Freudian Thought for the Contemporary Clinician

A Primer on Psychoanalytic Theory

Robert Mendelsohn

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000464450
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

This book uses clear language, modern contexts and key psychoanalytic concepts to exemplify how Sigmund Freud's thinking and legacy is directly relevant to contemporary therapists.

Interweaving theory with history, Freudian Thought for the Contemporary Clinician allows readers to take a walk in Freud's shoes, offering a new framework for understanding his arcane language and the cultural mores of the early 20th century. Robert Mendelsohn explores topics including sexuality and gender, racial injustice and cultural differences with direct reference to Freud's cases, demonstrating how traditional psychoanalytic ideas may inform solutions to issues we face today.

Featuring clinical examples and philosophical explorations delivered in an accessible style, Freudian Thought for the Contemporary Clinician will be a key text for psychoanalytic clinicians in practice and in training. It will also be of great interest to academics and scholars of psychoanalytic studies, the history of psychology and the history of ideas.

Chapter 1

The exploration of the neurosis and the early origins of psychoanalysis

DOI: 10.4324/9781003171393-2

Source: Studies on Hysteria, 1895

Welcome to The Freud Lectures.

In order to learn about Freud’s theories in the context of his time and to apply them to our time, I ask that you put yourself in Freud’s shoes:

Putting yourself in someone else’s shoes

For those of you who plan to do clinical work, it’s helpful to learn how to put yourself in the shoes of another. This is called the theory of mind.¹ As we will see with many of the principles of dynamic psychology, the theory of mind is understood by studying those who have trouble taking the viewpoint of others. We learn the most by looking closely at those who cannot put themselves in another’s place. Studying people diagnosed as narcissistic, and on the autism spectrum, we learn the theory of mind.

Freud and his history

Let’s practice the theory of mind by viewing Freud in historical context. A major idea of Freud’s time was Darwin’s theory of evolution (Darwin, 1859) as the driving force in adaptation to life.² This idea is the underpinning behind all of Freud’s thought. In parallel, Darwin’s theory was the driving force in Freud’s entire intellectual project.

This course is divided into three sections. The first is called Id Psychology, the study of the biopsychological drives. Following this is Ego Psychology, the study of that which modulates the drives. In the final section we talk about Freud’s case histories. We discuss his important cases and the role of clinical material in deepening his understanding of the mind. Then we briefly summarize the major theoretical/technical extensions and elaborations of Freud’s theory that led to post-Freudian ego psychology and object-relations theory (as well as offshoots of these: self-psychology and relational psychoanalysis).

Exploring the neuroses

Today we both begin and complete our study of the first period of Freud’s work before he developed psychoanalysis: exploring the neuroses (1886–1895).

A brief history

Freud was born to Jewish parents in Freiberg, then part of the Austro-Hungarian Empire (now the Czech Republic), on May 6, 1856. He qualified as doctor of medicine in 1881 at the University of Vienna. In 1885 he was appointed a docent (lecturer) in neuropathology at the University of Vienna, and in 1886 he went to France to study with the famous neurologists Charcot³ and Janet.⁴ Freud became an affiliated (adjunct) professor at the University of Vienna in 1902. He lived and worked in Vienna until the final year of his life, having set up his clinical practice there in 1886 after returning from France. In 1938 Freud left Austria to escape the Nazis, and he died in exile in England on September 23, 1939.

After Freud finished studying in Paris, he began to collaborate with Dr. Josef Breuer, the most senior neurologist in Vienna, who was working with hysterical patients. When they began their work, the study of hysteria (neurosis) was in chaos. Only a few people were doing work of value (Liebeault and Bernheim at Nancy, France; Charcot and Janet in Paris; and Breuer in Vienna). Liebeault, Bernheim, Charcot and Janet’s contributions were using hypnosis to both demonstrate and treat hysteria (Gay, 1988). Each of these clinicians put patients under hypnosis, paralyzed a limb, and through hypnosis showed, using words, that one can alter a somatic experience. Following their work, Josef Breuer from 1880 to 1882 treated a young woman, Anna O. (her real name was Bertha Pappenheim.⁵ She later quipped that it was she who invented psychoanalysis, not Freud. She believed that the most important part of her treatment with Breuer had not been the hypnosis, but instead the talking that occurred before and after each trance state). We will soon see, by the way, that Anna O. was actually not entirely wrong: As Freud later understood, and psychoanalysts who followed Freud reinforced, every psychoanalytic treatment hour is cocreated by the interchanges between the doctor and the patient (see the work on relational psychoanalysis; Aron, 1996).

