When Theories Touch

A Historical and Theoretical Integration of Psychoanalytic Thought

Steven J. Ellman

• Publisher: Routledge
• Year: 2020
• ISBN:
  9780429923937
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

This book aims to deconstruct the different theoretical perspectives of psychoanalysis, and reconstruct these concepts in a language that is readily understood. Wherever possible this is meant not to do away with terms that are meaningful, but to attempt to clarify terms and concepts. The book comes in three sections. The first examines Freud's different theories and describes how Freud shifted his emphasis over time. The second section covers all the major post-Freudian theorists: Hartmann and Anna Freud (together in one chapter), Melanie Klein, Fairbairn, Winnicott, Sullivan, Mahler, Kohut, Kernberg, and Bion; and a chapter on the movement from classical theory to contemporary conflict theory. The last section deals with issues raised in contemporary psychoanalysis - issues as they pertain to the clinical situation, and the rationale for a theory of endogenous stimulation.

Part I
Freud Chapters

Chapter One

Freud’s heroic era: the first ten years

Slightly before, slightly beyond

Chapter summary

The title of the chapter is from Walter Stewart’s book, Psychoanalysis: The First Ten Years (1963). In this chapter we look at the beginning of Freud’s career as a therapist and an emerging psychoanalyst. He attempts to formulate a theory where psychological disturbances are caused by a combination of environmental events and physiological conditions. He is strongly influenced by the neurophysiologists of his era, and the familiar Freudian concepts such as fantasy and transference do not play a prominent role in the theory of this era. Rather, in adults there are actual causes that produce neurotic symptoms. The sexual practices of the era are thought by Freud to produce symptoms such as anxiety and neurasthenia. He calls neuroses that are produced by sexual practices, such as excessive masturbation or coitus interruptus, actual neuroses. Neuroses that are caused by conditions in childhood are called psychogenic neuroses, but these disorders are also caused by “real” events, trauma in childhood. The trauma that Freud finds most often involves sexual abuse (before the child’s eighth birthday). This is a real event that causes psychological disturbance, and here Freud uses the concept of undischarged tension or libido to explain both the actual and psychological neuroses. Freud’s emerging psychological treatment is one where he is attempting to extirpate pathogenic memories through the cathartic method. In effect, he is attempting to have patients experience strong emotional reaction (abreaction) by bringing memories to consciousness. In this period, Freud has not fully developed the idea of unconscious ideas and his treatment method involves trying to pressure patients into remembering and abreacting. During this era, Freud moves from the use of hypnosis (Breuer’s technique) to a psychotherapy that is labelled the pressure technique.

Despite the fact that Freud has not yet developed his psychoanalytic theory, one can see many of his concepts in embryonic form. The concept of defence, resistance, and the beginning of the concept of unconscious motivation all have their roots in this period of Freud’s career. There are, of course, many other fragments in his emerging theory, including ideas about dreams and the importance of fantasy. Freud also begins his self-analysis during this period, and this is one factor that will lead Freud to question whether his patient’s reports of sexual abuse are real or the product of fantasy developed early in the person’s life.

Brief historical introduction

In 1882, a meeting occurred that contributed to changing the history of psychiatry and, indeed, of intellectual life in the Western hemisphere during the twentieth century and perhaps beyond. In this meeting, Josef Breuer told Sigmund Freud about his treatment of Anna O (Bertha Pappenheim). This discussion strongly contributed to Freud’s subsequent decision to begin to study hysteria. Freud began to collaborate with Breuer a number of years after this conversation, and in the interim he studied with Charcot and learnt about the views of Janet and Bernheim. He also translated and wrote a preface to Bernheim’s (1888) book Suggestion. Although various analysts have tried to minimize the effect of Breuer’s work and theoretical formulations on Freud, in my view it was the intrigue of the narrative that Breuer was experiencing with Bertha Pappenheim that captured Freud. Breuer, at this point in time, was a sophisticated reader of the scientific literature and his views about cortical tonicity also influenced Freud at various points in his career. However, it was the narrative of Ms Pappenheim and of the patients after her, in what Stewart (1963) calls Freud’s heroic period, that truly fascinated the young physician whose literary tendencies in many ways were more prominent than his scientific interests (Steiner, 2001).

