Approaching Psychoanalysis

An Introductory Course

David Livingstone Smith

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367323332
• eBook ISBN: 9780429910906
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book provides the scope and complexity of Freud's contributions and emphasizes the wide proliferation of the Lacanian approach. It describes psychoanalytical theories, and is helpful for the readers as a stimulus to independent investigation and critical thought.

Part One
The Work of Sigmund Freud

Chapter One
Mind and nature: the context of Freud's work

You call something a "mystery" when you will not see it.

Musa Farawani

Sigmund Freud was born Sigismund Schlomo (Solomon) Freud in the Moravian (Czech) village of Freiberg in 1856. The son of a Jewish wool-merchant from the northern province of Galicia, Freud was only one generation away from the mediaeval culture of traditional, rural Jewry. In 1859, the Freud family moved to Leipzig in search of employment and then wandered on to Vienna, where they settled in the Leopoldstadt district, living in slum conditions until they were able to improve their circumstances. There has been considerable dispute about the reasons for this move from Freiberg. Perhaps the most colourful theory is that it was connected with a counterfeiting ring of which the Freuds may have been a part (Gedo, 1986).

Vienna was one of the two capitals (the other being Budapest) of the magnificent, sprawling Austro-Hungarian Empire. During the latter half of the nineteenth century, the population of Vienna swelled with immigrants from the more far-flung provinces and many of them, like the Freuds, were Jews in search of opportunity. The liberal policies of the Emperor Franz Josef encouraged the assimilation of Jews into the mainstream of European cultural life. Vienna was perhaps the pinnacle of European cultural achievement and innovation in both the arts and the sciences. Those Jews seeking integration into this world therefore moved from a deeply traditional culture to the cutting edge of modernity. Freud was, as it were, midway between the shtetl and high European culture.

After graduating from secondary school, Freud entered the University of Vienna and eventually settled on the study of biology (although he read widely and took classes with luminaries such as the physicist Josef Stefan and the philosopher Franz Brentano). Freud's interests led him to specialize in neuroscience, a field that—as I shall describe—was the centre of intense disputes that had important implications for the most fundamental ways that we conceive of ourselves as human beings. Freud carried out research in Ernst Brücke's prestigious if primitive Physiological Institute, where he befriended or was befriended by Josef Breuer, a well-established physician. In his youth, Breuer had studied under Ewald Hering, who is best known for his work on the physiological mechanisms underpinning colour vision, and the research jointly undertaken by Hering and Breuer led to the discovery of the role of the vagus nerve in the self-regulating mechanism of breathing (the eponymous Hering-Breuer reflex). Hering was also the author of a celebrated lecture on unconscious mental activity (Butler, 1880); Freud later described this lecture as a "masterpiece" (Levine, 1926).

Breuer had also done important work on the function of the semicircular canal of the ear. He became Freud's friend, mentor, and financial sponsor. It was also Breuer who introduced Freud to the practice of psychotherapy.

During his time at the Physiological Institute, Brücke advised Freud that there were poor financial prospects facing him as a researcher, and he advised him to obtain a medical qualification. Freud accordingly extended his education and, on 5 September 1885, obtained his medical qualification. Freud opened his private practice on Easter Sunday, 1886. This characteristic swipe at the Roman Catholic majority in Vienna displays an important feature of Freud's personality: his desire to combat the hypocrisies of Christian culture, a motive that certainly had a decisive impact on his future work.

Freud came to establish himself as an expert in cerebral hemiplegias (paralyses) in children. He also became deeply involved in the new field of aphasiology—the study of speech disorders caused by damage to the brain. Freud's third major interest during the early period of his career was the disorder then known as hysteria. In 1885, Freud obtained a small grant enabling him to travel to Paris to study with Jean Martin Charcot, a world authority on neurology who had developed a special interest in hypnosis and hysteria. Freud's earliest contributions to psychology and psychotherapy centred on his investigations of hysteria.

Psychology, neuroscience, and psychiatry

Freud's work can only be properly understood and appreciated in the context of its rightful place in the history of ideas. Freud was a member of an international intellectual community that included psychologists, neuroscientists, psychiatrists, and philosophers. Although each of these groups was concerned with the study of the mind, each approached it from its own particular vantage point.

Psychologists wanted to understand the nature of normal mental processes. Psychology had become a scientific discipline in its own right largely through the efforts of Wilhelm Wundt, who attempted to harness the methods of experimental science to discipline the process of introspection. In his laboratory in Leipzig, Wundt and his colleagues exposed trained subjects to controlled stimuli, measured reaction-times, and solicited first-person reports. Inspired by the successes of the physicists, the new scientific psychologists hoped to identify the fundamental constituents of the psyche, the atoms of mental life. Within a few years, psychological laboratories began to spring up elsewhere in Europe and North America.