Freud learned that Anna O’s improvement was the result of two factors: The first is the release of repressed/blocked emotion, which Breuer and Freud called abreaction. The second is the making conscious of what had previously been unconscious, which they labeled insight.

Psychotherapy researchers still study these factors:

• (1.) Releasing pent-up emotion;
• (2.) Understanding the deeper (nonconscious) meaning of events in one’s life.

With some kinds of patients it’s the first (emotional release) that’s the primary curative factor. For those struggling with obsessive-compulsive disorder, abreaction – that is, getting emotions released, helping the patient to express emotions when they can’t do so (often, helping the patient to realize that they have emotions) – is the major goal.

With other people, such as those overwhelmed by their feelings (that is, they can’t control feelings, which is the case with people suffering from hysteria or borderline personality disorder), helping them to have insight, presenting them with meaning and sublimations (expanding their understanding of their confusing life) helps them.

That said, there’s still controversy in psychotherapy about which is more important, abreaction or insight. Later, clinicians added another factor to this, an equally important third factor: the experience of the therapeutic relationship.

However, Freud did something more than the presentation and exploration of abreaction and insight. This is the major reason that we study his work. Freud carried Breuer’s observations further. He reasoned that the road to understanding neurosis is in the mind as well as in the brain. Neurosis – and ultimately all of psychopathology – can be best understood by studying psychology, not just biology and neurology. This is all the more remarkable when we consider that Freud had been trained in medicine, particularly in neurology.

In fact, Freud struggled throughout his life with ambivalence as to which of these variables (the mind versus the brain) was the more important. As we see throughout the lectures, he never fully embraced either view; he never fully dealt with his ambivalence about this – and it affected his ideas. We’ll have more to say about this throughout these lectures.

To continue, Freud suggested that clinicians treating neurotics suffering from hysteria could describe hysteria, and work with hysterical neurosis, in a psychological way. Most of us now realize that mental-health issues/psychopathology are at least partly psychological. In Freud’s time, the most common “theory” was that any kind of mental illness was the result of a combination of several factors, among them evil spirits/the devil, moral degeneracy, or a hereditary or acquired physical disease. One scientific finding at the time bolstered the hereditary, or acquired physical disease, view: The physician Gray wrote a book called Gray’s Anatomy (the current popular TV show Grey’s Anatomy is a play on words using this famous textbook as a foil). The real Dr. Gray performed autopsies on the brains of people who had died while suffering from end-stage syphilis. Prior to their death, these patients exhibited psychotic symptoms. Gray found massive lesions in the brains of these patients and drew a strong correlation between brain lesions (biology) and severe emotional problems (psychology). I’m not suggesting that there’s no connection between the brain and the mind. However, while Freud was ultimately unable to find the ultimate connection between the two, he did show us the relationship between neurosis and the psychological mind.

Currently, psychoanalysts recognize that there is at the least a relationship between emotional problems and temperament. The psychoanalyst Otto Kernberg suggests that early attachment problems and parent/child misattunements occur when there are temperamental (biological) differences between mother and infant. In the 19th century, psychopathology was believed to be the result of an unknown brain lesion or bacterial infection. Therefore, one couldn’t effectively treat neurotics. You could merely make them comfortable while waiting for a biological cure. If the sufferer was wealthy you might refer them to a retreat house, where they could “rest their nerves” (this was called the “rest cure” because the belief was that if the person could rest the nerves, that might help them). Some people taking these rest cures did improve, at least temporarily, because they were removed from their family. Keep in mind as future psychologists that this viewpoint (mental problems are entirely biological) has not been abandoned. We understand that all of the complications of one’s background affect the person’s psychic life. The variables are complex. What we also now know is that with certain patients the combination of talk therapy and medication works best; with others, medication works better than talk therapy; and with a third category of patients, talk therapy works better than medication (Strauss et al., 2015).

