What is Psychoanalytic Therapy? – A Personal View, Part 3
To all intents and purposes modern secular psychotherapy originates at the beginning of the 20th century in the work of the Viennese neurologist Sigmund Freud (1856-1939).
In the 1880s one of Freud’s mentors, Josef Breuer, treated a young woman with emotional problems called Bertha Pappenheim. Bertha was immortalised in the literature under the sobriquet of “Anna O.” She was in great distress, suffering from various problems including occasional paralyses of her limbs, distortions in her vision, and a phobia about drinking water. Breuer got her to recount the memories of the traumatic events that had coincided with the onset of each of her symptoms. In this way he traced them to particular memories of the time Bertha had been caring for her father in his last illness.
Freud adapted and developed this approach with his own patients and gave formal shape to what Bertha herself had been the first to call “the talking cure”. Freud gave his work the name of psychoanalysis, which etymologically means “analysis of the soul (psyche)”.
Psychoanalysis began the contemporary practice that we now see everywhere in modern culture of treating people suffering from emotional problems by talking with them about their personal history and their experiences and feelings, using no other form of medical or psychological intervention apart from conversation, and without recourse to any religious frame of reference.
As Freud remarks however, there is nothing especially new in using dialogue as a way of helping people in emotional distress. Quite the contrary, words are the oldest instrument for trying to influence the spirits and demons that were for so long believed to inhabit the unhappy soul. (See for instance Freud’s essays “Psychic Treatment”, Psychische Behandlung, 1890, ERG 35, and “On Psychotherapy”, Über Psychotherapie, 1904, ERG 110) As Freud says: “Words are the essential instrument of psychotherapy. … The words of our daily speech are nothing other than faded magic.” (“Psychic Treatment”, Psychische Behandlung, 1890, ERG 17) The task of psychotherapy is to rediscover the magical power that resides in words to change our minds.
At the same time this new version of the ancient talking cure reflects a modern idea of the place of the soul in nature. For Plato and for the Christians the soul was what took us out of nature, made us go to war against nature, and ultimately, so the expectation was, enabled us to move on to a realm beyond nature after our natural deaths. Unlike this, the soul in psychoanalysis and in modern psychotherapy is treated as rooted in the nature of the body, whose task it is to interact between the needs of the body and the demands the rest of the natural world places on it.
The development of this way of treating the unhappy soul amounted to a revolution. In the immediate term this was a revolution in the treatment of mental illness. It showed for the first time that the language of mental illness, the way it expresses itself in various symptomatic behaviour patterns, feelings and experiences, is not something incomprehensible and closed to our rational understanding. It is in fact only a dialect of the everyday language used by normal people in normal circumstances.
By doing this, Freud changed the place occupied by madness in our culture. It was no longer something alien and frightening to be locked away out of sight but something in which we all to some extent partake and which, with a little sensitivity, we can all understand.
But in the longer term it was a revolution in the entire culture of the West. This is because the kernel of Freud’s achievement was that he discovered how to translate the expressions of mental illness into the language of our everyday concerns. The consequence of doing this was to make plain that a clear line between mental illness and mental health does not exist. Before Freud, people could reassure themselves, usually a little uneasily, that they were perfectly sane. Since Freud, this is something none of us can claim without sounding naive. As a result of Freud’s work we see now that human life at every level is suffused with irrationality.
“Being sick,” wrote Freud, “is in essence a practical concept. When you look at it from a theoretical point of view … you could easily say that we are all sick, that is to say, neurotic, because the conditions for developing symptoms can also be demonstrated in the case of normal people.” (Introductory Lectures, I, 1916-17 [Vorlesungen 350])
Freud stressed a number of things about human psychology in particular, for example: the role of unconscious emotions in guiding us, the unconscious transference of emotions aroused at one point in time by one person onto someone different at a later point in time, the prevalence of sexuality in our motives generally, and the fact that the mind evolves and develops, and therefore the importance of considering childhood experiences and relations with parents and family for an understanding of our emotional make-up. All of these ideas are now accepted by virtually everyone in the field of psychotherapy and counselling; their validity and importance are taken as a matter of course.
One should be aware therefore that all contemporary psychotherapy and counselling that relies on a conversation between therapist and client derives ultimately from Freud’s work.
However, it is easy for the layman to be unaware of this because as a culture we have not always been grateful to Freud for pointing out how extensive is the reach of the irrational in our lives. Many people are still upset with Freud for having done this. They find it hard to get a handle on the irrational in their own lives and feel threatened by acknowledging its extent. Even at this distance in time they continue to feel uncomfortable around Freud. A lot of the critical literature on him and his work is driven by this personal discomfort, rather than by a balanced concern to get at the truth. If you are not a specialist it can be difficult to distinguish serious scientific criticism of Freud’s work, which is essential to the continuing development of psychotherapy, from the often inaccurate accounts of what he said and did that are to be found side by side with it in the bookshops and on the websites. It is no criticism of the book industry that it relies on sales and income like every other, but the result of this is that sensational “revelations” about Freud, however fictional, will always get more publicity than careful scholarly studies of his life and work.
Freud stirs up our emotions. Therefore if you wish to think critically and fruitfully about his work it is important to try to think critically about your own feelings about him, so that you are thinking about him in a clear and objective way and not in an emotional way.
Tomorrow: (4) Psychoanalysis and Psychoanalytic Therapy