Freud and Psychoanalysis

Freud founded a discipline, introduced successive models of the mind, and created new methods of psychotherapy. If we find the fundamental propositions of his drive psychology deeply' problematic, other formulations have become so much a part of everyday’ life that we fail to recognize their origins in his writings—implicit, unarticulated assumptions about ourselves and our habits of mind. Practitioners rediscover the phenomenal accuracy' and clinical value of his observations, coming to see the ways in which his early' accounts of trauma, the dynamics of the unconscious, the workings of memory, and essential concerns in the clinical situation prefigure understanding and practice in our time.

Eric Kandel, Allan Schore, Mark Solms, and other scholars in the science of mind have characterized their research as a continuation of Freud’s attempts to establish an empirical psychology' at the end of the 19th century, showing how the Project for a scientific psychology, his early effort to create a neural model of the mind, anticipates fundamental developments in the fields of modern neuroscience. His account, illustrated by his sketches of neural networks thought to govern unconscious processes, explores the domains of perception, consciousness, attention, cognition, wishes, dreams, sexuality', and defense, seeking to formulate an understanding of the dynamics of the brain and mind. A decade before Charles Sherrington had given synapses their name, Freud proposed that points of communication between nerve cells, “contact barriers,” could be altered by learning, prefiguring conceptions of neuroplasticity'. Karl Pribram and Merton Gill, writing in the 1970s, predicted that researchers working to bridge the neurological and the psychological would come to think of the Project as a “Rosetta Stone” (1976).

While historical accounts of Freud’s contributions make sharp distinctions between his work as a neuroanatomist, neurologist, and psychoanalyst, the culture that shaped his early scientific training in medical school continued to influence his thinking and practice over the course of his career, and he remained steadfast in his belief that mental life is governed by the complex functioning of the brain. He was deeply moved by his readings of Charles Darwin and Goethe’s Ode to nature, he tells us in his Autobiographical study, deciding to abandon his plan to study law and pursue training in medicine (1925/1989).

As a neuroanatomist working in the physiology' laboratory of Ernst von Brucke at the University' of Vienna, he embraced the vision of a positivist science advanced by' his mentor and his contemporaries, Hermann von Helmholtz, Emil du Bois, and Carl Ludwig. They rejected notions of vitalism and the life force set forth in the romantic philosophy of nature that had shaped the teaching of physiology’ in medical education at the time and embraced the physical sciences, seeking to create a reductionist, analytic version of biology'. Freud came to believe that all psychological phenomena originate in neurophysiological processes, assuming a mechanical relation between brain and mind, proposing that we can think of the person as a dynamic system governed by the laws of nature. He set out to establish “a psychology' which shall be called a natural science: that is, to represent psychical processes as quantitatively determinate states of specifiable material particles...” (1895/1966, p. 295).

Two experiences were formative in shaping Freud’s emerging conceptions of mind and therapeutic practice: his collaboration with Josef Breuer, a colleague in Brucke’s laboratory', and his study with Jean-Martin Charcot, one of the leading neurologists in Europe, who had developed diagnostic procedures and therapeutic methods to treat the symptoms of neurosis at the Saltpetriere hospital in Paris.

Over the course of his research at Brucke’s Institute of Physiology', Freud came to know Breuer, a cultured Viennese physician who embraced the analytic biology' of Brucke and his contemporaries. Breuer had treated a patient known as Anna O.—later identified as Bertha Pappenheim, a feminist and one of the founders of the social work movement in Germany'—during Freud’s last two years at the Institute, between 1880 and 1882.

Breuer related that the adolescent had developed classic symptoms of hysteria while caring for her father. She reported the loss of sensation and motor paralysis of the left side of her body, difficulties in speech and hearing, and loss of consciousness. He placed her under hypnosis, following procedures that Charcot had developed to treat the symptoms of hysteria. Although the hypnotic procedure itself proved unsuccessful, Pappenheim found herself talking about her symptoms while in the altered state. Following her lead, Breuer encouraged her to continue processing her experience and found that her symptoms receded as she related the circumstances of their origin. She recounted how her father had rested his head on her left side, now paralyzed, as he was dying of a tubercular abscess in his lungs.

“It turned out that all her symptoms,” Freud later recalled in his Autobiographical study, “went back to moving events which she had experienced

The Psychodynamic Paradigm: 1 75 while nursing her father; that is to say, her symptoms had a meaning and they were residues or reminiscences of those emotional situations... When the patient recalled a situation of this kind... with a free expression of emotion, the mental act which she had originally suppressed, the symptom was abolished and did not return” (Freud, 1925/1989, p. 12). The origins of her symptoms lay in the traumatic events of her past, as Freud explained in his account of the treatment. Anna O. called this “chimney sweeping,” her “talking cure”; Breuer called it “catharsis.”

