New Introductory Lectures on Psychoanalysis

Ideas

Early work

Freud began his study of medicine at the University of Vienna in 1873.[94] He took almost nine years to complete his studies, due to his interest in neurophysiological research, specifically investigation of the sexual anatomy of eels and the physiology of the fish nervous system, and because of his interest in studying philosophy with Franz Brentano. He entered private practice in neurology for financial reasons, receiving his M.D. degree in 1881 at the age of 25.[95] Amongst his principal concerns in the 1880s was the anatomy of the brain, specifically the medulla oblongata. He intervened in the important debates about aphasia with his monograph of 1891, Zur Auffassung der Aphasien, in which he coined the term agnosia and counselled against a too locationist view of the explanation of neurological deficits. Like his contemporary Eugen Bleuler, he emphasized brain function rather than brain structure.

Freud was also an early researcher in the field of cerebral palsy, which was then known as "cerebral paralysis". He published several medical papers on the topic, and showed that the disease existed long before other researchers of the period began to notice and study it. He also suggested that William John Little, the man who first identified cerebral palsy, was wrong about lack of oxygen during birth being a cause. Instead, he suggested that complications in birth were only a symptom. Freud hoped that his research would provide a solid scientific basis for his therapeutic technique. The goal of Freudian therapy, or psychoanalysis, was to bring repressed thoughts and feelings into consciousness in order to free the patient from suffering repetitive distorted emotions.

Classically, the bringing of unconscious thoughts and feelings to consciousness is brought about by encouraging a patient to talk about dreams and engage in free association, in which patients report their thoughts without reservation and make no attempt to concentrate while doing so.[96] Another important element of psychoanalysis is transference, the process by which patients displace onto their analysts feelings and ideas which derive from previous figures in their lives. Transference was first seen as a regrettable phenomenon that interfered with the recovery of repressed memories and disturbed patients' objectivity, but by 1912, Freud had come to see it as an essential part of the therapeutic process.[97]

The origin of Freud's early work with psychoanalysis can be linked to Josef Breuer. Freud credited Breuer with opening the way to the discovery of the psychoanalytical method by his treatment of the case of Anna O. In November 1880, Breuer was called in to treat a highly intelligent 21-year-old woman (Bertha Pappenheim) for a persistent cough that he diagnosed as hysterical. He found that while nursing her dying father, she had developed a number of transitory symptoms, including visual disorders and paralysis and contractures of limbs, which he also diagnosed as hysterical. Breuer began to see his patient almost every day as the symptoms increased and became more persistent, and observed that she entered states of absence. He found that when, with his encouragement, she told fantasy stories in her evening states of absence her condition improved, and most of her symptoms had disappeared by April 1881. Following the death of her father in that month her condition deteriorated again. Breuer recorded that some of the symptoms eventually remitted spontaneously, and that full recovery was achieved by inducing her to recall events that had precipitated the occurrence of a specific symptom.[98] In the years immediately following Breuer's treatment, Anna O. spent three short periods in sanatoria with the diagnosis "hysteria" with "somatic symptoms",[99] and some authors have challenged Breuer's published account of a cure.[100][101][102] Richard Skues rejects this interpretation, which he sees as stemming from both Freudian and anti-psychoanalytical revisionism, that regards both Breuer's narrative of the case as unreliable and his treatment of Anna O. as a failure.[103]

Seduction theory

In the early 1890s, Freud used a form of treatment based on the one that Breuer had described to him, modified by what he called his "pressure technique" and his newly developed analytic technique of interpretation and reconstruction. According to Freud's later accounts of this period, as a result of his use of this procedure most of his patients in the mid-1890s reported early childhood sexual abuse. He believed these stories, which he used as the basis for his seduction theory, but then he came to believe that they were fantasies. He explained these at first as having the function of "fending off" memories of infantile masturbation, but in later years he wrote that they represented Oedipal fantasies, stemming from innate drives that are sexual and destructive in nature.[104]

