Century of Insight

The Twentieth Century Enlightenment of the Mind

Derry Macdiarmid, Sue Macdiarmid

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9780367101237
• eBook ISBN:
  9780429911743
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Century of Insight is the story of the discovery of the unconscious mind, based on the author's teaching of psychotherapy throughout his career. Beginning with the ideas of Freud and Jung, it is a journey that describes, through case histories, explanation and humour, how successive ideas have created a body of knowledge that the author calls the "Psychodynamic Enlightenment" of the 20th century. Whilst essentially it is a story of the 20th century, it includes a backdrop from tribal societies, and also ideas from 19th century Europe, including existentialism. In Part I, the ideas of Freud, Jung, and Adler are explained, their points of difference, and then how they disagreed so violently that they had to break with each other. Their individual theories and their personal conflict are understood from the story of their personalities and background. Why could Freud not tolerate the expansive Jung, and why did Jung clash so badly with his 'father'?

PART I

PREDECESSORS

CHAPTER ONE

Ihembi and anthropology

“A layman will no doubt find it hard to understand how pathological disorders … can be eliminated by ‘mere’ words. He will feel that he is being asked to believe in magic”

(Freud, 1890a)

Medicine among preliterate and tribal societies often has psychodynamic elements but is remarkably various, so I have chosen just one example to show how effective tribal medicine could be. In 1957, the Glaswegian anthropologist Victor Turner travelled to central Africa with his wife to study the Ndembu tribe. There, he met Ihembi, a doctor of the Ndembu people. Turner described Ihembi as a charismatic white-haired man with “a smile of singular sweetness” (Turner, 1967, p. 370). The original paper, “Schism and continuity in an African society: a study of Ndembu village life” is quite astonishing and because of it, I have always regarded Ihembi not only as a colleague, but also a master.

Ihembi had a patient called Kamahasanyi, who was complaining of tiredness, heart palpitation, and severe bodily pain. He felt that people were speaking against him, and would withdraw to his hut for long spells.

Ihembi’s treatment methods, though described in the mid twentieth century, were probably ancient. His system of psychopathology was a theory of witchcraft, which, essentially, involved uncovering secret hostilities between people. (In the Highland village where I grew up you would hear an old lady, if some accident befell her, saying darkly, “It’s baad wishes!”) In fact, there was a great deal of social conflict amongst the Ndembu tribe, especially marital woes. But, apart from the black magic they secretly employed to hurt others, there was another possible cause of the pains. In local culture, it was believed that the eyeteeth of hunters were where their power resided. These precious fragments were carefully kept after death, but they also had the magical ability to get inside the body of a living man and hurt him; this act was a sign that the ancestors were not happy with his behaviour. It was believed that Kamahasanyi was afflicted with the incisor of his own father as punishment for evading his social responsibilities by quarrelling with his family.

Ihembi and his helpers settled in the village and learnt all there was to be known about Kamahasanyi and everybody else there, too. The doctor examined the source of the witchcraft that was being directed towards Kamahasanyi and decided that the most likely witches, in this case, were Kamahasanyi’s fourth wife, Maria, and her mother. Maria was a dominant personality (as was Kamahasanyi’s father) who was showily unfaithful, and her mother, perhaps, wanted a different son-in-law. But Ihembi never accused or confronted them. With the aid of rites, he reflected his way through his differential diagnosis and treatment alternatives and finally developed his plan: to perform rites “to make ‘the livers of the Nswanamundong’u people white towards one another,’ to remove the state of mutual ill-feeling” (Turner, 1967, p. 387) in the village.

If you have lived in a village you will appreciate the audacity of Ihembi’s plan, in addition to its warm humanity, to remove mutual ill-feeling in the village. Goodness! But he had at his disposal powerful forces lost to us, in the form of magico–religious rites and performances.

The rites included drumming and singing, in which all the villagers took part. Then Ihembi made small incisions in Kamahasanyi’s skin and fixed some antelope horns over them with the intention of drawing out the tooth. Ihembi would check the horns regularly and if they were empty he would give what we might now call a case history of the patient, his life story and a description of his affliction, but he would declare it to all the village, so that they would know and share the information. He would ask them to contribute by confessing any bad feelings, especially secret ones, towards the patient. (These days we would call this family, or group, therapy.) Ihembi created his own formula for the treatment, one which the community understood: he whipped up excitement with drumming and singing, louder and louder, with declarations of prayers and confessions, until, after many hours, all felt sympathy for Kamahasanyi, and were longing for the tooth to be removed from his body.

Turner also reported that Ihembi gave tasks to family members to involve them. For example, the unfaithful Maria had to collect certain leaves and chew them and spit the juice on parts of her husband’s body, and tap him with a small hand-rattle to give him strength. Turner said that these acts reaffirmed “her wifely duties and her goodwill—the reverse of witchery” (Turner, 1967, p. 389). Many others had to join in with similar tasks.