Neuroscientists studied the relationship between the mind and the brain. Neuroscience emerged during the first half of the nineteenth century. Nineteenth-century neuroscientists were confined to study damaged brains: in the absence of modern imaging techniques, it was not possible to study intact living brains. However, if a patient was found who had suffered brain damage, it was possible to determine which if any mental functions were disturbed by this damage. The neuroscientists gathered numerous cases of "trauma" suffered by living brain tissue, and they used these to try to determine the role of brain structures in normal mental life.

Psychiatrists situated themselves within the tradition of clinical medicine: they were concerned with understanding the nature of mental aberrations. Scientific psychiatry was born in the middle of the nineteenth century with the work of Wilhelm Griesinger. Griesinger's slogan "Mind diseases are brain diseases" illustrated the impact of neuroscience on the new psychiatry.

Nineteenth-century philosophy defined the basic assumptions and world-view in which the psychologists, neuroscientists, and psychiatrists worked. The conceptual horizons of the sciences of mind were fixed by one immensely significant tradition in the history of philosophy: the dualistic legacy of the seventeenth-century polymath René Descartes.

Descartes held that mind and body were made from two distinct "substances". He believed that the body is made out of physical substance and exists in space, whereas the mind is made of immaterial substance and exists only in time. In contrast to the spiritual nature of mind, the body is nothing but a complicated machine. Over the next few centuries, other philosophers proposed novel forms of dualism. In one form or another, dualism remained the prevailing view of the relationship between mind and brain until the twentieth century.

In addition to his work on the relationship between mind and body, Descartes had a theory about the relationship of the mind with itself. He believed that our minds are transparent to themselves: that is, we automatically and incorrigibly know whatever is going on in our minds. In other words, Descartes held that all mental states are conscious and that consciousness is an intrinsic characteristic of anything mental. If all mental states are conscious, then introspection is the only sensible method for psychological research.

During the nineteenth century, dualism became more and more difficult to entertain seriously. Nineteenth-century developments in the fields of evolutionary biology, physics, and neuroscience sharply contradicted the older dualistic theories. These developments had a momentous effect on our relationship to ourselves. The new knowledge challenged extremely ancient and deeply rooted beliefs about the human soul.

The unconscious before Freud

The other aspect of the Cartesian package—the view that all mental phenomena are conscious—was also being challenged by new work in the sciences. Hypnosis, psychiatry, and neuroscience conspired to demonstrate the existence of unconscious mental processes: mental states existing outside of awareness. Researchers struggled to make these observations square with the received view that all mental states are conscious.

Some writers claimed that consciousness can be split. A portion of one's consciousness is split off or dissociated from one's main consciousness. According to this view, apparently unconscious mental processes are actually manifestations of split-off portions of consciousness itself.

Another alternative was to claim that so-called unconscious mental states are really nothing more than neurophysiological states. They are not mental at all. They are merely capable of giving rise to mental states. According to this view, when we forget something, it is not simply inaccessible: it literally disappears as an idea. Each time that we remember it, the underlying neurophysiological state simply generates it anew.

Hysteria

Freud's earliest psychological work, which was done in collaboration with Josef Breuer, concerned the causes, dynamics, and treatment of hysteria. It is therefore important to describe something of the context in which Breuer and Freud advanced their ideas.

"Hysteria" was a term used for a rather heterogeneous group of illnesses. Sufferers from hysteria might experience epileptiform fits, mysterious pains, paralyses and other motor disabilities, and sensory distortions such as hallucinations or fall victim to states of dissociation. What defined all of these symptomatic pictures as "hysterical" was the absence of any anatomical or physiological explanation for them.

The concept of hysteria had been around for a very long time. The earliest reference to it is found in the writings of the ancient Egyptians, who believed hysteria to be an exclusively feminine disorder and attributed it to the dislocation of the womb, which was imagined as wreaking havoc as it slithered its way around the inside of a woman's body. The Egyptian theory of the dynamics of hysteria was taken up by the Greeks. In fact, it was Hippocrates who first used the term "hysteria" (from the Greek for womb, hystera).

During the Middle Ages, Saint Augustine proclaimed that the disease was caused by witchcraft. As being a victim of the supernatural disease denoted the heretic, the patients so diagnosed came into the hands of the Inquisition. They were questioned under torture for having exposed themselves to the allure of the devil or witchcraft and were punished for it—often by death (Veith, 1977).

