Reva Klein explains
Imagine this. Three months after her father's death, a young woman called Anna wakes up in the morning to find that her voice has gone. She can speak only in a whisper and her throat is tight and painful. Her mother puts it down to a chill. One week passes, then two, then three. As well as no improvement to her condition, Anna's hands are now trembling uncontrollably and her appetite has gone. A doctor is sent for.
What happens next takes one of two forms, depending on when we choose to place this case. In the first scenario, set in Vienna in 1900, Dr A arrives at the large, lavishly furnished flat, sees the state that Anna is in - pale and thin, trembling, whispering through a painfully tight throat - and diagnoses hysteria, a catch-all term for nervous disorders suffered exclusively by women.
Treating these symptoms ranged from the benign (massage, warm baths, a long stay in a sanatorium in the mountains) to the nasty (electrotherapy, an early forerunner of electroconvulsive therapy) and long stretches of bed-rest. As hypnosis was very ... la mode, Doctor A might have also tried inducing a trance-like state in Anna in an attempt to get her to leave her symptoms behind. Whatever treatment the good doctor chose for her, it would be based on the assumption that her abnormal behaviour was the result of a physiological problem.
In the second possible scenario, the year is 2006 and Anna is in a psychoanalyst's consulting room. She may be reclining on a couch, with the analyst sitting behind her. Twice a week she has been going through the slow, painful process of looking at her present problems by analysing her past experiences, guided - sometimes imperceptibly - by her analyst. There are no rules or parameters involved in the process that she knows of: she free associates ideas, talking about what she wants to talk about without regard to chronology or what would, in other contexts, be considered significance. This freedom to roam mentally enables unconscious thoughts, including the substance of dreams, to rise to the surface and be interpreted.
Her analyst is there as part blank sounding board, part mirror, helping her reflect on what she is saying by suggesting meanings and connections between different aspects of her narrative as well as picking up on and questioning recurrent themes or words. Often, the psychoanalyst will be aware of transference, when Anna behaves towards the practitioner as though they were someone significant in her past life. She comes, with time, to understand why she lost her voice and suffered from a tightened throat, why her hands took to trembling, why she lost her appetite. She discovers that these responses to mourning and grief relate in part to an early childhood experience.
Through the analysis, Anna is enabled to conjure up memories of that incident and relate it to her present feelings and thoughts. And with that understanding comes the realisation that she has the power to respond and behave differently.
Responsibility for the shift in approaches between the first and second scenarios can largely be attributed to Sigmund Freud, a figure everyone has heard of, many have strong feelings about, few have read. Born 150 years ago, the father of psychoanalysis is a controversial character who, like it or not, is an icon of 20th-century thought. Take a minute to think about the way we bandy about terms such as Oedipus complex, Freudian slip, sibling rivalry and penis envy, how we label each other as neurotic and celebrities as narcissistic, how we complain about a friend's constant state of angst, about our partners' defensiveness - and you begin to appreciate the enormous influence Freud has had on the way we think about behaviour.
But why did he, rather than his contemporaries, such as Josef Breuer and S ndor Ferenczi, become a household name? In a nutshell, he shook things up, overturning received truths, upsetting various apple-carts and, as a consequence, attracting great hostility from fellow neurologists, psychologists, psychiatrists and swathes of the public. He wrote, among a great many other things, about the sexual desires that drive us from infancy and, from that point on, become sublimated into the unconscious and made manifest in our dreams.
Sex, according to Freud, is one of our most powerful instincts, and the guilt and repression surrounding it was responsible for neurosis, hysteria, depression and a range of psychosomatic disorders. These ideas scandalised the strait-laced sensibilities of Victorian-era Europe. To this day, his very name is, for some, synonymous with sexual obsession.
But take away the sex (if you can) and what remains is a man who brought, in an expansive, compelling, often brilliant way, a new understanding to the way the mind works and fresh thinking to the enigmas of why we behave the way we do, why we think the things we think, why our bodies feel the way they feel. At a time when the focus was on curing physical manifestations of mental illness, Freud immersed himself in the nature of relationships, the meaning of dreams, the power of desire, the significance of instinct.
