Psychoanalysis  

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This page Psychoanalysis is part of the psychology series  Illustration: The Heart Has Its Reasons (c.1887) by Odilon Redon
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This page Psychoanalysis is part of the psychology series
Illustration: The Heart Has Its Reasons (c.1887) by Odilon Redon

"If the little savage were left to himself so that he retained all his imbecility, uniting the little reason possessed by a child in the cradle with the passionate violence in a man thirty years old, he'd wring his father's neck and sleep with his mother." --Diderot, Rameau's Nephew


"It is often observed that psychoanalysis only flourishes in Protestant countries and presumably fills the same need as confession does in Catholic countries. But there are other resemblances. The fee fulfills the function of the tithe, the transference of the repentance, the long, long schedule of visits, of penance, and the reintegration of personality fulfills the same function as the absolution. The training analysis, where a fledgling psychoanalyst is analyzed by a fully qualified one, corresponds to the laying on of hands in ordination." --Eros Denied

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Train wreck at Montparnasse (October 22, 1895) by Studio Lévy and Sons.
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Train wreck at Montparnasse (October 22, 1895) by Studio Lévy and Sons.

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 and Jacques Lacan.

The basic tenets of psychoanalysis include the following:

  1. human behavior, experience and cognition are largely determined by innate and irrational drives;
  2. those drives are largely unconscious;
  3. attempts to bring those drives into awareness meet psychological resistance in the form of defence mechanisms;
  4. beside the inherited constitution of personality, one's development is determined by events in early childhood;
  5. conflicts between conscious view of reality and unconscious (repressed) material can result in mental disturbances such as neurosis, neurotic traits, anxiety, depression etc.;
  6. the liberation from the effects of the unconscious material is achieved through bringing this material into the consciousness (via e.g. skilled guidance).

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 studying child development.

Freudian psychoanalysis refers to a specific type of treatment in which the "analysand" (analytic patient) verbalizes 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 specifics of the analyst's interventions typically include confronting and clarifying 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. The theory has been criticised on numerous fronts including the view that it represents pseudo-science, but is still used by numerous psychologists today.

Contents

History

1890s

The idea of psychoanalysis was developed in Vienna in the 1890s by Sigmund Freud, a neurologist interested in finding an effective treatment for patients with neurotic or hysterical symptoms. Freud had become aware of the existence of mental processes that were not conscious as a result of his neurological consulting job at the Children's Hospital, where he noticed that many aphasic children had no organic cause for their symptoms. He wrote a monograph about this subject. In the late 1880s, Freud obtained a grant to study with Jean-Martin Charcot, the famed neurologist and syphilologist, at the Salpêtrière in Paris. Charcot had become interested in patients who had symptoms that mimicked general paresis, the psychotic illness that occurs due to tertiary syphilis. Charcot had found that many patients experienced paralyses, pains, coughs, and a variety of other symptoms with no demonstrable physical cause. Prior to Charcot's work, women with these symptoms were thought to have a wandering uterus (hysteria means "uterus" in Greek), but Freud learned that men could have psychosomatic symptoms as well. He also became aware of an experimental treatment for hysteria utilized by his mentor and colleague, Dr. Josef Breuer. The treatment was a combination of hypnotism and catharsis which utilized abreaction (ventilation of emotion). This treatment was used to treat the hysterical symptoms of Dr. Breuer's now famous patient, Anna O.

Freud's first theory to explain hysterical symptoms was the so-called "seduction theory". Since his patients under treatment with this new method "remembered" incidents of having been sexually seduced in childhood, Freud believed that they had actually been abused only to later repress those memories. This led to his publication with Dr. Breuer in 1893 of case reports of the treatment of hysteria. This first theory became untenable as an explanation of all incidents of hysteria. As a result of his work with his patients, Freud learned that the majority complained of sexual problems, especially coitus interruptus as birth control. He suspected their problems stemmed from cultural restrictions on sexual expression and that their sexual wishes and fantasies had been repressed. Between this discovery of the unexpressed sexual desires and the relief of the symptoms by abreaction, Freud began to theorize that the unconscious mind had determining effects on hysterical symptoms.

His first comprehensive attempt at an explanatory theory was the then unpublished Project for a Scientific Psychology in 1895. In this work Freud attempted to develop a neurophysiologic theory based on transfer of energy by the neurons in the brain in order to explain unconscious mechanisms. He abandoned the project when he came to realize that there was a complicated psychological process involved over and above neuronal activity. By 1900, Freud had discovered that dreams had symbolic significance, and generally were specific to the dreamer. Freud formulated his second psychological theory – that of there being an unconscious "primary process" consisting of symbolic and condensed thoughts, and a "secondary process" of logical, conscious thoughts. This theory was published in his 1900 opus magnum, 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. Freud also discovered what most of us take for granted today: that dreams were symbolic and specific to the dreamer. Often, dreams give clues to unconscious conflicts, and for this reason, Freud referred to dreams as the "royal road to the Unconscious."