During the Renaissance, the German physician Paracelsus rejected mediaeval superstition in favour of the ancient uterine theory of hysteria. During the seventeenth century, post-mortem examinations of hysterical women demonstrated that hysteria was not accompanied by pathological changes to the womb. Charles Le Pois and Thomas Sydenham rejected the traditional womb theory. It was Sydenham who first described hysteria as a psychological disorder and, in rejecting the womb theory, could assert that males could also suffer from it. Sydenham recommended a physical treatment regime of soothing medication, iron supplements, blood-letting, and vigorous exercise. By 1845, Ernst von Feuchtersieben, a Viennese psychiatrist, was recommending psychotherapy (including the analysis of the patient's dreams) as the treatment of choice.

This progressive trend was obstructed by Wilhelm Griesinger and his followers, whose descriptions of the "hysterical personality" seethed with contempt. Griesinger initiated a revival of the medieval attitude of moral disapproval, this time clothed in scientific rather than theological garb.

One of the voices opposing this chorus of disapproval was that of Jean-Martin Charcot. The son of a carriage builder, Charcot studied medicine and, after making a number of brilliant contributions to neurology, was given the chair of pathological anatomy at the University of Paris and was soon appointed to the chair of diseases of the nervous system. His medical reputation was equalled only by that of Louis Pasteur.

Charcot believed that hysteria was a constitutionally rooted neurological disorder which disposes certain individuals to respond hysterically to traumatic events and that the process of suggestion played a role in the generation of hysterical symptoms. He attempted to show this by demonstrating that hysterical individuals can be hypnotically induced to simulate neurotic symptoms and that these could also be removed by means of hypnosis.

Charcot's approach to hypnotism brought him into conflict with a group known as the "Nancy School", which was lead by Ambroise Liébeault, a rural physician, and Professor Hyppolyte Bernheim, of the University of Nancy. Charcot had claimed that susceptibility to hypnotic suggestion was physiologically determined, and rooted in a hysterical disposition. Liébeault and Bernheim asserted that hypnosis was a wholly psychological process and that susceptibility to it was not indicative of a pathological disposition. Bernheim accordingly claimed that hysteria was not an illness. It was, he believed, only an exaggeration of a natural tendency shared by all human beings confronted with emotional trauma. The dispute between the Charcotians and the Nancy School became rather acrimonious and was carried out both in the scholarly journals and in national newspapers such as Le Temps.

Perhaps the most important contributor to the literature on hysteria immediately after Charcot was Pierre Janet. Janet had been Charcot's student at the Salpêtrière. He emphasized the psychological character of hysterical afflictions and emphasized the role of "subconscious" ideas in hysteria. Janet believed that hysteria could be provoked by physical illness or by emotional shock, although he emphasized the former.

Therapy

The forms of psychotherapy current in the nineteenth century included psychosocial interventions such as suggestion (Bernheim), environmental management (Charcot), and forms of psychological analysis (Feuchtersieben).

The use of medication was an age-old approach to hysteria and was declining in popularity by the late nineteenth century. Doctors administered drugs that often complicated the original hysteria with a physician-induced addiction (Decker, 1991).

One of the most popular treatment modalities for hysteria was the Weir Mitchell "rest cure". Silas Weir Mitchell [1829-1914] was an American neuroscientist and also the author of poetry and "pop" novels, in 1877, he published his first book on the treatment of hysteria: the bizarrely titled Fat and Blood. Mitchell believed that hysterical women tended to be thin and lacked blood. He therefore proposed that the physical health of the patient was to be built up by means of a period of enforced rest supplemented by massage and electrotherapy. Mitchell combined his rest cure with "moral therapy"—efforts to influence patients psychologically to abandon the hysterical lifestyle.

Electrotherapy was a highly regarded method for treating hysteria. Treatment could go on for anything from a few months to several years. Electricity was applied either locally or generally and provoked a number of unpleasant side-effects (Decker, 1991).

Hydrotherapy, a less "high-tech" approach, was also widely employed for the treatment of hysteria. The most common form of hydrotherapy involved a high-pressure jet of cold water being directed at the patient. Alternatively, patients were tightly wrapped in cold, wet sheets.

Nineteenth-century technologies for treating hysteria were primitive, sometimes brutal, and unrelated to any sophisticated psychological understanding of the hysterical process (for a detailed discussion of these and more bizarre treatments, see Altschuler, 1965). This situation was decisively altered by the ground-breaking work undertaken by Joseph Breuer and his young collaborator Sigmund Freud, and it is to this development that we will now turn.

Chapter Two
Freud, Breuer, and hysteria: the cathartic method

If you laid your finger on my shoulder, it would affect you like fire running through your veins....

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• ACKNOWLEDGEMENTS
• Contents
• Introduction
• PART ONE The work of Sigmund Freud
• PART TWO Psychoanalysis after Freud
• REFERENCES
• INDEX