It is not the aim of the present chapter(s) to trace the intellectual influences on Freud; rather, we will evaluate his contributions as the most convincing evidence of how the intellectual ferment of his era affected his writings. We begin this chapter at a time (1892–1898) when Freud is starting to revolutionize the world of psychiatry with his theoretical concepts and his new psychotherapeutic technique. At this point in his career, Freud’s theoretical attempts are intimately intermingled with his therapeutic venture. (In a previous volume [1991] I expressed the view that, as Freud’s career progressed, he became increasingly involved in theoretical issues and that the psychoanalytic situation lost a position of primary importance. This was not a linear progression, for, in the era 1907–1916, he was active in writing about psychoanalytic treatment as well as bringing forth seminal theoretical papers. However, later in his career, when he was putting forth his best known works such as The Ego and the Id [1923b] he was no longer intensely involved in the clinical situation. Rather, he had become a world figure who was doing training analyses which were frequently not serious analytic encounters, in my opinion.) We join him when he and Breuer are describing their experiences in treating patients that they have diagnosed as hysterics (Breuer & Freud, 1895d). In fact, the patients that Freud treated in the late 1880s and 1890s presented a wide assortment of symptomatology and complaints, including conversion symptoms (pain in limbs, paresis, aphonia, etc.), depression, impotence, and hallucinations. It does not take a particularly careful reading of Freud’s cases to see that he was not only treating hysterics, but also patients who, in modern terms, run the gamut of diagnostic categories (including neurotic, borderline, and psychotic disorders). While Freud heard a wide array of symptoms and complaints in this, his “heroic era”, his focus was on the dramatic symptomatology he was encountering. Given this concern, many of the patients Freud saw in these early “heroic days” would today not be diagnosed in the same manner that governed Breuer and Freud’s nosological distinctions. Freud’s first therapeutic attempts were designed to remove the patient’s symptoms as rapidly as possible. He quickly learned that at times patients did not share his goals.

In the Standard Edition (Volume 2) the editors state that, “The Studies on Hysteria are usually regarded as the starting point of psycho-analysis”. They contend that the most important of Freud’s achievements recorded in this volume is the “invention of the first instrument for the scientific examination of the human mind” (S.E. 2, p. xvi). This comment on the part of the editors reveals their particular bias in understanding Freud’s work. The use of the term scientific is difficult to deal with in today’s psychoanalytic world. On the one hand, researchers might criticize the term, since Freud in any ordinary sense of the term was not conducting scientific research. Certain clinicians, on the other hand, have criticized Freud for being overly scientific. They maintain that he did not sufficiently emphasize the literary aspects of psychoanalysis. It is fascinating “to trace the early steps of the development” (S.E., 2, p. xvi) of his psychotherapeutic method, but the theoretical concepts that he formulates and comes to accept in this volume can be viewed as equally important in the history of psychoanalysis. He gives graphic clinical examples of how he conceptualizes his new ideas about the nature of defence and defence hysteria. (He does not, at this time, distinguish between resistance and defence, although he uses both terms.) He also gives us a clear indication of how he is conceiving of an idea that is not in consciousness. There is a temptation to say an idea that is unconscious, but, at this point in time, Freud has not yet fully elaborated this theoretical concept. Freud does present one of his first notions of the organization of ideas outside of consciousness (or in what he calls the secondary group of ideas). Freud, at this point, distinguishes between a primary group of ideas or associations, which are conscious, and a secondary split of group of ideas, which are outside of consciousness. Where are they, one might ask? There are two possible answers to this question: it is possible to think of a splitting of consciousness, or one might think of the ideas as unconscious. Freud, at this point, has not fully thought through where his concept of defence is about to take him and psychoanalysis. We will look at this issue more systematically in this and the next chapter.