1900–1940s

This "topographic theory" is still popular in much of Europe, although it has been superseded 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 genital) (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 utilizing an energic system, Freud conceptualized the question of 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 WW 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.

In 1923, he presented his new "structural theory" of an id, ego, and superego in a book entitled, The Ego and the Id. Therein, 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. Note the 180 degree shift - earlier he had thought that repression caused anxiety. Moreover, in 1926, in Inhibitions, Symptoms and Anxiety, Freud laid out 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), exploring how art, myth, religion, philosophy and therapy were illuminated by separation anxiety in the “phase before the development of the Oedipus complex” (p. 216). But there was no such phase in Freud’s theories. The Oedipus complex, Freud explained tirelessly, was the nucleus of the neurosis and 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 dared to suggest that the Oedipus complex might not be the only factor contributing to intrapsychic development

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 (guilt), 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 Hartmann, Kris, Rappaport and Lowenstein, new discoveries were made in understanding 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 50's 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 has developed into a flexible, effective treatment for 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 2000s there are approximately 35 training institutes for psychoanalysis in the United States accredited by the American Psychoanalytic Association which is a component organization of the International Psychoanalytical Association, and there are over 3,000 graduated psychoanalysts practicing in the United States. The International Psychoanalytical Association accredits psychoanalytic training centers 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. Freud published a paper entitled The History of the Psychoanalytic Movement in 1914, German original being first published in the Jahrbuch der Psychoanalyse.

Criticism

As a field of science

"The strongest reason for considering Freud a pseudo-scientist is that he claimed to have tested – and thus to have provided the most cogent grounds for accepting – theories which are either untestable or even if testable had not been tested. It is spurious claims to have tested an untestable or untested theory which are the most pertinent grounds for deeming Freud and his followers pseudoscientists... --Frank Cioffi

Psychoanalysis has progressively moved towards the fringes of mental health care. Its usefulness as a technique has not been demonstrated. The theoretical foundations of psychoanalysis lay in the same philosophical currents that lead to interpretive phenomenology rather than in those that lead to scientific positivism, making the theory largely incompatible with scientific approaches to the study of the mind.

Early critics of psychoanalysis believed that its theories were based too little on quantitative and experimental research, and too much on the clinical case study method. Some have accused Freud of fabrication, most famously in the case of Anna O. (Borch-Jacobsen 1996). Others have speculated that patients suffered from now easily identifiable conditions unrelated to psychoanalysis; for instance, Anna O. is thought to have suffered from an organic impairment such as tuberculous meningitis or temporal lobe epilepsy and not hysteria (see modern interpretations).

E. Fuller Torrey, writing in Witchdoctors and Psychiatrists (1986), stated that psychoanalytic theories have no more scientific basis than the theories of traditional native healers, "witchdoctors" or modern "cult" alternatives such as est. Frank Cioffi, author of Freud and the Question of Pseudoscience, cites false claims of a sound scientific verification of the theory and its elements as the strongest basis for classifying the work of Freud and his school as pseudoscience.

Psychologist Alice Miller charged psychoanalysis with being similar to the poisonous pedagogies, which she described in her book For Your Own Good. She scrutinized and rejected the validity of Freud's drive theory, including the Oedipus complex, which, according to her and Jeffrey Masson, blames the child for the abusive sexual behavior of adults.

Psychologist Joel Kupfersmid investigated the validity of the Oedipus complex, examining its nature and origins. He concluded that there is little evidence to support the existence of the Oedipus complex.

Cognitive scientists have also criticized psychoanalysis. Linguist Noam Chomsky has criticized psychoanalysis for lacking a scientific basis. Steven Pinker considered Freudian theory unscientific for understanding the mind. Evolutionary biologist Steven Jay Gould considered psychoanalysis as influenced by pseudoscientific theories such as recapitulation theory. Evolutionary psychologist Kevin B. MacDonald as well as psychologists Hans Eysenck have also criticized the field as pseudoscience.

A French 2004 report from INSERM said that psychoanalytic therapy is far less effective than other psychotherapies (including cognitive behavioral therapy). It used a meta-analysis of numerous other studies to find whether the treatment was "proven" or "presumed" to be effective on different diseases. Numerous studies have shown that its efficacy is related to the quality of the therapist, rather than the psychoanalytic school or technique or training.

Both Freud and psychoanalysis have been criticized in very extreme terms. Exchanges between critics and defenders of psychoanalysis have often been so heated that they have come to be characterized as the Freud Wars. The classic dismissal still belongs to Richard Feynman, who wrote off psychoanalysts as "witch doctors":

If you look at all of the complicated ideas that they have developed in an infinitesimal amount of time, if you compare to any other of the sciences how long it takes to get one idea after the other, if you consider all the structures and inventions and complicated things, the ids and the egos, the tensions and the forces, and the pushes and the pulls, I tell you they can't all be there. It's too much for one brain or a few brains to have cooked up in such a short time.

