Psychoanalysis

Part of Psychoanalysis
Freud's couch, London, 2004 (2).jpeg
ICD-9-CM94.31
MeSHD011572

Psychoanalysis is a set of theories and therapeutic techniques[1] related to the study of the unconscious mind,[2] which together form a method of treatment for mental-health disorders. The discipline was established in the early 1890s by Austrian neurologist Sigmund Freud and stemmed partly from the clinical work of Josef Breuer and others.

Freud first used the term psychoanalysis (in French) in 1896. Die Traumdeutung (The Interpretation of Dreams), which Freud saw as his "most significant work", appeared in November 1899.[3] Psychoanalysis was later developed in different directions, mostly by students of Freud such as Alfred Adler and Carl Gustav Jung,[a] and by neo-Freudians such as Erich Fromm, Karen Horney and Harry Stack Sullivan.[4] Freud retained the term psychoanalysis for his own school of thought.[5] The basic tenets of psychoanalysis include:

  1. a person's development is determined by often forgotten events in early childhood, rather than by inherited traits alone;
  2. human behaviour and cognition are largely determined by instinctual drives that are rooted in the unconscious;
  3. attempts to bring those drives into awareness triggers resistance in the form of defense mechanisms, particularly repression;
  4. conflicts between conscious and unconscious material can result in mental disturbances such as neurosis, neurotic traits, anxiety and depression;
  5. unconscious material can be found in dreams and unintentional acts, including mannerisms and slips of the tongue;
  6. liberation from the effects of the unconscious is achieved by bringing this material into the conscious mind through therapeutic intervention;
  7. the "centerpiece of the psychoanalytic process" is the transference, whereby patients relive their infantile conflicts by projecting onto the analyst feelings of love, dependence and anger.[6]

During psychoanalytic sessions, which typically last 50 minutes and ideally take place 4–5 times a week,[7] the patient (the "analysand") may lie on a couch, with the analyst often sitting just behind and out of sight. The patient expresses his or her thoughts, including free associations, fantasies and dreams, from which the analyst infers the unconscious conflicts causing the patient's symptoms and character problems. Through the analysis of these conflicts, which includes interpreting the transference and countertransference[8] (the analyst's feelings for the patient), the analyst confronts the patient's pathological defenses to help the patient gain insight.

Psychoanalysis is a controversial discipline and its validity as a science is contested. Nonetheless, it remains a strong influence within psychiatry, more so in some quarters than others.[b][c] The proportion of practitioners of Freudian psychoanalysis has declined as evidence-based medicine has increased the use of cognitive behavioral therapy.[11] Psychoanalytic concepts are also widely used outside the therapeutic arena, in areas such as psychoanalytic literary criticism, as well as in the analysis of film, fairy tales and other cultural phenomena.

History

1890s

The idea of psychoanalysis (German: Psychoanalyse) first started to receive serious attention under Sigmund Freud, who formulated his own theory of psychoanalysis in Vienna in the 1890s. Freud was a neurologist trying to find an effective treatment for patients with neurotic or hysterical symptoms. Freud realised that there were mental processes that were not conscious, whilst he was employed as a neurological consultant at the Children's Hospital, where he noticed that many aphasic children had no apparent organic cause for their symptoms. He then wrote a monograph about this subject.[12] In 1885, Freud obtained a grant to study with Jean-Martin Charcot, a famed neurologist, at the Salpêtrière in Paris, where Freud followed the clinical presentations of Charcot, particularly in the areas of hysteria, paralyses and the anaesthesias. Charcot had introduced hypnotism as an experimental research tool and developed the photographic representation of clinical symptoms.

Freud's first theory to explain hysterical symptoms was presented in Studies on Hysteria (1895), co-authored with his mentor the distinguished physician Josef Breuer, which was generally seen as the birth of psychoanalysis. The work was based on Breuer's treatment of Bertha Pappenheim, referred to in case studies by the pseudonym "Anna O.", treatment which Pappenheim herself had dubbed the "talking cure". Breuer wrote that many factors that could result in such symptoms, including various types of emotional trauma, and he also credited work by others such as Pierre Janet; while Freud contended that at the root of hysterical symptoms were repressed memories of distressing occurrences, almost always having direct or indirect sexual associations.[13]

Around the same time Freud attempted to develop a neuro-physiological theory of unconscious mental mechanisms, which he soon gave up. It remained unpublished in his lifetime.[14]

The first occurrence of the term "psychoanalysis" (written psychoanalyse) was in Freud's essay "L'hérédité et l’étiologie des névroses" which was written and published in French in 1896.[15][16]