Kamahasanyi, too, spoke out. He complained that no one had raised a finger to help him in his illness, and he had to go to a diviner himself, but that he was glad at last that he had been able to air his grievance. Finally, at the crisis of the last long, complex, and emotional rite, Ihembi managed to get the punishing tooth out of his patient’s body, ran outside the village with it, and called to the elders and Turner to come and see.

Some time later, Turner reported that villagers who had not been on speaking terms with each other became friendly, and the village more relaxed and at ease.

Turner attempted to get the Ndembu doctor to admit that the tooth removal was a trick, but the doctor denied it. Indeed, using deception to cure a patient is often the source of many a heated debate. More than a year later, Turner revisited the village and found Kamahasanyi flourishing: Maria was with him and they seemed to be getting on well.

We can see why anthropologists do not like the word “primitive” to be applied to these tribal rituals. Ihembi’s therapy apparently enabled Maria to resolve her feelings and become less hostile towards her husband. Surely this method is more enlightening than primitive. Indeed, in seventeenth-century England, Maria and her mother would have been burnt alive for witchcraft.

Ihembi used pharmacology, individual, marital, and especially group psychotherapy, religious ritual, a theory of witchcraft, common sense, drama, hypnosis (in producing dissociation in Kamahasanyi during part of the rites), personal charisma, all the force of traditional culture, and outright conjuring trickery, in an apparently irresistible attack on his patient’s illness.

However, Turner reported that by the 1950s the influence of missionaries on the village chiefs had already led to fines being imposed on Ihembi for deceiving the people. Thus, European culture was seeping in with a deeper devilry than Ihembi could cure. Over the twentieth century in Europe and America, we laboriously recovered some of Ihembi’s techniques. But we have had to dive deeper than he to get to the source of the real devilry.

CHAPTER TWO

Moral treatment and hypnosis

“[T]he deeper the emotions lie, the greater is the importance of discovering them”

(Carter, 1853)

For much of the nineteenth century, way before Freud, there was a kind of psychotherapy called “moral treatment”. Moral treatment grew out of the need to treat disturbed or “insane” individuals with more care and understanding. Prior to this new wave of thought, the insane were regarded with contempt by society and treated like animals. Moral treatment was seen as a more humane way of dealing with these sufferers.

Dr Robert Brudenell Carter, an ophthalmologist and GP in Leytonstone, was another master therapist and, like Ihembi, was a warm, humane man. He used moral treatment during therapy when dealing with patients suffering from hysteria, and, in 1853, published a book titled On the Pathology and Treatment of Hysteria.

A century later, the diagnosis of “hysteria” would be denounced as a snare and a delusion and, for a time, would vanish completely from the diagnostic manuals. But in the nineteenth century, during Carter’s time, it meant hysterical “fits” (collapsing in violent tears and laughter, etc.) and a great variety of symptoms presented as physical diseases but with no physical cause. The subject of “hysteria” is important to this history, as the way it was treated led to the discovery of dynamic psychotherapy at the end of the nineteenth century.

Almost no modern psychiatrist has ever heard of Carter, but his account of the illness and its cure was excellent apart from one missing observation, which would later be further explored by Freud.

Carter began his book by describing the effects of emotion on the body; for example, how emotion is discharged through muscular action, including the facial muscles, through the cardiovascular system (palpitations, heart missing a beat, blushing, turning pale etc.), the alimentary system (loss of appetite, nausea, bowels or bladder losing control, etc.—he could have added bulimia and anorexia), the lungs (sighing, gasping, sobbing, laughing, breath-holding, rapid breathing (hyperventilation)), the secretory glands (mouth dry, sweating), and so on. Carter was impressed by how powerfully emotions affected the body.

He assumed that animals could express their emotions without control, but when it came to our own emotions, he believed that society at the time would not allow for the release of these feelings, instead demanding that people control and sometimes suppress them. If suppressed, the emotions might come out in hysterical fits and, in the longer term, manifest into other hysterical symptoms. Carter gave examples from life to illustrate his point: a maidservant berated by her mistress for unfinished work falls into a hysterical fit. It later turns out that, earlier that day, the maid had told her lover that she was pregnant and received no offer of help. Carter also cites the case of Miss A, whose engagement had gone on for years with no sign of marriage, and comes home to find her sister in the drawing room with her new fiancé, to whom marriage is already arranged. Rather subdued, Miss A says little, but on her way to the door collapses into a hysterical fit.

Carter believed that it was a matter of common observation that “hysterical” symptoms were caused by suppressed emotion, occurring more frequently in women than men, as women were more often required by society to suppress their emotional reactions. Feelings women especially had to conceal were primarily sexual, followed by anger, hostility, then grief and care.

So, seventy-seven years before Freud wrote Civilisation and its Discontents, Carter had already stated that social norms were the cause of neurosis. He called hysteria “one of the misfortunes entailed upon the civilised female by the conditions of her existence” (Carter, 1853, p.93). In fact, Carter pointed to the effects of suppressed sexuality three years before Freud was even born.

