Introduction to Psychoanalysis

Contemporary Theory and Practice

Anthony W. Bateman, Jeremy Holmes

• Publisher: Routledge
• Year: 2002
• ISBN:
  9781134842063
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The need for a concise, comprehensive guide to the main principles and practice of psychoanalysis and psychoanalytic psychotherapy has become pressing as the psychoanalytic movement has expanded and diversified. An introductory text suitable for a wide range of courses, this lively, widely referenced account presents the core features of contemporary psychoanalytic theory and practice in an easily assimilated, but thought-provoking manner. Illustrated throughout with clinical examples, it provides an up-to-date source of reference for a wider range of mental health professionals as well as those training in psychoanalysis, psychotherapy or counselling.

Part I

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Theory

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Chapter 1

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Introduction: history and controversy

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The best way of understanding psycho-analysis is still by tracing its origin and development.

(Freud 1922: 235)

During its hundred-year existence psychoanalysis has grown from modest central European beginnings into a worldwide therapeutic and cultural presence. Freud is one of the half dozen thinkers whose ideas have shaped the twentieth century, and whose influence seems likely to continue into the next. Yet psychoanalysis has from the start been beset with controversy and doubt, both from within its own ranks and from without. Indeed, the universality of conflict, and the possibility but difficulty of its resolution, are central to the psychoanalytic message.

Contemporary political, religious and social uncertainties seem to have created an almost insatiable hunger for psychological knowledge. Training and treatment in psychotherapy and counselling are currently in great demand, especially in liberal and middle-class circles. Psychiatry and medicine, while still ambivalent, are increasingly turning to psychotherapy and counselling to complement their powerful but narrow scientific approach. And yet, at the epicentre of this turmoil, psychoanalysis itself is in crisis. Partly a victim of its own success, it struggles to differentiate itself from psychoanalytic psychotherapy and its other offspring. With the death of Freud’s immediate followers, the apostolic era is over and there is a search for new forms of leadership. Economic recession threatens the economic base of psychoanalysis. Historians, not all of them biased, question Freud’s personal and scientific integrity. The philosophical credentials of psychoanalysis continue to come under increasingly sophisticated scrutiny. As psychoanalysis diversifies there is an urgent search for unity and common ground.

It is beyond the scope and competence of this ‘introduction’ to tackle these sweeping issues head on. Our aim is to present the core features of contemporary psychoanalytic theory and practice, a bedrock which might then form the basis for a wider discussion about the nature and role of psychoanalysis within psychiatry, psychotherapy and society. However we shall in this introductory chapter try to point the reader towards some of the key issues of debate and controversy which preoccupy present- day psychoanalysis. In order to put these discussions into context, as well as being a backdrop to the whole book, we start with a simplified account of the history and evolution of the psychoanalytic movement.

HISTORY OF THE PSYCHOANALYTIC MOVEMENT

Freud liked to compare the adult personality with an archaeological site which contained layer upon layer of civilisation, each based upon, and retaining some features of the one which it replaced. He saw the ego as a ‘precipitate of abandoned object cathexes’, constructed from the important figures from the past with whom each individual has identified. Both metaphors could be applied to psychoanalysis itself, which, if approached historically, reveals how new ideas often emerge from, but do not entirely replace, previous ones, and where the personality of a thinker is sometimes as important as the content of his or her contribution. The story of psychoanalysis is a mixture of history, geography, and charismatic influence. (See Fig. 1 for a ‘family tree’ of psychoanalysis.)

Freud (1914b, 1927) described several phases in the evolution of psychoanalysis.

1885–1897: the ‘pre-analytic’ phase

Psychoanalysis comprises three interrelated strands: a set of specific psychotherapeutic techniques such as free association and interpretation; a model of psychological development; and a ‘metapsychology’, speculative hypotheses about the nature and structure of the mind. In this book we approach psychoanalysis as primarily a craft; it is consistent with this viewpoint that Freud was first propelled towards the invention of his ‘new science’ for quite mundane and practical reasons.