In 1896 Freud also published his so-called seduction theory which proposed that the preconditions for hysterical symptoms are sexual excitations in infancy, and he claimed to have uncovered repressed memories of incidents of sexual abuse for all his current patients.[17] However, by 1898 he had privately acknowledged to his friend and colleague Wilhelm Fliess that he no longer believed in his theory, though he did not state this publicly until 1906.[18] Though in 1896 he had reported that his patients "had no feeling of remembering the [infantile sexual] scenes", and assured him "emphatically of their unbelief",[19] in later accounts he claimed that they had told him that they had been sexually abused in infancy. This became the received historical account until challenged by several Freud scholars in the latter part of the 20th century who argued that he had imposed his preconceived notions on his patients.[20][21][22] However, building on his claims that the patients reported infantile sexual abuse experiences, Freud subsequently contended that his clinical findings in the mid-1890s provided evidence of the occurrence of unconscious fantasies, supposedly to cover up memories of infantile masturbation.[23] Only much later did he claim the same findings as evidence for Oedipal desires.[24]

By 1899, Freud had theorised that dreams had symbolic significance, and generally were specific to the dreamer. Freud formulated his second psychological theory— which hypothesises that the unconscious has or is a "primary process" consisting of symbolic and condensed thoughts, and a "secondary process" of logical, conscious thoughts. This theory was published in his 1899 book, The Interpretation of Dreams.[25] Chapter VII was a re-working of the earlier "Project" and Freud outlined his "Topographic Theory". In this theory, which was mostly later supplanted by the Structural Theory, unacceptable sexual wishes were repressed into the "System Unconscious", unconscious due to society's condemnation of premarital sexual activity, and this repression created anxiety. This "topographic theory" is still popular in much of Europe, although it has fallen out of favour in much of North America.[26]

1900–1940s

International Psychoanalytic Congress. Photograph, 1911. Freud and Jung in the center

In 1905, Freud published Three Essays on the Theory of Sexuality[27] in which he laid out his discovery of so-called psychosexual phases: oral (ages 0–2), anal (2–4), phallic-oedipal (today called 1st genital[by whom?]) (3–6), latency (6-puberty), and mature genital (puberty-onward). His early formulation included the idea that because of societal restrictions, sexual wishes were repressed into an unconscious state, and that the energy of these unconscious wishes could be turned into anxiety or physical symptoms. Therefore, the early treatment techniques, including hypnotism and abreaction, were designed to make the unconscious conscious in order to relieve the pressure and the apparently resulting symptoms. This method would later on be left aside by Freud, giving free association a bigger role.

In On Narcissism (1915)[28] Freud turned his attention to the subject of narcissism. Still using an energic system, Freud characterized the difference between energy directed at the self versus energy directed at others, called cathexis. By 1917, in "Mourning and Melancholia", he suggested that certain depressions were caused by turning guilt-ridden anger on the self.[29] In 1919 in "A Child is Being Beaten" he began to address the problems of self-destructive behavior (moral masochism) and frank sexual masochism.[30] Based on his experience with depressed and self-destructive patients, and pondering the carnage of World War I, Freud became dissatisfied with considering only oral and sexual motivations for behavior. By 1920, Freud addressed the power of identification (with the leader and with other members) in groups as a motivation for behavior (Group Psychology and the Analysis of the Ego).[31] In that same year (1920) Freud suggested his "dual drive" theory of sexuality and aggression in Beyond the Pleasure Principle, to try to begin to explain human destructiveness. Also, it was the first appearance of his "structural theory" consisting three new concepts id, ego, and superego.[32]

Three years later, he summarised the ideas of id, ego, and superego in The Ego and the Id.[33] In the book, he revised the whole theory of mental functioning, now considering that repression was only one of many defense mechanisms, and that it occurred to reduce anxiety. Hence, Freud characterised repression as both a cause and a result of anxiety. In 1926, in Inhibitions, Symptoms and Anxiety, Freud characterised how intrapsychic conflict among drive and superego (wishes and guilt) caused anxiety, and how that anxiety could lead to an inhibition of mental functions, such as intellect and speech.[34] Inhibitions, Symptoms and Anxiety was written in response to Otto Rank, who, in 1924, published Das Trauma der Geburt (translated into English in 1929 as The Trauma of Birth), analysing how art, myth, religion, philosophy and therapy were illuminated by separation anxiety in the "phase before the development of the Oedipus complex".[35] Freud's theories, however, characterized no such phase. According to Freud, the Oedipus complex, was at the centre of neurosis, and was the foundational source of all art, myth, religion, philosophy, therapy—indeed of all human culture and civilization. It was the first time that anyone in the inner circle had characterised something other than the Oedipus complex as contributing to intrapsychic development, a notion that was rejected by Freud and his followers at the time.