Another version of events focuses on Freud's proposing that unconscious memories of infantile sexual abuse were at the root of the psychoneuroses in letters to Fliess in October 1895, before he reported that he had actually discovered such abuse among his patients.[105] In the first half of 1896, Freud published three papers, which led to his seduction theory, stating that he had uncovered, in all of his current patients, deeply repressed memories of sexual abuse in early childhood.[106] In these papers, Freud recorded that his patients were not consciously aware of these memories, and must therefore be present as unconscious memories if they were to result in hysterical symptoms or obsessional neurosis. The patients were subjected to considerable pressure to "reproduce" infantile sexual abuse "scenes" that Freud was convinced had been repressed into the unconscious.[107] Patients were generally unconvinced that their experiences of Freud's clinical procedure indicated actual sexual abuse. He reported that even after a supposed "reproduction" of sexual scenes the patients assured him emphatically of their disbelief.[108]

As well as his pressure technique, Freud's clinical procedures involved analytic inference and the symbolic interpretation of symptoms to trace back to memories of infantile sexual abuse.[109] His claim of one hundred percent confirmation of his theory only served to reinforce previously expressed reservations from his colleagues about the validity of findings obtained through his suggestive techniques.[110] Freud subsequently showed inconsistency as to whether his seduction theory was still compatible with his later findings.[111] In an addendum to The Aetiology of Hysteria he stated: "All this is true [the sexual abuse of children]; but it must be remembered that at the time I wrote it I had not yet freed myself from my overvaluation of reality and my low valuation of phantasy".[112] Some years later Freud explicitly rejected the claim of his colleague Ferenczi that his patients’ reports of sexual molestation were actual memories instead of fantasies, and he tried to dissuade Ferenczi from making his views public.[111] Dr. Karin Ahbel-Rappe concludes in her study ""I no longer believe": did Freud abandon the seduction theory?’’: "Freud marked out and started down a trail of investigation into the nature of the experience of infantile incest and its impact on the human psyche, and then abandoned this direction for the most part."[113]

Cocaine

As a medical researcher, Freud was an early user and proponent of cocaine as a stimulant as well as analgesic. He believed that cocaine was a cure for many mental and physical problems, and in his 1884 paper "On Coca" he extolled its virtues. Between 1883 and 1887 he wrote several articles recommending medical applications, including its use as an antidepressant. He narrowly missed out on obtaining scientific priority for discovering its anesthetic properties of which he was aware but had mentioned only in passing.[114] (Karl Koller, a colleague of Freud's in Vienna, received that distinction in 1884 after reporting to a medical society the ways cocaine could be used in delicate eye surgery.) Freud also recommended cocaine as a cure for morphine addiction.[115] He had introduced cocaine to his friend Ernst von Fleischl-Marxow who had become addicted to morphine taken to relieve years of excruciating nerve pain resulting from an infection acquired while performing an autopsy. His claim that Fleischl-Marxow was cured of his addiction was premature, though he never acknowledged he had been at fault. Fleischl-Marxow developed an acute case of "cocaine psychosis", and soon returned to using morphine, dying a few years later after more suffering from intolerable pain.[116]

The application as an anesthetic turned out to be one of the few safe uses of cocaine, and as reports of addiction and overdose began to filter in from many places in the world, Freud's medical reputation became somewhat tarnished.[117]

After the "Cocaine Episode"[118] Freud ceased to publicly recommend use of the drug, but continued to take it himself occasionally for depression, migraine and nasal inflammation during the early 1890s, before discontinuing in 1896.[119] In this period he came under the influence of his friend and confidant Fliess, who recommended cocaine for the treatment of the so-called nasal reflex neurosis. Fliess, who operated on the noses of several of his own patients, also performed operations on Freud and on one of Freud's patients whom he believed to be suffering from the disorder, Emma Eckstein. The surgery proved disastrous.[120] It has been suggested that much of Freud's early psychoanalytical theory was a by-product of his cocaine use.[121]

The Unconscious

The concept of the unconscious was central to Freud's account of the mind. Freud believed that while poets and thinkers had long known of the existence of the unconscious, he had ensured that it received scientific recognition in the field of psychology. The concept made an informal appearance in Freud's writings.