In 1886, at the age of 30, Freud married. He realised that he would need to provide for his wife and what was within a few years to become a large and growing family. Although he was already well known as a distinguished neurologist and neuroanatomist, the opportunities either for advancement in a university rife with antisemitism, or for private neurological practice, were slight. At the same time he was aware of the many patients with hysterical symptoms and what he was later to call psychoneurotic disorders who thronged physicians’ consulting rooms. He had visited Paris and been impressed by Charcot’s demonstration of the extent of hysterical phenomena, and by accounts of Janet’s successful hypnotic treatment of hysteria. He therefore determined to build his practice around the treatment of these patients.

Here he was helped by one of the several important friendships that contributed to the gestation and birth of psychoanalysis. Freud’s friend Breuer, a general practitioner, had been experimenting with the use of hypnosis in the treatment of a young girl (the famous ‘Anna O’) suffering from paralyses and episodes of mental confusion. Breuer had found that by putting her into a hypnotic trance and asking her to speak freely about whatever was troubling her, the symptoms were temporarily relieved. Freud began to work with Breuer, a collaboration which they wrote up as Studies in Hysteria (Breuer and Freud 1895), based on thirteen such cases. Their‘cathartic’ approach centred on the idea that neuroses resulted from the‘damming up’ of painful affect, and that, like the lancing of a boil, if mental distress could be released via its verbal expression (‘abreaction’) under hypnosis, relief would follow.

At this point we encounter one of the features of Freud’s character which has shaped the course of the history of psychoanalysis: his capacity to confront and theorise about a difficulty (or ‘resistance’) and turn it to advantage. He came up against a number of problems with hypnosis. First, he found that there were patients whom he was unable to hypnotise. Second, he began to be suspicious of the idea of hypnotic ‘suggestion’, feeling that it overemphasised the role of the physician and compromised the patient’s autonomy. Third, he observed at first hand the phenomenon of transference when Breuer’s patient, on waking from a trance, flung her arms passionately around her physician. Finally, searching for a traumatic explanation for the patient’s difficulties he discovered, or thought that he had discovered, that they sprung from sexual trauma in childhood, a view that was repellent to the more prudish and timorous Breuer.

1897–1908: psychoanalysis proper: freud’s wilderness years

The next few years were a period of intellectual ferment and emotional crisis for Freud, during which, with the help of his friend Fleiss, with whom he maintained an intense correspondence, he established the practical and theoretical foundations of psychoanalysis which have lasted to this day.

He abandoned hypnosis, and devised the method of free association, aided at first by light pressure of the analyst’s hand on the patient’s forehead. He began to see neurosis not simply in terms of actual trauma, although this still played a part, nor as Janet had believed as the result of‘weakness’ of the nervous system (an idea that was in a sense revived with the ‘deficit’ models of Kohut and Winnicott, see Chapter 2 ), but as the result of unconscious conflict. At the core of this conflict were instinct- driven phantasies (see p. 39) concerning sexuality: the male child’s oedipal wish to possess his mother, in conflict with the fear of his father’s possessive retribution. The Three Essays on the Theory of Sexuality (1905) emphasised the central importance of infantile sexuality and the role of bodily experience in the early development of the personality, which has become one of the pillars of psychoanalytic thinking.

Freud’s move from ‘seduction theory’ to the idea of unconscious phantasy has provoked huge controversy among historians, especially in the light of contemporary knowledge of the extent of childhood sexual abuse. The idea of wish-fulfilment and phantasy are central to psychoanalysis. Freud realised that his patient’s accounts of seductions reflected the wish-based, pleasure principle-driven nature of the inner world, and this was a vital step forward. Nevertheless he also continued to acknowledge the role of outer reality: ‘seduction during childhood retained a certain share, though a lesser one, in the aetiology of the neuroses’ (Freud 1927).