The fit or other symptom obtains sympathy, which Carter believed was a deep and universal need of mankind. The day after the fit, the friends visit to sympathise with the sufferer, who is reminded of the emotions that caused the fit the first time, so she has another, and so it is with the other symptoms. As the sympathy never reaches the true sore place, because we only get sympathy for the symptom and not for the secret hurt, the need, never assuaged, can become an addiction.

Carter believed his patients were malingering, cheating. Sometimes, they did it in a certain indirect way. He observed that when we want to assume a facial expression suitable to an occasion, a funeral or a wedding, say, we do not do it by deliberately moving the muscles of the face (there are at least thirty) like raising a hand, but by thinking of something, or at least thinking up a mood or attitude, that will produce the desired expression. For example, some actors used to claim that they would think of corpses to stop a fit of giggles on stage. Similarly, one of Carter’s patients could make herself vomit by thinking of a putrid dead cat made into a pudding.

Although Carter thought his patients were just cheating, morally culpable, and in desperate need of moral treatment, he treated them with quite remarkable respect and sympathy. He believed that they lacked the moral education their families should have provided in how to digest and deal with disappointments and unfairness. However, Carter never revealed his suspicions about his patients’ dishonesty to their families or friends (although he sometimes threatened to). He saw his patients as sympathy starved rather than attention seeking.

Carter also saw that hysterical symptoms were sometimes caused by negative feelings towards the person making them angry—an observation of great importance, to be heard of again, often! He believed that frustration was not to blame, but the inability to talk about the problem and get sympathy for it. Besides, there were other things to be frustrated about apart from sexual fulfilment, such as the difficulty of getting revenge on our nearest and dearest, etc.

Carter took his patients to live in his own home, where they were treated with firm kindness by his wife and daughters, and the servants were trained to ignore the symptoms, which, thus, ceased to be a source of sympathy. But by talking to everybody who was close to the patient as well as to the patient (a bit like Ihembi), Carter tried to find out the original source of the upset.

Then he set up a one-to-one confrontation, in which he patiently and au fond kindly uncovered the deception. This provoked some very stormy scenes, and his accounts were the first recorded descriptions of what I call the Battle with the Patient (an important and recurring theme in psychotherapy):

The patient needs to hear the truth, and have her conduct put before her, in a light which no ingenuity of hers can possibly pervert into the interesting or romantic; while at the same time, all this must be done with a degree of self-possession and good temper on the part of the operator. (Carter, 1853, p. 114)

In other words, if the doctor is on the verge of losing his temper, he must make an excuse to stop the interview and take it up again later.

Carter would stick to his guns until the patient admitted he had got it right. Evidently, after uncovering the original emotional wound, he offered sympathy and understanding for that instead of for the symptoms.

Thus, if in your family you cannot show your hurt and get sympathy for it (“Come and have a cuddle, love!”), if you cannot reproach whoever has hurt you and get an apology (“Oh, I’m sorry! Come and have a cuddle!”), and if you cannot resolve a fight by plain speaking (“Yes, all right, I see what you mean, I’m sorry, give me a cuddle!”), then an alternative is symptoms that get sympathy or revenge so indirectly that they do not satisfy.

Carter believed his patients were only pretending, and that worsening of the symptoms only meant further moral decline. However, he did record that when certain patients told him they were not pretending, that the symptoms were just there, and they really did not know why, he somehow knew that, actually, they were telling the truth. The explanation of that was to come forty years later at the Salpêtrière Hospital in Paris.

Jean-Martin Charcot was a neurologist and chief physician at the women’s Salpêtriere Hospital in the later nineteenth century. The Salpêtrière had essentially been an asylum for the impoverished women of Paris who suffered from “nervous diseases”. Charcot believed there was a neurological basis for insanity and set out to prove that it was possible to successfully treat the “incurable”. He was interested in hysteria and in hypnosis, the latter of which he was prestigious enough to make medically respectable. Charcot was as famous for his pupils as his theories, and taught Freud, Babinski, Janet, and Bouchard, among others.

He believed that hysteria was a neurological disorder and used hypnosis to demonstrate what he thought of as the typical hysterical fit, which was very similar to an epileptic one. He carried out these experiments often using his favourite patient, “Blanche”, otherwise known as the “Queen of Hysterics”. Blanche was young, pretty, and a bit of a star who was inclined to bully the other patients. When Freud went home after his months at the Salpêtrière, he took with him a print of a painting by André Brouillet, which portrayed Charcot and Blanche demonstrating to a cr...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• FOREWORD by Sue Macdiarmid
• INTRODUCTION
• PART I: PREDECESSORS
• PART II: FOREFATHERS
• PART III: THE HUMANISATION OF PSYCHOANALYSIS
• PART IV: LEGACY FOR THE TWENTY-FIRST CENTURY
• REFERENCES
• INDEX