it operates merely on the 'pleasure principle', without realism or foresight. The ego develops slowly and gradually, being concerned with mediating between the urgings of the id and the realities of the external world; it thus operates on the 'reality principle'. The super-ego is held to be the part of the ego in which self-observation, self-criticism and other reflective and judgemental faculties develop. The ego and the super-ego are both partly conscious and partly unconscious.
Ego psychology
Ego psychology was initially suggested by Freud in Inhibitions, Symptoms and Anxiety (1926). The theory was refined by Hartmann, Loewenstein, and Kris in a series of papers and books from 1939 through the late 1960s. Leo Bellak was a later contributor. This series of constructs, paralleling some of the later developments of cognitive theory, includes the notions of autonomous ego functions: mental functions not dependent, at least in origin, on intrapsychic conflict. Such functions include: sensory perception, motor control, symbolic thought, logical thought, speech, abstraction, integration (synthesis), orientation, concentration, judgment about danger, reality testing, adaptive ability, executive decision-making, hygiene, and self-preservation. Freud noted that inhibition is one method that the mind may utilize to interfere with any of these functions in order to avoid painful emotions. Hartmann (1950s) pointed out that there may be delays or deficits in such functions.
Frosch (1964) described differences in those people who demonstrated damage to their relationship to reality, but who seemed able to test it. Deficits in the capacity to organize thought are sometimes referred to as blocking or loose associations (Bleuler), and are characteristic of the schizophrenias. Deficits in abstraction ability and self-preservation also suggest psychosis in adults. Deficits in orientation and sensorium are often indicative of a medical illness affecting the brain (and therefore, autonomous ego functions). Deficits in certain ego functions are routinely found in severely sexually or physically abused children, where powerful effects generated throughout childhood seem to have eroded some functional development.
Modern conflict theory
A variation of ego psychology, termed "modern conflict theory", is more broadly an update and revision of structural theory (Freud, 1923, 1926); it does away with some of structural theory's more arcane features, such as where repressed thoughts are stored. Modern conflict theory centres around how emotional symptoms and character traits are complex solutions to mental conflict. It dispenses with the concepts of a fixed id, ego and superego, and instead posits conscious and unconscious conflict among wishes (dependent, controlling, sexual, and aggressive), guilt and shame, emotions (especially anxiety and depressive affect), and defensive operations that shut off from consciousness some aspect of the others. Moreover, healthy functioning (adaptive) is also determined, to a great extent, by resolutions of conflict.
A major objective of modern conflict-theory psychoanalysis is to change the balance of conflict in a patient by making aspects of the less adaptive solutions (also called "compromise formations") conscious so that they can be rethought, and more adaptive solutions found. Current theoreticians following Brenner's many suggestions (see especially Brenner's 1982 book, The Mind in Conflict) include Sandor Abend, MD (Abend, Porder, & Willick, (1983), Borderline Patients: Clinical Perspectives), Jacob Arlow (Arlow and Brenner (1964), Psychoanalytic Concepts and the Structural Theory), and Jerome Blackman (2003), 101 Defenses: How the Mind Shields Itself).
Object relations theory
Object relations theory attempts to explain the ups and downs of human relationships through a study of how internal representations of the self and others are organised. The clinical symptoms that suggest object relations problems (typically developmental delays throughout life) include disturbances in an individual's capacity to feel warmth, empathy, trust, sense of security, identity stability, consistent emotional closeness, and stability in relationships with significant others. (It is not suggested that one should trust everyone, for example.) Concepts regarding internal representations (also sometimes termed, "introjects," "self and object representations," or "internalizations of self and other") although often attributed to Melanie Klein, were actually first mentioned by Sigmund Freud in his early concepts of drive theory (Three Essays on the Theory of Sexuality, 1905). Freud's 1917 paper "Mourning and Melancholia", for example, hypothesized that unresolved grief was caused by the survivor's internalized image of the deceased becoming fused with that of the survivor, and then the survivor shifting unacceptable anger toward the deceased onto the now complex self-image.
Vamik Volkan, in "Linking Objects and Linking Phenomena", expanded on Freud's thoughts on this, describing the syndromes of "Established pathological mourning" vs. "reactive depression" based on similar dynamics. Melanie Klein's hypotheses regarding internalizations during the first year of life, leading to paranoid and depressive positions, were later challenged by René Spitz (e.g., The First Year of Life, 1965), who divided the first year of life into a coenesthetic phase of the first six months, and then a diacritic phase for the second six months. Margaret Mahler (Mahler, Fine, and Bergman, "The Psychological Birth of the Human Infant", 1975) and her group, first in New York, then in Philadelphia, described distinct phases and subphases of child development leading to "separation-individuation" during the first three years of life, stressing the importance of constancy of parental figures, in the face of the child's destructive aggression, to the child's internalizations, stability of affect management, and ability to develop healthy autonomy.
Later developers of the theory of self and object constancy as it affects adult psychiatric problems such as psychosis and borderline states have been John Frosch, Otto Kernberg, Salman Akhtar and Sheldon Bach. Peter Blos described (in a book called On Adolescence, 1960) how similar separation-individuation struggles occur during adolescence, of course with a different outcome from the first three years of life: the teen usually, eventually, leaves the parents' house (this varies with the culture). During adolescence, Erik Erikson (1950–1960s) described the "identity crisis," that involves identity-diffusion anxiety. In order for an adult to be able to experience "Warm-ETHICS" (warmth, empathy, trust, holding environment (Winnicott), identity, closeness, and stability) in relationships (see Blackman, 101 Defenses: How the Mind Shields Itself, 2001), the teenager must resolve the problems with identity and redevelop self and object constancy.
Interpersonal psychoanalysis
Interpersonal psychoanalysis accents the nuances of interpersonal interactions, particularly how individuals protect themselves from anxiety by establishing collusive interactions with others, and the relevance of actual experiences with other persons developmentally (e.g. family and peers) as well as in the present. This is contrasted with the primacy of intrapsychic forces, as in classical psychoanalysis. Interpersonal theory was first introduced by Harry Stack Sullivan, MD, and developed further by Frieda Fromm-Reichmann, Clara Thompson, Erich Fromm, and others who contributed to the founding of the William Alanson White Institute and Interpersonal Psychoanalysis in general.
Modern psychoanalysis
"Modern psychoanalysis" is a term coined by Hyman Spotnitz and his colleagues to describe a body of theoretical and clinical approaches that aim to extend Freud's theories so as to make them applicable to the full spectrum of emotional disorders and broaden the potential for treatment to pathologies thought to be untreatable by classical methods. Interventions based on this approach are primarily intended to provide an emotional-maturational communication to the patient, rather than to promote intellectual insight. These interventions, beyond insight directed aims, are used to resolve resistances that are presented in the clinical setting. This school of psychoanalysis has fostered training opportunities for students in the United States and from countries worldwide. Its journal Modern Psychoanalysis has been published since 1976.
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