Psychoanalysis is a system of psychology originated by the Viennese physician Sigmund FREUD in the 1890's and then further developed by himself, his students, and other followers. It consists of three kinds of related activities: (1) a method for research into the human mind, especially inner experiences such as thoughts, feelings, emotions, fantasies, and dreams; (2) a systematic accumulation of a body of knowledge about the mind; and (3) a method for the treatment of psychological or emotional disorders.
Psychoanalysis began with the discovery that HYSTERIA, an illness with physical symptoms that occurred in a completely healthy physical body--such as a numbness or paralysis of a limb or a loss of voice or a blindness--could be caused by unconscious wishes or forgotten memories. (Hysteria is now commonly referred to as conversion disorder.) The French neurologist Jean Martin CHARCOT tried to rid the mind of undesirable thoughts through hypnotic suggestion, but without lasting success. Josef Breuer, a Viennese physician, achieved better results by letting Anna O., a young woman patient, try to empty her mind by just telling him all of her thoughts and feelings.
Freud refined Breuer's method by conceptualizing theories about it and, using these theories, telling his patients through interpretations what was going on inside the unconscious part of their minds, thus making the unconscious become conscious. Many hysterias were cured this way, and in 1895, Breuer and Freud published their findings and theories in Studies in Hysteria.
CLASSIC PSYCHOANALYTIC THEORY
Traditional psychoanalytical theory states that all human beings are born with instinctual drives that are constantly active even though a person is usually not conscious of thus being driven. Two drives--one for sexual pleasure, called libido, the other called aggression--motivate and propel most behavior. In the infant, the libido first manifests itself by making sucking an activity with pleasurable sensations in the mouth. Later similar pleasures are experienced in the anus during bowel movements, and finally these erotically tinged pleasures are experienced when the sexual organ is manipulated. Thus psychosexual development progresses
from the oral through the anal to the phallic stage. (Phallic, in psychoanalytic theory, refers to both male and female sexual organs.)
During the height of the phallic phase, about ages three to six, these libidinous drives focus on the parent of the opposite sex and lend an erotic cast to the relation between mother and son or between father and daughter, the so-called Oedipus COMPLEX. However, most societies strongly disapprove of these sexual interests of children. A TABOO on incest rules universally. Parents, therefore, influence children to push such pleasurable sensations and thoughts out of their conscious minds into the unconscious by a process called repression. In this way the mind comes to consist of three parts: (1) an executive part, the EGO, mostly conscious and comprising all the ordinary thoughts and functions needed to direct a person in his or her daily behavior; (2) the id, mostly unconscious and containing all the instincts and everything that was repressed into it; and (3) the superego, the conscious that harbors the values, ideals, and prohibitions that set the guidelines for the ego and that punishes through the imposition of guilt feelings.
Strong boundaries between the three parts keep the ego fairly free from disturbing thoughts and wishes in the id, thereby guaranteeing efficient functioning and socially acceptable behavior. During sleep the boundaries weaken; disturbing wishes may slip into the ego from the id, and warnings may come over from the superego. The results are intrapsychic conflicts, often manifested in dreams (see DREAMS AND DREAMING), sometimes even in frightening NIGHTMARES. Freud elucidated this concept in his first major work, The Interpretation of Dreams (1900; Eng. trans., 1913). Something very similar to the weakening of boundaries during sleep sometimes happens during ordinary daytime activities when some impulses from the id manages to cross the repression barrier to invade the ego and cause faulty actions such as slips of the tongue. Psychoneurotic symptoms occur if psychologically hurtful experiences during childhood have left the repression too weak or have distorted the ego, or if overstimulation has left the id wishes too strong, or if the delicate balance between ego, id, and superego has been upset by injury or other events. Any kind of psychic trauma may lead to the ego becoming an area of intrapsychic conflict between the intruding id, the threatening superego, and the powerful influences emanating from the surrounding environment. Furthermore, the damage done to the basic psychological structures by traumatic experiences leaves those structures weakened and with defective functioning.
