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Case study: SIGMUND FREUD

Case study: SIGMUND FREUD

new approach to the understanding of human personality. Through his skill as a scientist, physician, and writer, Freud combined ideas prevalent at the time with his own observation and study to produce a major theory of psychology. Most importantly, he applied these ideas to medical practice in the treatment of mental illness. His newly created psychotherapy treatments and procedures, many of which in modified form are applied today, were based on his understanding of unconscious thought processes and their relationship to neurotic symptoms (see Neurosis). Regarded with skepticism at the time, Freud’s ideas have waxed and waned in acceptance ever since. Nevertheless, he is regarded as one of the greatest creative minds of the 20th century.

I. Freud’s life

Freud was born into a middle-class Jewish family in Freiberg, Moravia (now PÅ™íbor, Czech Republic), on May 6, 1856. When he was three years old his family, fleeing from the anti-Semitic riots then raging in Freiberg, moved to the German city of Leipzig. Shortly thereafter, the family settled in Vienna, where Freud remained for most of his life.

Although Freud’s ambition from childhood had been a career in law, he became intrigued by the rapidly developing sciences of the day after reading the work of British scientist Charles Darwin. Freud decided to become a medical student shortly before he entered Vienna University in 1873. Inspired by the scientific investigations of the German poet Johann Wolfgang von Goethe, Freud was driven by an intense desire to study natural science and to solve some of the challenging problems confronting contemporary scientists.

In his third year at the university Freud began research work on the central nervous system in the physiological laboratory under the direction of German physician Ernst Wilhelm von Brücke. Neurological research was so engrossing that Freud neglected the prescribed courses and as a result remained in medical school three years longer than was normally required to qualify as a physician. In 1881, after completing a year of compulsory military service, he received his medical degree. Unwilling to give up his experimental work, however, he remained at the university, working in the physiological laboratory. At Brücke’s urging, he reluctantly abandoned theoretical research to gain practical experience.

Freud then spent three years at the General Hospital of Vienna, devoting himself successively to psychiatry, dermatology, and nervous diseases. In 1885, following his appointment as a lecturer in neuropathology at Vienna University, he left his post at the hospital. Later that year he worked in Paris with French neurologist Jean Charcot.

On his return to Vienna in 1886 Freud began private practice in neurology. Also that year Freud married Martha Bernays, to whom he had become engaged four years earlier. The first of their children was born the following year. Their family would become complete with the birth of Anna in 1895, who herself would become an important psychoanalyst (see Anna Freud).

In 1902 Freud was appointed professor of neuropathology at the University of Vienna, a post he held until 1938. In 1923 he developed cancer of the jaw. Although repeated operations and prosthetic appliances in his mouth made his life most uncomfortable, he continued working incessantly until his death. When the Germans occupied Austria in 1938, Freud was persuaded by friends to escape with his family to England. He died in London on September 23, 1939.

II. Freud’s work

Freud was by training a research scientist and a physician. His decision to devote himself to the neglected and poorly understood area of emotional disorders has to do with currents of the time as well as his own interests. Chief among these was the prevailing attitude toward scientific endeavor at the time. Scientists were looking for causes and for connections between previously unrelated phenomena. Although Jewish by birth and cultural tradition, Freud saw all religion as illusory and was non-practicing. Instead, he can be seen as a determinist, viewing the world and human experience as understandable in terms of cause and effect.

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A. Hypnosis and the influence of Charcot

In 1885 Freud was awarded a government grant enabling him to spend 19 weeks in Paris as a student of French neurologist Jean Charcot. Charcot, who was the director of the clinic at the mental hospital, the Salpêtrière, was then treating nervous disorders by the use of hypnotic suggestion. Fascinated by the apparent success of these treatments, Freud met and studied with several of the leading figures in the field.

Charcot’s group had been tackling the problem of hysteria, a term derived from the Greek word for “womb.” Hysteria traditionally was seen as a condition of women and was characterized by unexplained fainting, paralysis, loss of sensation, tics, and tremors. In time, Charcot came to see that men could also be so troubled. Although the mechanism of hysteria was not understood, Charcot and his contemporaries showed that its symptoms could be cured by hypnosis. Freud’s studies under Charcot influenced him greatly in channeling his interests to psychopathology (the study and treatment of disorders of the mind).

In his practice in Vienna, Freud met many patients with nervous disorders for which there was no apparent physical cause. Their symptoms included paralyzed limbs, tics, tremors, loss of consciousness, memory impairment, and numbness that could not be explained. These unexplained cases were labeled as “neurotic,” meaning that they were similar to neurological conditions. In time they became known collectively as “neuroses.”