Breuer’s account of Anna O. deepened Freud’s interest in the treatment of mental conditions, and he made arrangements to study with Charcot at the Saltpetriere in Paris in autumn of 1885 and spring of 1886. He worked in his laboratory and attended his clinical demonstrations, where he used hypnotic suggestion to induce and alleviate traumatic paralyses. When he returned to Vienna in 1887 he asked Breuer to teach him the methods he had developed in his treatment of Anna O.

In his attempts to clarify the etiology' and mechanisms of the range of problems in functioning he encountered in his practice as a neurologist, Freud found that organic symptoms followed patterns that corresponded to neuroanatomy, consistent with the established understanding of the distribution of nerves, tracts, and regions of the brain. Symptoms originating in mental conditions, however, operated independently of the nervous system, as if anatomy did not exist. He came to appreciate the ways in which unconscious mental processes could influence behavior over the course of his fellowship. He realized the crucial role of psychological understanding in efforts to provide help and care: “The signs of (neurotic) illness originate from nothing other than a change in the action of their minds upon their bodies and the immediate cause of their disorders is to be looked for in their minds” (Freud, 1890, p. 286).

Freud encouraged Breuer to prepare an account of his treatment of Anna O., reconstructed from memory almost 14 years later, and it became the prototype of the cathartic method. In their pioneering work, Studies in hysteria, published in 1895, Breuer and Freud traced the origins of a range of problems in functioning to traumatic experience. They proposed that memories of traumatic events are dissociated from conscious experience, and the emotion associated with the experience is converted to somatic symptoms. What is left in awareness, they theorized, is a symbol that is connected with traumatic events through unconscious associative networks. If the patient can bring implicit memories of traumatic experience to awareness and process the “strangulated” emotion associated with events, the affect is “discharged” and symptoms recede. The goal of treatment, in Freud’s earliest formulation of psychotherapy, was to alleviate symptoms through the processing and integration of traumatic experience; he called the expression of the repressed emotion associated with the symptoms “abreaction” (Breuer & Freud, 1893-1895/1955).

Freud drew on Darwin and evolutionary biology' as he continued to develop his conceptions of mind, shifting the focus of his theorizing from trauma to the dynamics of instinctual life and unconscious forces, coming to create what Frank Sulloway has called a “genetic psychobiology” (1979). He proposed instinctual drive as the core constituent of psychic life, believing that the most fundamental human motives are rooted in biology. In his model of the mind the origins of pathogenic experience lie not in repressed memories of traumatic events, but most deeply in the vicissitudes of instinctual life; maladaptive ways of negotiating intrapsychic conflict precipitate problems in living. In fashioning his drive psychology', Freud came to privilege instinct over relational and social life, fantasy processes over perception of actual events, and psychic reality over actual experience in the outer world, thereby establishing the defining features of classical psychoanalysis (Borden, 2009; for an expanded discussion see Mitchell, 1988, pp. 41-62).

In his topographic model of the mind, introduced in The interpretation of dreams at the turn of the century, Freud outlined three domains of mental life: the unconscious, encompassing motivations, feelings, and thoughts that originate in the dynamics of instinctual life; the preconscious, the region of feelings and thoughts that are accessible to awareness through the focusing of attention; and the conscious realm of perceptions, feelings, and thoughts that are in awareness at the moment. He described two forms of psychic functioning: primary process, operating out of awareness, mediating the realms of dreams and fantasy, and secondary' process, operating in the domain of consciousness, governing the executive functions of the ego and the dynamics of rational, reflective thinking (Freud, 1900/1953).

In his revised theory of mind, Freud introduced two ideas that would shape the course of psychoanalytic understanding. First, he had come to believe that emotional and cognitive processes operate largely out of awareness, and he proposed that most of our mental life is unconscious, viewing conscious feelings and thoughts as the exception rather than the rule. Second, he argued that mental events do not occur by chance but follow the principle of psychic determinism. In accordance with our current understanding of brain function, he assumed that associations in memory’ are causally linked; presumably, associative connections govern unconscious and conscious domains of experience through different neural structures. However irrational neurotic symptoms may' seem, he proposed, they have meaning and make sense in light of the concrete particulars of earlier experience and the dynamics of psychic life.