Such conflicts and defects can cause intense ANXIETY and severe DEPRESSION. In order to keep functioning effectively, the ego attempts to maintain control by achieving some sort of compromise between the contending forces. Often such compromises appear in the form of inhibitions or compulsions that affect behavior. Abnormal behavior and the anxiety, depressions, and PHOBIAS that go with them are called psychoneurotic symptoms in psychoanalytic theory. Neurotic character is the phrase used to designate a consistent pattern of neurotic behavior. When the damage abnormally distorts self-esteem, the resulting disturbance is called a narcissistic personality disorder, or a disorder of the self.
Patients seek psychoanalytic treatment because they suffer from one or more of a variety of psychological symptoms such as anxiety, depression, sexual and other inhibitions, obsessive thoughts, compulsive actions, irrational angers, shyness and timidity, phobias, inability to get along with friends or spouses or co-workers, low self-esteem, a sense of feeling unfulfilled, nervous irritability, and blocked creativity. The defects and repressed conflicts that cause these symptoms are usually indicative of a psychoneurosis or a narcissistic personality disorder. Normal ego functioning and the joy of life that comes with easy relationship to others are seriously interfered with or sometimes lost altogether. Psychoanalysis does not promise a quick cure but holds out the hope that through better understanding of oneself and of others one can achieve an amelioration of symptoms as well as a smoother and more effective socialization of one's behavior.
Psychological maladaptations usually originate from painful misunderstandings or outright failures in the child's relationship to his or her parents. Sometimes parents lack the appropriate and attuned empathic understanding that children need. Sometimes severe physical or mental illness or the death of a parent or sibling causes serious psychic wounds. Consequently, even in adults, there remain ever-present though usually unconscious fears that the early hurtful experiences will now be repeated again with others. Transference is the unconscious expectation that the old injuries and insults will now again be suffered, only this time at the hands of friends, spouses, children, bosses, just about anybody--as if transferred from the past into the present. Transference makes one have irrational expectations from the people with whom one lives and works. For example, one may feel a need to be appreciated by one's supervisors similarly to a child's needing approval from his or her parents. Frustration of these expectations may evoke immature rage or other immature behavior. Transference causes great distress, but it also makes treatment possible.
The method of treatment seems simple at first. The patient reclines on a comfortable couch in the analyst's office with the analyst seated behind the patient. The recumbent position, as well as not being able to see the analyst, minimizes distraction and allows concentration on inner experiences, thoughts, wishes, fantasies, and feelings. The patient is instructed to say absolutely everything that comes to mind without censoring anything, a technique that is called free association. This brings about a state of regression in which long-forgotten events and painful encounters are remembered, often with great clarity and intense emotions. At the same time, because of transference, the patient experiences the analyst as well, as if he or she were a figure from the past, perhaps resembling a parent.
The analyst often can trace the connection between the patient's current fantasies and feelings about the analyst and the origin of these thoughts and emotions in childhood experiences. The re-experienced conflicts and traumas, together with the accompanying fears and feelings, then are interpreted by the analyst. The patient learns to recognize the connections between the past and the present. The combination of insight together with the powerful emotional re-experience during the regressed state brought about by the analytic method cause a reorganization of the psychological structures into more healthfully adaptive patterns. The analyst's friendly and calmly explaining attitude that is devoid of any moralizing or other biases creates an atmosphere in which, most of the time, all human failings and foibles can be looked at, talked about, and finally resolved.
Typically, an analysis lasts for a few years, with four to five sessions per week of about 45 minutes each. In this way the psychoneuroses and the narcissistic personality disorders can be treated successfully in a majority of patients. Serious mental illnesses such as schizophrenia, manic-depressive illness, and the psychoses caused by organic malfunctioning of the brain cannot be cured by psychoanalytic treatment, though the patient can often benefit from psycho-pharmacological treatment--sedatives, tranquilizers, anti-depressants--in combination with psychotherapy.
In the United States most psychoanalysts are physicians who, after medical school, first specialized in PSYCHIATRY and who then were trained as psychoanalysts in an institute for psychoanalysts. Institute training typically takes from five to seven years. Outside the United States many non-medical psychologists and other behavioral scientists have been trained as psychoanalysts, and recently non-medical candidates are being trained in increasing numbers by American institutes.