The attempt to delineate an era is of course highly artificial, and we will, at times, need to make reference to Freud’s earlier work (or activities) to gain a clearer vision of his theoretical positions during this period. In a similar vein, while we will not be focusing on biographical material, at times we will look at aspects of Freud’s life. For example, it is hard to understand some of Freud’s theoretical preoccupations unless one has some inkling of his relationship during this period with Fliess, Freud’s confidant, co-conspirator and the recipient of a good deal of Freud’s transference. In this brief introduction, we have gone over some of Freud’s career prior to this period; here we can begin to look at the new concepts that Freud is beginning to develop.

We will begin by looking at Freud’s first publication with Breuer and showing how it presages many of his concepts during this period. Then we will systematically look at the development of each of the ideas that Freud has introduced in his preliminary communication. In this chapter, we will look quote Freud extensively to give the reader more of a first-hand sense of Freud’s conceptualizations in this, perhaps most unfamiliar, era of his work.

Studies on hysteria: preliminary communication

Freud tells us “that psycho-analysis started with researches into hysteria” (1913m, p. 207) and that hypnosis was his original therapeutic technique. In his publication with Breuer (Breuer & Freud, 1893a) he is describing his experiences treating patients who are diagnosed as hysterics. Today, many of these patients would not be diagnosed as having hysterical disorders. Rather, many of them would be seen as having conversion symptoms, at times with more severe diagnoses. By and large, these patients are women (Freud had presented a paper on his treatment of a male hysteric, and some members of the audience treated this report with some scepticism) whose complaints have usually not been taken seriously by the physicians of Freud’s Vienna or, indeed, by physicians in most of the European continent. Breuer, in 1882, had told Freud of a hysterical patient he had treated and this conversation had what might be considered a deferred influence on Freud. We know that, several years later, Freud travelled to Paris to study with Charcot. Freud told Charcot of Breuer’s treatment of Anna O (Bertha Pappenheim); however, Charcot seemed to evince little interest in the case report. Nevertheless, when Freud returned to Vienna, he found a path back to Breuer and Breuer’s method of treatment where he utilized hypnosis, called the cathartic method. By the time Breuer and Freud are publishing their preliminary communication (1893a), Freud has already treated several hysterical patients using hypnosis and the cathartic method. He has also begun to experiment with other methods of treatment and, in 1895, he publishes his new method and his new ideas about hysteria.

In 1893, he and Breuer tell us that the aim of his hypnotic technique is to bring about the “reproduction of a memory which was of importance in bringing about the onset of the hysteria… the memory [is] either of a single major trauma… or of a series of interconnected part-traumas” (Breuer & Freud, 1893a, p. 14). It was Freud’s view that “hysterics suffer mainly from reminiscences” (ibid.). These memories or reminiscences are the result of psychical trauma “or more precisely the memory of the trauma… [which] acts like a foreign body long after its entry must continue to be regarded as an agent that is still at work” (ibid., p. 6). Breuer and Freud reported that, to their surprise,

Each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying affect, and when the patient had described that event in the greatest possible detail and had put the effect into words. Recollection without affect almost invariably produces no result. [ibid.]

Thus, in Freud’s early conceptualizations, he is attempting to establish the precipitating cause(s) of hysterical attacks. He has found that usually the patient is unaware of the meaning of these attacks. As a result of his and Breuer’s investigations, they have seen that external events determine the pathway of hysterical attacks and that each attack is related to the first attack. This relationship may extend over many years, and they comment on the similarity of hysteria to the traumatic neuroses. There is a clear precipitating event and a clear relationship between the precipitating event and subsequent attacks. They wondered whether all neuroses are formed in the way that they have conceptualized the hysterical neuroses.

Beyond this attempt to describe the course of hysterical symptoms, Freud also points out that the symptoms are related to painful, anxiety-provoking memories that are stored apart from the person’s primary or conscious (primary system) ideas about themselves. These thoughts, which are stored as a secondary group (secondary system) of ideas, are not readily accessible to consciousness. Freud contrasts hysterics with normal or “healthy” experiences. In normal circumstances, the affect associated with disturbing events is worn away or discharged. In the following paragraph, we can see Freud’s ideas of how memories are normally managed.

