Sigmund Freud and the Birth of Psychoanalysis as an Interpretive Discipline
By Andrew Guthrie, Ph.D.
In 1885-86 Sigmund Freud studied with Jean Martin Charcot, a world famous neurologist, who was studying hysterical symptoms in women, such as paralysis, convulsions, somnambulism, hallucinations, loss of speech, and sensations of memory. While the popular view held that hysteria was caused either by an irritation of the female sexual organs, or was a case of play-acting, Charcot believed that hysteria was neither imaginary nor exclusive to women, but was what he called a neurosis. He discovered that hysterical symptoms, such as paralysis of the hand, ignored anatomical explanations, and concluded that hysteria was a disturbance of function and not structure. It was not the nerves of the hand themselves that were damaged; something was disordered in the patient’s thoughts about his hand, and these thoughts were central to the functional disability. “The problem (was) not in the flesh . . .the problem (was) an idea, out of awareness . . .” (Mitchell & Black, 1995, p. 3). To treat the pathological idea, Charcot placed patients in hypnotic trances and was able to temporarily remove their symptoms through hypnotic suggestion.
In 1886, Freud began to practice as a neuropathologist and used electrotherapy (the local, electrical stimulation of skin and muscles) for the treatment of hysteria. Freud concluded that electrotherapy was useless, but that it occasionally worked due to the power of suggestion. Remembering Charcot’s use of hypnotic suggestion in treating hysteria, Freud decided to consult Josef Breuer about his experiments with hypnotism. Breuer shared with Freud the story of one of his patients, Anna O, who suffered from a severe nervous cough, a squint, visual disturbances, paralysis of the right arm and neck, and a strange speech problem. She was agitated by violent hallucinations that ceased when she fell into a quiet trance in Breuer’s company and mumbled words to herself, which Breuer repeated. In this way, Anna O was able to talk about her hallucinations, and she emerged from her trances feeling relieved. She called these exercises her “talking-cure chimney-sweeping” (Appignanesi & Zarate, 1979).
Unfortunately, she soon became phobic of drinking water, and revealed while in a trance a memory of witnessing a dog drinking from a water glass. She had felt this was disgusting but could not express her disgust in the original situation. When she woke from her trance she was able to consciously express her disgust at the dog, and could finally drink water again. Breuer repeated this method with Anna’s other symptoms, and made three conclusions based on this work: each symptom disappeared when it was traced back to its first occasion, symptoms were removed by recalling forgotten unpleasant events, and a symptom emerged with greatest force when it was being talked away. Breuer called this method the cathartic method. Freud was greatly influenced by Breuer’s discoveries, and together they published Studies in Hysteria in 1895.
In this publication, Freud and Breuer concluded that hysterics suffer from reminiscences, or painful, unpleasant memories of a traumatic nature. Traumatic memories are pathogenic, disease-creating entities that do not ‘wear away’ but remain an active and unconscious force motivating behaviour. Banishment of painful memories from consciousness requires an active repressing mechanism operating at an unconscious level of mental life, and this repression causes the damming up of the energy (libido) associated with the memory. The dammed up affect is converted into the physical symptoms of hysteria, which can be treated by abreaction, or the process of releasing a repressed emotion about a previously forgotten event. Therefore, the goal of analysis was to fill in the gap in the patient’s memory by enabling the patient to relive the original traumatic experience that caused the symptom (Strenger, 1991).
Soon, Freud stopped hypnotizing his patients, instead encouraging them to lie down on a couch and say whatever thoughts entered their mind while he sat behind them.Patients were to behave like passengers on a train, gazing out the window at their thoughts, feelings, and fantasies, and describing all that they saw without criticism or selection. The analyst was to listen by not directing his attention to anything in particular and by maintaining an evenly suspended attention in the face of all that he heard. The rule of giving equal notice to everything was the necessary counterpart of the demand made on the patient that he should communicate everything that occurs to him without criticism or selection.
In one of my favourite quotations from Freud, he writes further about the analytic attitude required of the analyst: “Experience soon showed us that the attitude which the analytic physician could most advantageously adopt was to surrender himself to his own unconscious mental activity, in a state of evenly suspended attention, to avoid so far as possible reflection and the construction of conscious expectations, not to try to fix anything that he heard particularly in his memory, and by these means to catch the drift of the patient’s unconscious with his own unconscious. It was then found that . . . the patient’s associations emerged like allusions, as it were, to one particular theme and that it was only necessary for the physician to go a step further in order to guess the material which was concealed from the patient himself and to be able to communicate it to him” (Freud, 1921, p. 239). (It is obvious in this passage how far away Freud had travelled from the notion of psychoanalysis as an objective fact-finding mission that revealed true, verifiable results. How many scientists surrender themselves to their own unconscious activity and are content with merely catching the drift of their subject with their own unconscious before guessing what their subject means?)