Freud’s observation of Charcot’s use of hypnosis in the treatment of similar disorders led him to conclude that there could be powerful mental processes operating that remain hidden from conscious understanding. He began to employ hypnosis in his own practice, publishing articles on the subject in 1892. Freud came to understand hysterical neurotic symptoms as the product of a conflict between opposing mental forces. Conscious forces representing “will” were balanced by unconscious opposing forces representing “counterwill.” He understood hypnosis to act on the side of will to subjugate the counterwill, thus obliterating the symptom. The idea of conflict proposed in the 1892 paper “A Case of Successful Treatment by Hypnotism: With Some Remarks on the Origin of Hysterical Symptoms Through ‘Counterwill’” was to become a fundamental principle of psychoanalysis.

B. The beginnings of psychoanalysts

The next important development in Freud’s theory of psychology came out of work he conducted with his friend and colleague Josef Breuer, a Viennese physician who was involved in the treatment of a young woman who was distressed while caring for her dying father. The patient had developed a number of hysterical symptoms, which Breuer initially treated by hypnotic suggestion. Initial success gave way to disappointment when on her father’s death her symptoms returned with increased severity. Somewhat at a loss as to how to proceed, Breuer had continued to talk to his patient on a daily basis and in time she began to talk about various reminiscences from the past and about her daydreams. Remarkably, as her narrative revisited memories from the past, which were associated with the onset of a particular symptom, each symptom disappeared when accompanied by an emotional outburst. Breuer made use of this discovery to eliminate her symptoms one at a time. He called the treatment the cathartic technique (from the Greek katharsis meaning “purgation”). The treatment was time consuming and required considerable effort to reach dimly recalled and otherwise inaccessible memories.

Freud and Breuer published the case and several others in 1895 under the title Studies on Hysteria. Their view was summed up in the statement “Hysterics suffer mainly from reminiscences.” They proposed that when faced with emotionally traumatic memories, hysterics subjugate them from conscious appreciation to prevent the unbearable emotional pain and suffering that they cause. Rather than being driven out of the mind, however, these memories are driven into an area of the mind that is unconscious and inaccessible. Here the memories may be redirected from the emotional system into the somatic (bodily) system and appear as apparently unexplained physical symptoms. The cases that constitute Studies on Hysteria outline the transition from treatment by hypnotic suggestion to the earliest descriptions of what is now known as psychoanalysis.

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Working on his own Freud hypothesized that hysterical symptoms were most likely to arise when repressed traumatic memories related to adverse childhood sexual experiences. This view generated tremendous controversy at the time because the existence of childhood sexuality was not widely accepted. In time Freud was forced to reconsider this aspect of his theory, instead relating the repressed memories to childhood fantasies of sexuality and their relationship to parental figures.

1. Dreams

The next development in Freud’s theory stemmed from his observations on dreaming. He came to see that many of the characteristics of dreams were shared with the symptomatic memories recalled by his patients in the narrative of “free association.” In his therapeutic relationship with his patients, Freud had abandoned hypnotic suggestion in favor of encouraging the person to speak freely about whatever came into his or her mind. Unintentionally, the patient would bring order to these free associations, whose structure and content Freud used to try to understand underlying unconscious processes.

In dreams Freud noted the same apparently unstructured experiences of thoughts and images coming into the mind that seemed to be representative of some underlying unconscious process. To explain these phenomena, he suggested the existence of an inner censor that effected a compromise between conflicting mental forces and in the process disguised their meaning from conscious appreciation. He defined “resistance” as the unconscious defense against awareness of repressed experiences in order to avoid the resulting anxiety. He traced the operation of unconscious processes, using the free associations of the patient to guide him in the interpretation of dreams and slips of speech. Slips of speech or parapraxes, now known as “Freudian slips,” Freud claimed, were revelations of unconscious wishes. His 1904 publication, The Psychopathology of Everyday Life, discusses these ideas.

Freud came to understand the mind as a series of layers, with the most superficial layers in conscious appreciation and the deeper layers containing repressed memories and remaining unavailable to conscious thought. He termed this the topographical model and likened it to an iceberg, a small part of which is visible above the surface while the greater submerged part remains obscured from view. These ideas were published in 1900 in The Interpretation of Dreams.

During the first two decades of the 1900s Freud concentrated on modifying and improving his theory of psychoanalysis. He defined a number of principles and described a model of personality development.

2. The unconscious

Perhaps Freud’s greatest contribution was to describe the unconscious and to postulate that it obeys the principle of psychic determinism, which holds that human thoughts, feelings, and impulses, rather than being random, are linked in a system of causally related phenomena, behind which lies some reason or meaning. Freud concluded that on this basis unconscious processes could be investigated and understood. Some experiences that are not immediately accessible to conscious appreciation can be brought into the conscious mind by the process of remembering. Freud referred to these experiences as the preconscious. Still-deeper thoughts cannot be remembered and are actively repressed in the unconscious.