The fading of a memory or the losing of its affect depends on various factors. The most important of these is whether there has been an energetic reaction to the event that provokes an affect. By “reaction” we here understand the whole class of voluntary and involuntary reflexes—from tears to acts of revenge—in which, as experience shows us, the affects are discharged. If this reaction takes place to a sufficient amount a large part of the effect disappears as a result. Linguistic usage bears witness to this fact of daily observation by such phrases as “to cry oneself out”, and to “blow off steam” (literally “to rage oneself out”). If the reaction is suppressed, the affect remains attached to the memory. An injury that has been repaid, even if only in words, is recollected quite differently from one that has had to be accepted. [1893a, p. 8]

In this formulation, Freud maintained that under normal or optimal circumstances people are able to deal with, or wear away, distressing affect by fully experiencing or discharging the affect. They may also deal with an affect by being able to counteract an experience in thought or action. If, for instance, a situation stimulated an idea that brought up the affect of shame, the person might be able to nullify this idea by reminding themselves of their positive attributes. They might assure themselves that the event that caused the affect of shame was a singular or infrequent occurrence, and this might allow them to wear away this affect. Alternatively, they might do something in reality to counteract this experience. Thus, normal people are continually discharging affect or putting a memory of a disturbing or humiliating circumstance into appropriate perspective. They are able to this “by considering (one’s) own worth” (ibid., p. 9). Put in other terms, a normal person can have either small abreactions (discharges of affect through thought or action) or deal with the personal insult or aversive effect more gradually “through the process of association” (ibid.). Forgetting, or, more accurately, the fading of memories, takes place when the affect is “worn away”. Freud believed that memories can be fully recaptured when the affect is reunited with the idea or representation. Thus, even normal memories are potentially available if the affect is reunited with the idea. For this to occur in this model, the affect must be stimulated by an external source. This point will become clearer as we progress further into Freud’s ideas. Freud has implicitly introduced several of the themes that will continue in his work to the end of his career. The first of these has already begun to surface, that is, the concept of psychic energy. This theoretical assumption is more formally stated in “The neuro-psychoses of defence” (1894a), but here this concept is present as an accompaniment to his ideas about defence. Defence is a concept that is lurking behind and within the phrase, “hysterics suffer from reminiscences”. In addition, Freud states that the reminiscences are “experiences… completely absent from the patients’ (normal or conscious) memory” (1893a, p. 9). This is what Freud is referring to as the secondary group of ideas, or what we might say is the beginning of his theory of unconscious processes. Forgetting takes place when the affect is worn away from the idea, this is true in both normal and neurotic experience. The difference is how the affect is worn away: in normal experience, it is worn away in the primary associational pathway; in neurotic experience, it is dispatched through the process of defence.

Defence in hysteria and the psychoneuroses

Breuer, Janet, and Charcot: alternative concepts

A reader of Breuer and Freud’s preliminary communication would have been hard pressed to guess what was in store for the psychiatric world during the next few years. Freud gave little indication of his new theoretical inclinations in his chapter with Breuer. In this chapter, hypnoid states are mentioned as an important factor in the aetiology of hysteria. (Studies on Hysteria was published in 1895, but the first chapter in this book (co-authored by Breuer and Freud) had been published previously as a paper in 1893.) In Breuer’s theoretical chapter in Studies on Hysteria, he presents a sophisticated neuro-physiological theory about the genesis of hypnoid states. Breuer saw hypnoid states as a necessary condition for the formation of hysterical or conversion symptoms. It was his view that, during this type of hypnogogic (what I mean here is a state that is close to sleep onset, as hypnogogic imagery is that imagery that one has while falling asleep) state the person was more prone to be overwhelmed (traumatized) by stimuli. His theory stated the conditions for a threshold shift that made the cortex more susceptible to trauma. While Breuer did not stre...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• BRIEF HISTORY AND ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• SERIES EDITOR’S PREFACE
• PREFACE
• PART I: FREUD CHAPTERS
• PART II: MAJOR POST-FREUDIAN THEORISTS
• PART III: CONTEMPORARY ISSUES IN PSYCHOANALYSIS
• EPILOGUE
• REFERENCES
• INDEX