Implicit in conflict was resistance to the analyst’s attempts to penetrate the defensive structures of neurosis, as a first step towards change. Freud initially saw transference as a resistance, impeding the smooth flow of free association, but as he came to realise that transference phantasies were an in vivo re-enactment of the patient’s core difficulties, it became the centrepiece of the psychoanalytic method. The culmination of this period was The Interpretation of Dreams, which Freud always considered to be his finest work (see Chapter 6). Here Freud drew on his own personal struggles – his sibling rivalry, ambivalent reactions to his father’s death in 1896, sense of being his mother’s favourite, pride and humiliation in his Jewishness, and professional isolation and ambition – to develop a theory not just of dreams but of the mind itself.

1907/8–1920: the beginnings of the psychoanalytic movement

As the first decade of the century progressed, so Freud’s ideas began to take hold among a group of progressive physicians and intellectuals who became the first psychoanalytic circle: Jung, Adler, Stekel, Abraham, Ferenczi, Jones and Rank – the original ‘ring bearers’ for whom Freud had special rings made, as he did for all of his favoured disciples. In 1908 the first psychoanalytic congress was held in Salzburg and a journal inaugurated. Jung, the first non-Jew to join the ranks of psychoanalysis soon became Freud’s ‘crown prince’, and with the influential Bleuler, his chief at the Burgholzli, formed a psychoanalytic nucleus in Switzerland. Freud and Jung were invited to the USA in 1910, where Freud gave the prestigious Clark lectures. The two men diverted themselves on the Atlantic crossing by analysing each other’s dreams. Perhaps this intimacy was too much: by 1913 Jung had split from Freud, protesting about Freud’s insistence on the centrality of sex, his suspicion of religion, and authoritarian methods. Adler, too, had left in 1911 to set up his own school of psychotherapy, which emphasised aggression and the ‘inferiority complex’, rather than Freud’s libido and oedipus, as central determinants of character.

Jung and Adler ’s defections were by no means the last that psychoanalysis was to suffer (Stekel had also left in 1911) but the psychoanalytical movement continued to grow, with clinics established in Budapest, Berlin and London, the latter thanks to Ernest Jones’s combination of energy, intellectual gifts and absolute devotion to Freud.

The 1914–18 war had a major impact on the evolution of psychoanalysis in Europe. Freud, now aged 60, his fame fully established, continued to work prodigiously, producing the great metapsychological papers On Narcissism and Mourning and Melancholia, as well as the Introductory Lectures in Psychoanalysis (delivered, by established psychoanalytic tradition, extempore) during this period. The carnage of the world war turned his thoughts to the darker side of human psychology and Freud began to emphasise aggression more than before, ideas that would culminate in the 1920s with the notion of thanatos, the death instinct.

In Britain the war had a positive impact on the spread of psychoanalytic methods and ideas. Large numbers of soldiers returned from the front with battle fatigue or shell shock (forerunners of the contemporary diagnosis of Post-Traumatic Stress Disorder). Conventional psychiatry at that time had little to offer, leaving the way open for psychoanalytic methods at such centres as the Brunswick Square Clinic headed by James Glover, which became a breeding ground for British psychoanalysis, employing James’s brother Edward Glover, Sylvia Payne, Ella Sharpe, Susan Isaacs and Marjorie Brierly, all later to become prominent psychoanalysts. The Cassel Hospital was founded in the immediate aftermath of the war as an in-patient unit for psychoanalytic treatment of war casualties.

1920 to Freud’s death in 1939

Freud’s powers as a theoretician remained undiminished to the end of his life. In 1923 he saw the publication of The Ego and the Id, his major revision of the ‘topographical’ model (which had divided the mind into the unconscious, preconscious and conscious parts), proposing instead the ‘structural’ or tripartite model of id, ego and superego (see pp. 35–7). In 1926 he produced a revised theory of anxiety, which he now saw as signalling a threat to the self, rather than being a manifestation of surplus erotic energy or ‘libido’. A short but highly influential paper on fetishism (Freud 1927) introduced the idea of splitting of the ego, which remains central to contemporary psychoanalysis. Throughout the 1930s Freud continued with his speculations about religion, as well as struggling with ideas about female sexuality, stimulated no doubt by the increasing numbers of distinguished female analysts.