The unconscious was first introduced in connection with the phenomenon of repression, to explain what happens to ideas that are repressed. Freud stated explicitly that the concept of the unconscious was based on the theory of repression. He postulated a cycle in which ideas are repressed, but remain in the mind, removed from consciousness yet operative, then reappear in consciousness under certain circumstances. The postulate was based upon the investigation of cases of traumatic hysteria, which revealed cases where the behavior of patients could not be explained without reference to ideas or thoughts of which they had no awareness. This fact, combined with the observation that such behavior could be artificially induced by hypnosis, in which ideas were inserted into people's minds, suggested that ideas were operative in the original cases, even though their subjects knew nothing of them.

Freud, like Josef Breuer, found the hypothesis that hysterical manifestations were generated by ideas to be not only warranted, but given in observation. Disagreement between them arose when they attempted to give causal explanations of their data: Breuer favored a hypothesis of hypnoid states, while Freud postulated the mechanism of defense. Richard Wollheim comments that given the close correspondence between hysteria and the results of hypnosis, Breuer's hypothesis appears more plausible, and that it is only when repression is taken into account that Freud's hypothesis becomes preferable.[122]

Freud originally allowed that repression might be a conscious process, but by the time he wrote his second paper on the "Neuro-Psychoses of Defence" (1896), he apparently believed that repression, which he referred to as "the psychical mechanism of (unconscious) defense", occurred on an unconscious level. Freud further developed his theories about the unconscious in The Interpretation of Dreams (1899) and in Jokes and Their Relation to the Unconscious (1905), where he dealt with condensation and displacement as inherent characteristics of unconscious mental activity. Freud presented his first systematic statement of his hypotheses about unconscious mental processes in 1912, in response to an invitation from the London Society of Psychical Research to contribute to its Proceedings. In 1915, Freud expanded that statement into a more ambitious metapsychological paper, entitled "The Unconscious". In both these papers, when Freud tried to distinguish between his conception of the unconscious and those that predated psychoanalysis, he found it in his postulation of ideas that are simultaneously latent and operative.[122]

Dreams

Freud believed that the function of dreams is to preserve sleep by representing as fulfilled wishes that would otherwise awaken the dreamer.[123]

In Freud's theory dreams are instigated by the daily occurrences and thoughts of everyday life. His claim that they function as wish fulfillments is based on an account of the “dreamwork" in terms of a transformation of "secondary process" thought, governed by the rules of language and the reality principle, into the "primary process" of unconscious thought governed by the pleasure principle, wish gratification and the repressed sexual scenarios of childhood.[124]

In order to preserve sleep the dreamwork disguises the repressed or “latent" content of the dream in an interplay of words and images which Freud describes in terms of condensation, displacement and distortion. This produces the "manifest content" of the dream as recounted in the dream narrative. For Freud an unpleasant manifest content may still represent the fulfilment of a wish on the level of the latent content. In the clinical setting Freud encouraged free association to the dream's manifest content in order to facilitate access to its latent content. Freud believed interpreting dreams in this way could provide important insights into the formation of neurotic symptoms and contribute to the mitigation of their pathological effects.[125]

Psychosexual development

Freud's theory of psychosexual development proposes that, following on from the initial polymorphous perversity of infantile sexuality, the sexual "drives" pass through the distinct developmental phases of the oral, the anal and the phallic. Though these phases then give way to a latency stage of reduced sexual interest and activity (from around the age of approximately five up until puberty), they leave, to a greater or lesser extent, a "perverse" and bisexual residue which persists during the formation of adult genital sexuality. Freud argued that neurosis or perversion could be explained in terms of fixation or regression to these phases whereas adult character and cultural creativity could achieve a sublimation of their perverse residue.[126]