Philosophers, writers and medical professionals of various disciplines had been delving into related territory long before Freud arrived on the scene in early 20th-century Vienna. The fundamental difference between him and virtually everyone in the field who had gone before him was his originality, the way he chose to present his new thinking and the openness with which he changed his mind on basic precepts and admitted his mistakes.
Using scientific as well as literary, sociological and political reference points, he devised a novel interpretation of the human psyche.
The central plank of his radical theoretical construction was his concept of the unconscious. This massive hinterland, representing the bulk of what we call the mind, is where the key to understanding feelings and behaviour resides. Here sits, among other things, repressed thoughts and feelings, needs and desires that have been shoved into it because of their intensity or the pain or trauma with which they are associated.
Despite their presence in the deep recesses of our mind, they are anything but dormant. Indeed, they inform everything we think and do, along with and sometimes even more than conscious thoughts. One of the most vivid ways the unconscious makes itself known to us is through dreams which, Freud suggested, represent our hopes and desires (including, yes, sexual ones) in a way that our conscious won't allow us to do, often in symbolic forms. And so, analysing patients' dreams was a crucial way in which Freud circumvented patients' conscious thoughts and, in doing so, he was able to unravel the truth about what was going on in their minds.
Here's what Freud says about some of our innate and fundamental instincts:
* The satisfaction of our basic needs for food and warmth are experienced as both practical - the alleviation of hunger and cold - and pleasurable. This is expounded on by way of discussing the three basic phases of infancy, which focus on erotogenic, or pleasure-inducing, zones in the body: the oral, the anal and the phallic.
* The infant sucking at its mother's breast experiences its first sexual awakening while doing so. This is the oral stage of earliest infancy, in which the core of the infant's physical being is perceived to be in its mouth. It is the entry point for all that is good in the world, all that can alleviate discomfort and distress: the mother's breast. In early infancy, all experiences of which the baby is aware begin and end there.
* The oral stage leads on to the anal stage, when, says Freud, the child discovers pleasure in defecating. This is a harder one to swallow, as it were - he contends that the young child discovers his or her ability to exert control in emotional ways as well as physically in this phase: to expel, to destroy and also to withhold.
* Then comes the phallic stage, which, despite its name, is not exclusive to males. This is when the genitals are discovered and fiddled around with rather a lot to the child's great delight and often to the parents'
consternation. The infant is blissfully ensconced in the "pleasure principle", where it is "anarchic, sadistic, aggressive, self-involved and remorselessly pleasure-seeking".
These phases are collectively referred to as libidinal forces, the engine that drives one of several kinds of mental energy mapped by Freud. Rather than presenting themselves sequentially, the three phases overlap. For the infant, the overall effect is a total lack of awareness of any difference between the self and the external world. It is a time of sensation, in which needs have to be met immediately.
The instincts, in other words, dominate the young infant. They are one of the three components that Freud included in his structural view of the psyche (a term he used as a synonym for the mind) : the id, the ego and the super-ego.
In the earliest stages of development, Freud wrote, it is the "id" (meaning "it" in German) that dominates. This is an unconscious representation of motivational drives or instincts that demand immediate satisfaction. But you don't have to be a baby for your id to take control of things. Think of road rage, a toddler's tantrum, or a teenager's splenetic outburst when they don't get what they want the moment they want it. Or, indeed, think of someone who gives in to their amorous or lustful or gluttonous desires with blithe abandon. That's the id at work.
As the child develops in its first year, the powerful force of the id becomes mediated by the formation of the ego. We all know what we mean when we talk about someone having a huge ego, but Freud had something different in mind. For him, the ego is, confusingly, a part of the id that is reasonable, that rises above instinct and passion to function in the external world. Children with well-developed egos will stand out from others as self-directed, motivated, assured, socially adept. They know who they are.
This part of the psyche is concerned with self-observation and self-criticism. For the super-ego to function, the infant will have introjected (absorbed) its parents' responses and attitudes, or rather, the remembered experiences of its parents' responses. While the parental voice informing the super-ego can be of a benign and guiding nature, it can also be chastising, harsh, unrelenting. People with low self-esteem often have a hypercritical super-ego that always punishes, never rewards.
All very interesting, but rather complicated. And what does it mean in terms of making people who have psychological problems feel better? How did Freud put the intricate, sometimes head-bangingly convoluted models he created to good use in his new brand of treatment, which he called psychoanalysis?