From the beginnings in the late 19th century, psychoanalytic theory and practice have continued to develop into the present modern practices. Initially, Freud believed that forgotten sexual seductions of children were the cause of neurosis and that remembering the trauma and emotions was therapeutic. He later modified and elaborated his views into the theory of infantile instinctual drives as the motivating force for normal behavior and, when miscarried, as the cause of neurosis. Drive psychology gradually expanded into a closer study of the ego's ways of coping with the instinctual drive, the so-called ego psychology.
Continuing research has discovered much evidence that the early relationships between children and parents, the so-called object relations, have the greatest impact on later psychological development. The influence of the care givers, especially during infancy, leaves a lasting imprint on the personality. Emphasis on the object-relations theory developed by Melanie KLEIN characterizes psychoanalysis in much of Britain and Latin America. In the United States a particular aspect of object relations, namely their effects on the sense of self and on self-esteem, are being studied by a growing number of psychoanalysts.
Initiated by Heinz Kohut, self-psychology is being developed by his followers into one of the main concepts that make up the body of psychoanalytic theory. Self-psychology is a psychology of subjective experience. The self-psychologically oriented psychoanalyst, in addition to considering the usual psychoanalytic data of inner experiences such as dreams and free associations, emphasizes the use of empathic immersion by the analyst into the life experience of the patient as an essential source of data for treatment and for theorizing. Self-psychology postulates a nuclear self at the core of the individual. A cohesive, vigorous, and balanced self lends the person a sense of self and of well-being.
Any experience with objects, including persons, that evoke and strengthen the self are "self-object" experiences and are needed by every human being from birth to death in order to sustain a cohesive self. Absence of or faulty self-object experiences cause a loss of cohesion with attendant fragmentation of the self.
In addition to their clinical application, psychoanalytic theories have been used as guides to doing research in certain social sciences as well as in the humanities. Some cross-cultural anthropological investigations, for example, have used interviewing techniques that were based on the psychoanalytic method. Some psychohistorical studies have employed the theories of psychoanalysis in the interpretation of the dynamic forces underlying historical events. Biographical research has been enriched by adding the insights of psychoanalysis, and the resulting psycho-biographies have added a dimension of depth to the understanding of some outstanding persons, as, for example, in Gandhi's Truth (1969) by Erik ERIKSON. But it is in the application of psychoanalysis to artistic and literary criticism that analysts, especially Freud (on Leonardo da Vinci and Michelangelo), Kurt Eissler (on Hamlet), Jacques Lacan (on Edgar Allen Poe), and Heinz Kohut (on Thomas Mann), have made their most widely known contributions.
Research in the theories and methods of psychoanalysis presents special difficulties. In contrast to the natural sciences, psychoanalytic data are private, subjective, and often non-repeatable inner experiences. They are grasped by introspection and by empathy and, therefore, are not publicly verifiable in the same way that natural science data can be demonstrated. Nevertheless, continuing attempts to compare and to check findings with colleagues in a worldwide psychoanalytic community, in addition to finding confirmation of psychoanalytic concepts from research in contiguous sciences, provide a measure of verification.
Ernest S. Wolf
Bibliography: Abraham, Karl, Selected Papers on Psychoanalysis, 2 vols. (1927-55); Alexander, Franz, The Scope of Psychoanalysis, (1961); Fenichel, Otto, The Psychoanalytic Theory of Neurosis, (1945); Ferenczi, Sandor, Selected Papers, 3 vols.,(1926-55); Freud, Sigmund, Complete Psychological Works, 24 vols.,ed. by James Strachey (1955-75); Hartmann, Heinz, Essays on Ego Psychology (1964); Klein, Melanie, The Psychoanalysis of Children, (1932; repr. 1984); Kohut, Heinz, How Does Analysis Cure? (1984); Winnicott, D. W., Collected Papers (1958); Wolf, Ernest, Treating the Self (1988).
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