Unconscious experiences, according to Freud, are not subject to the same logic characteristic of conscious experience. Unconscious ideas, images, thoughts, and feelings can be condensed or dramatized in the form of abstract concepts and imagery. Often the relationship between the original experience and the unconscious symbolic representation can seem obscure.

3. Role of conflict

The central theme of conflict had arisen early in Freud’s work. Conflict arises in a person’s conscious mind when one set of beliefs impacts adversely on another area of belief, causing emotional suffering felt as disappointment, anger, or frustration. Freud was interested in the unconscious aspect of mental conflict. He described the “pleasure principle” as another fundamental of psychoanalytic theory. This holds that human beings have a tendency to seek pleasure and avoid pain. The principle is said to dominate in early life, bringing the developing individual into conflict with the external world. These conflicts are retained in the unconscious.

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Freud’s original concept held that the conflicts of early life arose as a result of innate human drives or instincts. He conceptualized how development might occur in terms of the drives and their satisfaction according to the pleasure principle. Among the chief drives was the libidinal, or sexual, drive, which serves the human species by directing individuals to reproduce. Awareness of a need to keep rein on the free expression of drives gradually develops, and failure to rein in these drives (and fantasies about their expression) is felt as guilt. Life becomes an equilibrium between drives, conflicts, and reality. Freud believed that by understanding the crucial events and fantasy wishes of childhood, psychoanalysis could shed understanding on later adult character development with its attendant conflicts and neurotic symptoms. Later, he extended his model to include psychoses (serious mental disorders in which people have a distorted view of reality).

Conflicts repressed into the unconscious are retained, according to Freud. From time to time they may overcome repression and reemerge into conscious appreciation, precipitating anxiety or panic. To counteract this, the individual unconsciously produces various defense mechanisms, which become part of that person’s character. Examples of defense mechanisms include projection, where the individual ascribes to others his or her own unconscious desires (“I hate you,” for example, becomes “You hate me”), and reaction formation, where the individual adopts a pattern of behavior directly opposed to a strong unconscious drive. In 1923 Freud reformulated his ideas in a structural model of the mind that postulated the existence of the id, the ego, and the superego.

Freud gave the name “id” to unconscious drives. The id knows nothing of morality or reality. It seeks only to gratify the instinctual drives, and it operates solely according to the pleasure principle. Freud held that the biological drives of a young person are often frustrated by delays and restricted by the demands of parents and other older members of the family. As time passes, the demands of the community or society also become important obstacles to id gratification. In adapting to the environment, the child begins to acquire an ego, or set of conscious perceptions, memories, and thoughts that enable the person to deal effectively with reality. Thus, according to Freud, the ego obeys the reality principle. As the individual absorbs the teachings of family and society, he develops a superego, or conscience, that frequently conflicts with the drives of the id. In many cases the ego reduces the conflict by at least partially fulfilling the id impulses through socially acceptable behavior. Often, however, the conflict disappears on the conscious level as unfulfilled impulses are repressed into the unconscious mind.

Freud’s therapy consisted of listening to the patient relate a narrative of free associations over many sessions. By listening to the patient’s associations, Freudian slips, contents of dreams, and thoughts, he linked and interpreted these experiences to the patient’s conscious world. He came to understand the nature of “transference,” in which the patient develops feelings for the therapist that are in fact representative of previous feelings toward other important figures in the patient’s life. These thoughts and feelings Freud interpreted and linked to the patient’s current emotional state.

C. Major influences

Freud’s early psychological work shows the influence of the sciences of the day on his thinking. Ideas from physics, chemistry, and evolutionary theory occur regularly in his writing. At the time, Charles Darwin’s writings, especially the theory of evolution, were challenging contemporary Judeo-Christian belief. Indeed it was Darwin who emphasized instincts for survival and reproduction, formulated in Freud’s theory as basic drives.

Freud’s ideas can be seen in the same context as Darwin’s. Freud, too, challenged philosophical and religious thinking by suggesting that human beings were rather less in control of their own thoughts and actions than previously believed. His contention that unconscious thoughts and actions had to arise from within the self rather than from God conflicted with the contemporary notion of soul. From Freud’s time on, the disciplines of philosophy and psychology developed separately.

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Freud was particularly interested in the “association” school of psychology, which included Johann Friedrich Herbart and Wilhelm Max Wundt, the former of whom may have contributed to free association as a therapeutic technique. Psychodynamic theory-the model of conflicting forces influencing the subconscious-also has its origins in the physical concepts of opposing forces and vector analysis. Freud’s theory that unresolved conflicts can be converted into physical symptoms reflects the principle of conservation of energy held by the first law of thermodynamics.

Yet Freud’s ideas were new and radical, and it is easy to see why Freud came into conflict so readily with the society



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