Freud’s daughter Anna pioneered the psychoanalytic treatment of children, and, after her mother’s death, cared for her father – Antigone to his Oedipus. When the Nazis arrived in Austria in 1938, Freud was allowed to leave for England, whence many analysts had already fled. With Anna, he settled at Maresfield Gardens in Hampstead. He died a year later in 1939, just before the outbreak of war.

Psychoanalysis in Britain

The politics of the psychoanalytic movement has been characterised from the start by a tension between the need to defend the faith – including the expulsion of heretics if necessary – and the wish to extend its boundaries and to accommodate new ideas. Psychoanalytic ideas had an important impact on intellectual life in Britain in the 1920s, influencing progressive psychiatrists and medical practitioners as well as members of the Bloomsbury Group, among whom Karin and James Strachey began medical training specifically in order to become psychoanalysts (Pines 1991). Ernest Jones was determined to preserve psychoanalytic identity from dilution by psychotherapeutic fellow travellers and hangers on. However, unlike his American counterparts, he was generally in favour of recognition and equal status for ‘lay’ (i.e. non-medical) analysts, for which he had Freud’s full support (Freud 1926). When Alix and James Strachey organised a British lecture tour for the young Berlin-based psychoanalyst Melanie Klein, Jones took to her at once and invited her to come to settle in London, as well as arranging for his children to be analysed by her. Unattached – she was a divorced woman whose children were nearly grown up – she accepted, a fateful move for the history of psychoanalysis.

Klein, who had been analysed by Ferenczi and Abraham, had devised a method of play therapy derived from dream interpretation which she claimed enabled her to understand the minds of infants and small children. As her work developed she applied these findings to analytic work with disturbed adult patients, focusing on the mother–infant relationship, and claiming that oedipal conflicts could be found in the first year of life – much earlier than Freud had thought. Later, especially after the death of her beloved son in a climbing accident (Grosskurth 1986), she emphasised the role of aggression and envy in infantile life, and extended her own analyst Abraham’s classification of developmental stages with the idea of an early ‘paranoid–schizoid position’ to be superseded in the mature child by the ‘depressive position’ (see pp. 38–9).

Freud was suspicious of Klein, especially as her ideas conflicted with those of his daughter Anna, also a child psychoanalyst, who doubted the validity of Klein’s speculations about the mental life of infants, and who felt that a more supportive technique was needed in treating children. As refugee psychoanalysts started to arrive in London in the 1930s, tension built up between the Viennese immigrants and the followers of Klein, who included Riviere, Rickman, Isaacs and, as students, Winnicott, Bion and Bowlby. After Freud’s death in 1939 rivalries heightened, and by 1944 two distinct camps had emerged, clustered around Klein and Anna Freud. The atmosphere was electric and there was grave danger of the British Society splitting apart. A series of talks were organised, ‘the controversial discussions’ (King and Steiner 1990) and a compromise emerged, the ‘gentlemen’s agreement’ (arranged by three women, Klein, Anna Freud and the mediator Sylvia Payne). This established two separate groups within the Society, roughly corresponding with the Kleinians and Anna Freudians, each with its own training programme and quotas on committees. Later a third group, the Independents or ‘middle group’, emerged.

There followed a period of great creativity within the British Society. Klein became a dominant figure and her ideas were extended by Bion, Segal, Winnicott, Rosenfeld, Joseph and others. The British ‘object relations’ perspective was a significant move away from Freud’s drive- based developmental schema to one in which the infant–mother relationship was of central importance. They drew partly on Kleinian ideas of an inner world populated by representations of early childhood relationships distorted by phantasy, and partly on the work of Independents such as Michael Balint who postulated a primary relatedness separate from the drives for food and sex. Bion and Winnicott, in very different ways, emphasised the role of the maternal environment, or ‘breast’, in providing favourable or unfavourable conditions for psychological growth and integration. Although John Bowlby was himself gradually estranged from the Society, his linking of ethology with psychoanalysis provided scientific support for object relations ideas. Fa...