Freud continued to revise his formulations of the mind over the next two decades, introducing the structural model in The ego and the id (1923/1961). He described three core structures of personality': the id, the ego, and the superego. He moved beyond the criterion of consciousness that had shaped his earlier version of the topographic model and categorized mental processes on the basis of their functions and purposes, centering on conflict between fulfillment of instinctual needs, the dictates of conscience, and the demands of reality'. The id (the “it,” in the original German, a term Freud drew from Nietzsche) represents the biological substrates of psychological experience. Freud thought of this region as the source of raw, unstructured instinctual forces that press for

The Psychodynamic Paradigm: 1 77 expression; it operates unconsciously, governed by the pleasure principle. In his earliest formulations of drive psychology Freud centered on the sexual instinct; in a revision of his theory' in 1920, having witnessed the brutality' of World War I, he proposed an aggressive instinct as well. The ego or “I,” the conscious sense of self, is instrumental in perception, governing executive functions in accordance with the reality' principle. As such it mediates the dynamics of instinctual experience, conscience, and the realities of the social surround. In the domain of neuroscience, we find points of connection with current formulations of the executive functions of the prefrontal cortex, as described in Chapter 2. He thought of the superego as the moral agency, formed through identifications with the values of parents and social attitudes, mediating conflict between the id and the ego. The three structures of personality' regulate the dynamics of emotion, thought, and behavior in adaptive functioning (see Kandel, 2012, for expanded accounts).

Therapeutic Action

Although Freud introduced successive models of the mind in his efforts to create a unified theory of personality', psychopathology', and therapeutic action, he worked as a clinician from the mid-1880s onward, focused on the concrete particularities of people and problems in functioning, and he outlines what we have come to think of as basic principles and pragmatic considerations in all forms of psychotherapy. He emphasizes the crucial functions of the therapeutic alliance; a shared understanding of what is the matter and the focus of treatment; active provisions of support and education; recognition and management of transference reactions; and exploration of defensive behaviors, which often take the form of resistance (Breuer & Freud, 1893-1895/1955; see Borden, 1999, 2000, 2009; and Brendel, 2006, for accounts of Freud’s clinical pragmatism).

In his earliest formulations of neurosis, as described earlier, he assumed that symptoms originate in repressed memories of traumatic experience. The goal of therapy was to help the patient recover memories, process emotions associated with the events, and integrate the experience into the present sense of self and life story'. As he revised his theory of mind, however, he broadened the scope of the therapeutic endeavor, shifting the focus of his concern from the treatment of symptoms to the reorganization of personality' itself. In refashioning his formulations of neurosis he focused on conceptions of impulse, anxiety', defense, and conflict.

He came to think of neurosis as a closed system of drives and defenses, working to understand the ways in which underlying conflict precipitates symptoms, constricts ways of being and relating, and perpetuates problems in living. The fundamental task of psychoanalysis, he proposed, is to help patients explore unconscious conflicts that perpetuate problems in living and to develop more functional ways of mediating inner experience and outer realities. He believed that the therapeutic process would deepen understanding of emotions, thoughts, and behaviors that perpetuate difficulties, bring greater acceptance of the self, and improve psychological and social functioning, expanding capacities for love and work.

Freud introduced a range of approaches and techniques intended to help the patient suspend defenses, allowing derivatives of instinctual energies to emerge through free association and transference reactions to the therapist. He developed the method of free association—advising the patient to say what comes to mind in an accepting, non-judgmental manner—in an effort to circumvent the dynamics of defensive processes and activate conflictual experience in the clinical situation. In his conception of transference the patient re-experiences sensations, feelings, and thoughts he believed to originate in the dynamics of instinctual life.

Although Freud found that he could help patients recreate problematic feelings, thoughts, and actions in the therapeutic situation, he realized that insight itself did not necessarily bring about change. He came to believe that varying degrees of resistance are inevitable as we work toward growth, explaining:

The resistance accompanies the treatment step by step. Every single association, every' act of the person under treatment must reckon with the resistance and represents a compromise between the forces that are striving toward recovery' and the opposing ones.

(1912/1958, p. 103)

In introducing the principle of “working through” in his seminal paper on technique, “Remembering, repeating, and working through,” Freud emphasizes that the therapist and patient must be prepared to engage recurring emotions, wishes, conflicts, defenses, and transference reactions as they' emerge in different forms (1914/1958). Ongoing exploration and formulation of unconscious experience, resistance, and transference states deepen understanding of underlying motivations and conflicts, fostering integrations of neural networks and life experience. Carefully focused observation, challenge, and interpretation convey' the clinician’s efforts to grasp potential meanings hidden in the manifest content of words and the functions of behavior that operate out of awareness, deepening insight and understanding, helping the patient to re-appropriate aspects of self that have been repressed or repudiated. Acceptance and integration of dissociated sensations, feelings, and thoughts foster change and growth, strengthening the sense of self and identity', ego functions, and coping capacities.

As we have seen in earlier accounts of neural development, researchers assume that the repeated activation and processing of sensation, emotion, imagery, cognition, and behavior facilitates neural integration in accord with the principles of Hebbian learning or long-term potentiation (see Chapter 2). From the perspective of contemporary neuroscience, Freud introduced a range of therapeutic methods that allow us to explore the discontinuities and

The Psychodynamic Paradigm: 1 79 dissociations of neural networks encompassed in conscious and unconscious domains of experience, strengthening the development, integration, and regulation of the core structures and functions of the brain.

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