By 1936 the "Principle of Multiple Function" was clarified by Robert Waelder.[36] He widened the formulation that psychological symptoms were caused by and relieved conflict simultaneously. Moreover, symptoms (such as phobias and compulsions) each represented elements of some drive wish (sexual and/or aggressive), superego, anxiety, reality, and defenses. Also in 1936, Anna Freud, Sigmund's daughter, published her seminal book, The Ego and the Mechanisms of Defense, outlining numerous ways the mind could shut upsetting things out of consciousness.[37]

1940s–present

When Hitler's power grew, the Freud family and many of their colleagues fled to London. Within a year, Sigmund Freud died.[38] In the United States, also following the death of Freud, a new group of psychoanalysts began to explore the function of the ego. Led by Heinz Hartmann, Kris, Rappaport and Lowenstein, the group built upon understandings of the synthetic function of the ego as a mediator in psychic functioning[jargon]. Hartmann in particular distinguished between autonomous ego functions (such as memory and intellect which could be secondarily affected by conflict) and synthetic functions which were a result of compromise formation[jargon]. These "Ego Psychologists" of the 1950s paved a way to focus analytic work by attending to the defenses (mediated by the ego) before exploring the deeper roots to the unconscious conflicts. In addition there was burgeoning interest in child psychoanalysis. Although criticized since its inception, psychoanalysis has been used as a research tool into childhood development,[39] and is still used to treat certain mental disturbances.[40] In the 1960s, Freud's early thoughts on the childhood development of female sexuality were challenged; this challenge led to the development of a variety of understandings of female sexual development[citation needed], many of which modified the timing and normality of several of Freud's theories (which had been gleaned from the treatment of women with mental disturbances). Several researchers[41] followed Karen Horney's studies of societal pressures that influence the development of women.

In the first decade of the 21st century, there were approximately 35 training institutes for psychoanalysis in the United States accredited by the American Psychoanalytic Association (APsaA), which is a component organization of the International Psychoanalytical Association (IPA), and there are over 3000 graduated psychoanalysts practicing in the United States. The IPA accredits psychoanalytic training centers through such "component organisations" throughout the rest of the world, including countries such as Serbia, France, Germany, Austria, Italy, Switzerland,[42] and many others, as well as about six institutes directly in the United States.

Other Languages
Afrikaans: Psigoanalise
Alemannisch: Psychoanalyse
العربية: تحليل نفسي
asturianu: Sicoanálisis
azərbaycanca: Psixoanaliz
Bân-lâm-gú: Cheng-sîn-hun-sek
беларуская: Псіхааналіз
беларуская (тарашкевіца)‎: Псыхааналіз
български: Психоанализа
Boarisch: Psychoanalyse
bosanski: Psihoanaliza
català: Psicoanàlisi
čeština: Psychoanalýza
Cymraeg: Seicdreiddiad
Deutsch: Psychoanalyse
Ελληνικά: Ψυχανάλυση
español: Psicoanálisis
Esperanto: Psikoanalizo
euskara: Psikoanalisi
français: Psychanalyse
Gaeilge: Sícanailís
galego: Psicanálise
ગુજરાતી: મનોવિષ્લેષણ
한국어: 정신분석학
hrvatski: Psihoanaliza
Bahasa Indonesia: Psikoanalisis
interlingua: Psychoanalyse
íslenska: Sálgreining
italiano: Psicoanalisi
қазақша: Психоанализ
Kiswahili: Saikoanalisia
latviešu: Psihoanalīze
lietuvių: Psichoanalizė
Ligure: Psicoanalixi
македонски: Психоанализа
مازِرونی: روان کاوی
Nederlands: Psychoanalyse
日本語: 精神分析学
norsk nynorsk: Psykoanalyse
occitan: Psicanalisi
oʻzbekcha/ўзбекча: Psixoanaliz
ភាសាខ្មែរ: ចិត្តវិភាគ
Tok Pisin: Saikoanalisis
português: Psicanálise
română: Psihanaliză
Runa Simi: Sikuanalisis
русский: Психоанализ
sicilianu: Psicanalisi
Simple English: Psychoanalysis
slovenčina: Psychoanalýza
slovenščina: Psihoanaliza
српски / srpski: Психоанализа
srpskohrvatski / српскохрватски: Psihoanaliza
svenska: Psykoanalys
Tagalog: Sikoanalisis
Türkçe: Psikanaliz
українська: Психоаналіз
Tiếng Việt: Phân tâm học
粵語: 心理分析