Studies on Hysteria

In 1895 Freud and Breuer published Studies on Hysteria, Freud’s first major work (Breuer was collaborator). The book shows the origin of Freud’s thinking about neurosis and revolves around this clinical observation: Neurosis is a defense against the intolerable. From this observation, Freud later developed the idea of “primary thoughts,” the thoughts also found in dreams (they’re the unseen forbidden thoughts pushing to become conscious; they cause an “intolerable experience”). A second group of thoughts are “secondary thoughts” (thoughts that are defensive because the organism finds the primary thoughts to be intolerable). Freud went on to rework this idea into “the pleasure principle” and “the reality principle.” Later still he reformulated them into “the ego” and “the id.”

Freud never actually changed his basic understanding of how the mind processes, functions, defends and gratifies human needs. He reworked it, elaborating and expanding upon it. In hysterical neurosis, Freud found that an intolerable experience is connected in some way to the patient’s past. Freud believed that the neurotic adult suffered a trauma in childhood and hasn’t dealt with the trauma effectively. While a “normal” person might have a trauma, release toxic emotion connected to it, and store the intolerable experience away in the mind as a memory, neurotics can’t let go of the trauma – and the trauma’s associated emotions. The neurotic remembers the trauma unconsciously. The trauma returns to haunt the neurotic through symptoms or inhibitions.

STUDENT: Can you clarify release of emotion?

DR. M: Yes. When my daughter told her two-year-and-six-month-old (my granddaughter) that this child was going to have a sibling, my granddaughter said “Oh.” She calmly walked into her bedroom, and then threw her toys all around the room while yelling. When she returned to her parents’ room, she was calm, even happy. It was going to be better for her to have released some emotion, than if she had never expressed any emotion at all.

Freud expanded on the work of Charcot and Breuer, which was the work of hypnosis: abreaction (releasing emotion) and insight (making the unconscious conscious). However, Freud soon abandoned hypnosis for two reasons: first, he wondered if the memories that the patient produced might be suggested to the patient – and therefore hypnosis might not be reliable or valid. Second, Freud’s patients could not always be easily hypnotized and he wondered why. Freud began to believe that there is a psychological force that blocks the hypnotic process in the patient, and that this force has something to do with the relationship between the hypnotist (doctor) and patient. These were the first observations of what Freud would later call “resistance” and “transference” (Fine, 1987). Resistance is the blocking force, and transference is the relationship. Freud discovered something that he called “free association.” Free association is a technique where the patient is asked to say everything that comes to mind, no matter how trivial the thought(s) might appear to be. Freud was following an assumption of science: that every association has a cause.

Freud and Breuer said that the intolerable experience comes from the past. “The neurotic suffers from reminiscences.” They meant that the neurotic suffers from unconscious, undischarged memories. First, Freud saw the hysteric’s intolerable experience as any kind of emotional experience. Later he narrowed it to sexual feelings/thoughts. Freud noted that many neurotics presented with s...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Contents
• List of figures
• Foreword
• Preface
• Acknowledgments
• Introduction
• 1 The exploration of the neurosis and the early origins of psychoanalysis
• 2 Dreams: psychoanalysis begins
• 3 Dreams: where psychoanalysis begins; an early structural model of the mind
• 4 Sexuality and the “stages of development” theory
• 5 Psychoanalysis and the beginnings of a “theory of mind”
• 6 The beginning of ego psychology: the process of identification
• 7 Further explorations in ego psychology “Beyond the pleasure principle” and the ego, the id and the superego
• 8 Anxiety and the Ego: a new theory of anxiety, a new theory of defense and a new theory of object relations
• 9 Freud’s case studies I: hysteria
• 10 Freud’s case studies II: obsessional neurosis, phobia and reconstruction
• 11 Conclusion: Freud’s psychoanalysis: a “talk therapy” for the 21st century
• Index