After Freud's later development of the theory of the Oedipus Complex this normative developmental trajectory becomes formulated in terms of the child's renunciation of incestuous desires under the phantasised threat of (or phantasised fact of, in the case of the girl) castration.[127] The "dissolution" of the Oedipus Complex is then achieved when the child's rivalrous identification with the parental figure is transformed into the pacifying identifications of the Ego ideal which assume both similarity and difference and acknowledge the separateness and autonomy of the other.[128]

Freud hoped to prove that his model was universally valid and turned to ancient mythology and contemporary ethnography for comparative material arguing that totemism reflected a ritualized enactment of a tribal Oedipal conflict.[129]

Id, ego and super-ego

Freud proposed that the human psyche could be divided into three parts: Id, ego and super-ego. Freud discussed this model in the 1920 essay Beyond the Pleasure Principle, and fully elaborated upon it in The Ego and the Id (1923), in which he developed it as an alternative to his previous topographic schema (i.e., conscious, unconscious and preconscious). The id is the completely unconscious, impulsive, childlike portion of the psyche that operates on the "pleasure principle" and is the source of basic impulses and drives; it seeks immediate pleasure and gratification.[130]

Freud acknowledged that his use of the term Id (das Es, "the It") derives from the writings of Georg Groddeck.[131] The super-ego is the moral component of the psyche, which takes into account no special circumstances in which the morally right thing may not be right for a given situation. The rational ego attempts to exact a balance between the impractical hedonism of the id and the equally impractical moralism of the super-ego; it is the part of the psyche that is usually reflected most directly in a person's actions. When overburdened or threatened by its tasks, it may employ defence mechanisms including denial, repression, undoing, rationalization, and displacement. This concept is usually represented by the "Iceberg Model".[132] This model represents the roles the Id, Ego, and Super Ego play in relation to conscious and unconscious thought.

Freud compared the relationship between the ego and the id to that between a charioteer and his horses: the horses provide the energy and drive, while the charioteer provides direction.[130]

Life and death drives

Freud believed that people are driven by two conflicting central desires: the life drive (libido or Eros) (survival, propagation, hunger, thirst, and sex) and the death drive. The death drive was also termed "Thanatos", although Freud did not use that term; "Thanatos" was introduced in this context by Paul Federn.[133] Freud hypothesized that libido is a form of mental energy with which processes, structures and object-representations are invested.[134] Prior to the war, Freud believes, fiction had constituted a different mode of relation to death, a place of compensation in which "the condition for reconciling ourselves to death is fulfilled, namely, if beneath all vicissitudes of life a permanent life still remains to us".[135]

In Beyond the Pleasure Principle, Freud inferred the existence of the death instinct. Its premise was a regulatory principle that has been described as "the principle of psychic inertia", "the Nirvana principle", and "the conservatism of instinct". Its background was Freud's earlier Project for a Scientific Psychology, where he had defined the principle governing the mental apparatus as its tendency to divest itself of quantity or to reduce tension to zero. Freud had been obliged to abandon that definition, since it proved adequate only to the most rudimentary kinds of mental functioning, and replaced the idea that the apparatus tends toward a level of zero tension with the idea that it tends toward a minimum level of tension.[136]

Freud in effect readopted the original definition in Beyond the Pleasure Principle, this time applying it to a different principle. He asserted that on certain occasions the mind acts as though it could eliminate tension entirely, or in effect to reduce itself to a state of extinction; his key evidence for this was the existence of the compulsion to repeat. Examples of such repetition included the dream life of traumatic neurotics and children's play. In the phenomenon of repetition, Freud saw a psychic trend to work over earlier impressions, to master them and derive pleasure from them, a trend was prior to the pleasure principle but not opposed to it. In addition to that trend, there was also a principle at work that was opposed to, and thus "beyond" the pleasure principle. If repetition is a necessary element in the binding of energy or adaptation, when carried to inordinate lengths it becomes a means of abandoning adaptations and reinstating earlier or less evolved psychic positions. By combining this idea with the hypothesis that all repetition is a form of discharge, Freud reached the conclusion that the compulsion to repeat is an effort to restore a state that is both historically primitive and marked by the total draining of energy: death.[136]