It's important to remember that Freudian thought was based on his work initially as a neurological researcher and then as a clinician of many decades' experience. His case studies give insights into the mastery of his observational powers and intuition as much as into the psychological complexities of his patients. It was in his consulting rooms and in the drawing rooms of his well-heeled patients, most of them women but some men and one notable young boy, that he observed behaviour which he generalised into theories.
The lack of scientific data and empirical evidence beyond the case studies were major weapons which his detractors used to discredit him. His apparent preoccupation with sex in his writings alienated his medical colleagues and outraged the public. But, in the end, the power of his narratives, the luminosity of his intellect and the acuity of his observations and interpretations have illuminated the psychical landscape for generations since. And they have provided a strong foundation for many later theorists and clinicians, however great the distance they have put between themselves and Freud
While psychoanalysis had become a male-dominated bastion, there were two outstanding women in the movement who were, for a considerable time, arch-rivals.
Anna Freud, the youngest of Freud's six children, was psychoanalysed by her father in her early 20s, and became deeply involved in analysis thereafter, developing her own approach, based on her father's work, to working with children. After the Second World War, she set up what later became the Anna Freud Centre for child psychoanalysis in Hampstead.
Melanie Klein, another pioneer of child psychoanalysis, presented a direct challenge to Anna Freud by developing object relations theory, an approach that centred on the mother-infant relationship as the focus of personality development. Her run-ins with Anna Freud, who was a fierce defender of her father's work, threatened to split the British Psychoanalytical Society, but an eventual rapprochement enabled them to work in parallel.
Case study: Little Hans
One of Freud's famous case studies centred on his narrative of a five-year-old boy, whom Freud called Little Hans. The son of middle-class Viennese admirers of Freud, he was the youngest child to have been analysed by Freud, albeit mainly through the father's reports.
Briefly, Hans had developed a fear of horses that prevented him from leaving home - the streets of early 20th-century Vienna were teeming with horse-drawn carriages. Through a series of long interviews with the boy, Freud was able to attribute this phobia to a number of factors, including literal interpretations of parental teasing, the arrival of a new sister, and the witnessing of a horse collapsing in the street.
Intertwined with this was an Oedipal situation, in which the boy yearned for the caresses of his mother in her bed, in defiance of his father.
Ultimately, the case study of Little Hans illuminated, among many things, the consequences of the little deceptions that parents spin to their children in the name of decency (Hans was told that the stork had delivered his little sister, that a doctor would be called to cut off his widdler if he didn't stop playing with it and that a guardsman would come and arrest him for being naughty).
The cumulative effect of these incidents on this highly sensitive, intelligent little boy was anger and distrust at being deceived, invoking Philip Larkin's "This Be the Verse":
They fuck you up, your mum and dad.
They may not mean to, but they do.
Here is a selection of key theories that brought Freud notoriety from some, admiration from others.
Based on the Greek myth of Oedipus, the ill-fated king of Thebes who unwittingly killed his father and married his mother, this refers to a period of development up until the age of five, during which a child will feel intense love for the parent of the opposite sex and feel hatred towards the parent of the same sex, who stands in the child's way of possessing its love object.
In the case of girls, this is sometimes called the Elektra complex.
While boys will envy their father's bigger versions of themselves, all women, claimed Freud, wish they had one, too. Once they get an eyeful of a brother's or playmate's and recognise it as "a superior counterpart of their own small and inconspicuous organ... from that time forward (they) fall victim to envy for the penis."
This envy, Freud postulates, is connected to jealousy which, he says, "plays a far larger part in the mental life of women than of men" and which is always fuelled by displaced penis envy.
Views such as these have made it difficult for feminists to accept Freudian psychoanalysis and have provided a basis for criticism by post-Freudians, both men and women.
These are techniques which, in Freud's words, "the ego makes use of in conflicts which may lead to neurosis." Induced by real or imagined anxieties, they serve the purpose of protecting the ego from threats coming from the id, the super-ego and the external world.
Freud for Beginners by Richard Appignanesi and Oscar Zarate, Pantheon
Books (pound;6.37 from Amazon)
Freud: A Very Short Introduction by Anthony Storr, Oxford University Press
Sigmund Freud (Internet Encyclopaedia of Philosophy):
Sigmund Freud Archive:
Full text of The Interpretation of Dreams