Karl Popper argued that psychoanalysis is a pseudoscience because its claims are not testable and cannot be refuted; that is, they are not falsifiable. Karl Kraus, an Austrian satirist, was the subject of a book written by noted libertarian author Thomas Szasz. The book Anti-Freud: Karl Kraus's Criticism of Psychoanalysis and Psychiatry, originally published under the name Karl Kraus and the Soul Doctors, portrayed Kraus as a harsh critic of Sigmund Freud and of psychoanalysis in general. Other commentators, such as Edward Timms, author of Karl Kraus – Apocalyptic Satirist, have argued that Kraus respected Freud, though with reservations about the application of some of his theories, and that his views were far less black-and-white than Szasz suggests. Adolf Grünbaum argues that psychoanalytic based theories are falsifiable, but that the causal claims of psychoanalysis are unsupported by the available clinical evidence. A prominent academic in positive psychology wrote that 'Thirty years ago, the cognitive revolution in psychology overthrew both Freud and the behaviorists, at least in academia. ... [T]hinking ... is not just a [result] of emotion or behavior. ... [E]motion is always generated by cognition, not the other way around.'

Michel Foucault and Gilles Deleuze claimed that the institution of psychoanalysis has become a center of power and that its confessional techniques resemble the Christian tradition. Jacques Lacan criticized the emphasis of some American and British psychoanalytical traditions on what he has viewed as the suggestion of imaginary "causes" for symptoms, and recommended the return to Freud. Together with Gilles Deleuze, Félix Guattari criticised the Oedipal structure. Luce Irigaray criticised psychoanalysis, employing Jacques Derrida's concept of phallogocentrism to describe the exclusion of the woman from Freudian and Lacanian psychoanalytical theories. Gilles Deleuze and Félix Guattari, in their 1972 work Anti-Œdipus, take the cases of Gérard Mendel, Bela Grunberger and Janine Chasseguet-Smirgel, prominent members of the most respected associations (IPa), to suggest that, traditionally, psychoanalysis enthusiastically embraces a police state.

Freudian theory

Many aspects of Freudian theory are indeed out of date, and they should be: Freud died in 1939, and he has been slow to undertake further revisions. His critics, however, are equally behind the times, attacking Freudian views of the 1920s as if they continue to have some currency in their original form. Psychodynamic theory and therapy have evolved considerably since 1939 when Freud's bearded countenance was last sighted in earnest. Contemporary psychoanalysts and psychodynamic therapists no longer write much about ids and egos, nor do they conceive of treatment for psychological disorders as an archaeological expedition in search of lost memories. --Drew Westen, "The Scientific Legacy of Sigmund Freud Toward a Psychodynamically Informed Psychological Science". November 1998 Vol. 124, No. 3, 333-371

An increasing amount of empirical research from academic psychologists and psychiatrists has begun to address this criticism. A survey of scientific research suggested that while personality traits corresponding to Freud's oral, anal, Oedipal, and genital phases can be observed, they do not necessarily manifest as stages in the development of children. These studies also have not confirmed that such traits in adults result from childhood experiences (Fisher & Greenberg, 1977, p. 399). However, these stages should not be viewed as crucial to modern psychoanalysis. What is crucial to modern psychoanalytic theory and practice is the power of the unconscious and the transference phenomenon.

The idea of "unconscious" is contested because human behavior can be observed while human mental activity has to be inferred. However, the unconscious is now a popular topic of study in the fields of experimental and social psychology (e.g., implicit attitude measures, fMRI, and PET scans, and other indirect tests). The idea of unconscious, and the transference phenomenon, have been widely researched and, it is claimed, validated in the fields of cognitive psychology and social psychology (Westen & Gabbard 2002), though a Freudian interpretation of unconscious mental activity is not held by the majority of cognitive psychologists. Recent developments in neuroscience have resulted in one side arguing that it has provided a biological basis for unconscious emotional processing in line with psychoanalytic theory i.e., neuropsychoanalysis (Westen & Gabbard 2002), while the other side argues that such findings make psychoanalytic theory obsolete and irrelevant.

Freud's psychoanalysis was criticized by his wife, Martha. René Laforgue reported Martha Freud saying, "I must admit that if I did not realize how seriously my husband takes his treatments, I should think that psychoanalysis is a form of pornography." To Martha there was something vulgar about psychoanalysis, and she dissociated herself from it. According to Marie Bonaparte, Martha was upset with her husband's work and his treatment of sexuality.

Jacques Derrida incorporated aspects of psychoanalytic theory into his theory of deconstruction in order to question what he called the 'metaphysics of presence'. Derrida also turns some of these ideas against Freud, to reveal tensions and contradictions in his work. For example, although Freud defines religion and metaphysics as displacements of the identification with the father in the resolution of the Oedipal complex, Derrida insists in The Postcard: From Socrates to Freud and Beyond that the prominence of the father in Freud's own analysis is itself indebted to the prominence given to the father in Western metaphysics and theology since Plato.

See also




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