While the patient freely associates and communicates the contents of his mind he frequently recalls traumatic memories, often from his own childhood, which lead to the re-experiencing of the original repressed emotion, and cure from the neurotic symptom. Freud and Breuer were able to show that the physical symptoms of hysteria had meaning and could be understood, and were therefore accessible to interpretation (Appignanesi & Zarate, 1979). While modern psychoanalysts tend to equate understanding with interpretation, seeing their role as interpreters or translators of their own understanding, Freud did not attempt to communicate his understanding but merely wished to interpret, as if interpretation was a scientific procedure that discovered and relayed unconscious truths instead of helping to construct truth through the analyst’s attempt to understand.
For Freud and Breuer to suggest that hysterical symptoms mean something was to imply that they mean something other than what they present in reality. In other words, symptoms are symbols (Oremland, 1997). Hysterical blindness may symbolize a forbidden wish to look, a wish that is related to early, repressed, unacceptable experiences that are enhanced and distorted. AsFreud’s thinking evolved, this type of conflict was considered to be the central clinical problem underlying all psychopathology, in particular internal conflict resulting from incompatibility between sexual and aggressive aspects of psychic life and repressive forces. Conflicts were now thought to arise when the sexual and aggressive drives (Id) were not contained by the Ego, which organizes, channels, delays, and gratifies needs, but instead are prohibited by the Superego (conscience). Symptoms are the result of a compromise between a patient’s wish and the internal prohibition against this wish (Mitchell & Black, 1995), and may be inevitable by-products of living with others. Freud imagined Man as a centaur whose most primal urges are prohibited not only by parents who have become internalized but by the civilization to which one belongs. If one desired to belong to human civilization, one’s sexual and aggressive impulses were necessarily subjected to repression, and the result was a neurotic symptom. Therefore, neurosis was the price of civilization.
With the aid of interpretation, Freud found the patient’s Ego was strengthened to deal with the demands of the Id, and the patient’s conscious choice then replaced their unconscious defence of these drives (Greenberg & Mitchell, 1983). In the early days of Freud’s practice, the interpretation of the patient’s resistances to knowing unacceptable, usually sexual or aggressive impulses was the central focus of interpretation. This was known as resistance analysis. The analyst’s main task was not so much to investigate the objectionable, unconscious trend as to get rid of the patient’s resistance to it. But, “ . . . even when this obstacle seemed to be surmounted, even when the analyst has succeeded in guessing or deducing the nature of the unconscious trend . . . even then it would often happen that the symptom persisted unshaken” (Meissner, 1991, p. 8-9).
In response, Freud discovered that the transference could be interpreted as well as the resistance, and soon found it to be the most important factor in treatment. Transference has been defined by contemporary Freudians as a component of interpersonal experience from the unacknowledged past that vitally influences one’s current view of others and determines the nature of any interpersonal interaction (Brenner, 1982). Transference is like Janus, the Roman god with two-faces, where one face is turned to the past, and the other is turned to the present. Like the unconscious and dreams, transference does not know time, but is a spatial and temporal concept that distorts the experiencing of objects in the present (the analyst) by internalized, object representations (one’s parents) from the past. Psychoanalysis does not create transference, as transference is an essential determinant of all psychic reality, but merely brings it to light (Freud, 1905).
Freud soon discovered that as the patient’s attention became focussed on the analyst in the transference, the original symptoms became drained of their cathexis, and a transference neurosis appeared in which the original conflicts which led to the onset of the neurosis were re-enacted in the relationship to the analyst. The transference neurosis becomes therapeutic when the analyst makes a transference interpretation that makes explicit the patient’s transference, and the patient is compelled to create a new solution to the old conflict.
During this process, the analyst becomes the patient’s auxiliary Superego (Rado, 1925), or surrogate conscience, with the patient’s Ego taking over the functions of his old Superego which previously banished unacceptable parts of the patient’s mind from consciousness and created the neurotic symptoms that forced the patient to seek treatment (Alexander, 1925). In simpler terms, due to the analyst’s interpretations, the patient’s conscience is relieved and superimposed by the parental qualities of the analyst, which are presumed to be less harsh and more realistic than the patient’s parents. In light of the patient’s newfound understanding, he is able to accept his sexual and aggressive feelings without recklessly acting them out (where Id would win) or heedlessly repressing them from consciousness (where Superego wins). The experiential field of the patient becomes increasingly influenced by the modulating effects of his (mostly) conscious, real, reflective self (Ego). When internal, dynamic conflicts find resolution in response to repeated transference interpretations (called “working through”), the transference neurosis is relinquished and the patient’s relationships inside and outside of the analysis commence with less conflict and more understanding.