Femininity and female sexuality

Initiating what became the first debate within psychoanalysis on femininity, Karen Horney of the Berlin Institute set out to challenge Freud's account of the development of feminine sexuality. Rejecting Freud's theories of the feminine castration complex and penis envy, Horney argued for a primary femininity and penis envy as a defensive formation rather than arising from the fact, or "injury", of biological asymmetry as Freud held. Horney had the influential support of Melanie Klein and Ernest Jones who coined the term "phallocentrism" in his critique of Freud's position.[137]

In defending Freud against this critique, feminist scholar Jacqueline Rose has argued that it presupposes a more normative account of female sexual development than that given by Freud. She notes that Freud moved from a description of the little girl stuck with her 'inferiority' or 'injury' in the face of the anatomy of the little boy to an account in his later work which explicitly describes the process of becoming 'feminine' as an 'injury' or 'catastrophe' for the complexity of her earlier psychic and sexual life.[138]

According to Freud, "Elimination of clitoral sexuality is a necessary precondition for the development of femininity, since it is immature and masculine in its nature."[139] Freud postulated the concept of "vaginal orgasm" as separate from clitoral orgasm, achieved by external stimulation of the clitoris. In 1905, he stated that clitoral orgasms are purely an adolescent phenomenon and that, upon reaching puberty, the proper response of mature women is a change-over to vaginal orgasms, meaning orgasms without any clitoral stimulation. This theory has been criticized on the grounds that Freud provided no evidence for this basic assumption, and because it made many women feel inadequate when they could not achieve orgasm via vaginal intercourse alone.[140][141][142][143]

Religion

Freud regarded the monotheistic God as an illusion based upon the infantile emotional need for a powerful, supernatural pater familias. He maintained that religion – once necessary to restrain man's violent nature in the early stages of civilization – in modern times, can be set aside in favor of reason and science.[144] "Obsessive Actions and Religious Practices" (1907) notes the likeness between faith (religious belief) and neurotic obsession.[145] Totem and Taboo (1913) proposes that society and religion begin with the patricide and eating of the powerful paternal figure, who then becomes a revered collective memory.[146] These arguments were further developed in The Future of an Illusion (1927) in which Freud argued that religious belief serves the function of psychological consolation. Freud argues the belief of a supernatural protector serves as a buffer from man's "fear of nature" just as the belief in an afterlife serves as a buffer from man's fear of death. The core idea of the work is that all of religious belief can be explained through its function to society, not for its relation to the truth. This is why, according to Freud, religious beliefs are "illusions". In Civilization and Its Discontents (1930), he quotes his friend Romain Rolland, who described religion as an "oceanic sensation", but says he never experienced this feeling.[147] Moses and Monotheism (1937) proposes that Moses was the tribal pater familias, killed by the Jews, who psychologically coped with the patricide with a reaction formation conducive to their establishing monotheist Judaism;[148] analogously, he described the Roman Catholic rite of Holy Communion as cultural evidence of the killing and devouring of the sacred father.[89][149]

Moreover, he perceived religion, with its suppression of violence, as mediator of the societal and personal, the public and the private, conflicts between Eros and Thanatos, the forces of life and death.[150] Later works indicate Freud's pessimism about the future of civilization, which he noted in the 1931 edition of Civilization and its Discontents.[151]

In a footnote of his 1909 work, Analysis of a Phobia in a Five year old Boy, Freud theorized that the universal fear of castration was provoked in the uncircumcised when they perceived circumcision and that this was "the deepest unconscious root of anti-Semitism."[152]


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