Psychoanalysis is a set of psychological and psychotherapeutic theories and associated techniques, originally popularised by Austrian physician Sigmund Freud and stemming partly from the clinical work of Josef Breuer and others. Since then, psychoanalysis has expanded and been revised, reformed and developed in different directions. This was initially by Freud’s colleagues and students, such as Alfred Adler and Carl Gustav Jung who went on to develop their own ideas independently from Freud. Later neo-Freudians included Erich Fromm, Karen Horney, Harry Stack Sullivan and Jacques Lacan.
The basic tenets of psychoanalysis include the following:
besides the inherited constitution of personality, a person’s development is determined by events in early childhood;
human attitude, mannerism, experience, and thought is largely influenced by irrational drives;
irrational drives are unconscious;
attempts to bring these drives into awareness meet psychological resistance in the form of defense mechanisms;
conflicts between conscious and unconscious, or repressed, material can materialise in the form of mental or emotional disturbances, for example: neurosis, neurotic traits, anxiety, depression etc.;
the liberation from the effects of the unconscious material is achieved through bringing this material into the conscious mind (via e.g. skilled guidance, i.e. therapeutic intervention).
Under the broad umbrella of psychoanalysis there are at least 22 theoretical orientations regarding human mental development. The various approaches in treatment called “psychoanalysis” vary as much as the theories do. The term also refers to a method of analysing child development.
Freudian psychoanalysis refers to a specific type of treatment in which the “analysand” (analytic patient) verbally expresses his thoughts, including free associations, fantasies, and dreams, from which the analyst induces the unconscious conflicts causing the patient’s symptoms and character problems, and interprets them for the patient to create insight for resolution of the problems. The analyst confronts and clarifies the patient’s pathological defenses, wishes and guilt. Through the analysis of conflicts, including those contributing to resistance and those involving transference onto the analyst of distorted reactions, psychoanalytic treatment can hypothesize how patients unconsciously are their own worst enemies: how unconscious, symbolic reactions that have been stimulated by experience are causing symptoms.
Psychoanalysis has received criticism from a wide variety of sources. One notable critique of psychoanalysis is that it constitutes a pseudoscience. Nonetheless, it remains a strong influence within the realm of psychiatry, and more so in some quarters than others.
The predominant psychoanalytic theories can be organised into several theoretical “schools.” Although these theoretical “schools” differ, most of them continue to emphasise the strong influence of unconscious elements affecting people’s mental lives. There has also been considerable work done on consolidating elements of conflicting theory. As in all fields of healthcare, there are some persistent conflicts regarding specific causes of some syndromes, and disputes regarding the best treatment techniques. In the 21st century, psychoanalytic ideas are embedded in Western culture, especially in fields such as childcare, education, literary criticism, cultural studies, and mental health, particularly psychotherapy. Though there is a mainstream of evolved analytic ideas, there are groups who follow the precepts of one or more of the later theoreticians. Psychoanalytic ideas also play roles in some types of literary analysis such as Archetypal literary criticism.
Topographic theory was named and first described by Freud in The Interpretation of Dreams (1900). The theory hypothesises that the mental apparatus can be divided into the systems Conscious, Pre-conscious and Unconscious. These systems are not anatomical structures of the brain but, rather, mental processes. Although Freud retained this theory throughout his life he largely replaced it with the Structural theory. The Topographic theory remains as one of the metapsychological points of view for describing how the mind functions in classical psychoanalytic theory.
Structural theory divides the psyche into the id, the ego, and the super-ego. The id is present at birth as the repository of basic instincts, which Freud called “Triebe” (“drives”): unorganised and unconscious, it operates merely on the ‘pleasure principle’, without realism or foresight. The ego develops slowly and gradually, being concerned with mediating between the urgings of the id and the realities of the external world; it thus operates on the ‘reality principle’. The super-ego is held to be the part of the ego in which self-observation, self-criticism and other reflective and judgemental faculties develop. The ego and the super-ego are both partly conscious and partly unconscious.
Ego psychology was initially suggested by Freud in Inhibitions, Symptoms and Anxiety (1926). The theory was refined by Hartmann, Loewenstein, and Kris in a series of papers and books from 1939 through the late 1960s. Leo Bellak was a later contributor. This series of constructs, paralleling some of the later developments of cognitive theory, includes the notions of autonomous ego functions: mental functions not dependent, at least in origin, on intrapsychic conflict. Such functions include: sensory perception, motor control, symbolic thought, logical thought, speech, abstraction, integration (synthesis), orientation, concentration, judgment about danger, reality testing, adaptive ability, executive decision-making, hygiene, and self-preservation. Freud noted that inhibition is one method that the mind may utilize to interfere with any of these functions in order to avoid painful emotions. Hartmann (1950s) pointed out that there may be delays or deficits in such functions.
Frosch (1964) described differences in those people who demonstrated damage to their relationship to reality, but who seemed able to test it. Deficits in the capacity to organize thought are sometimes referred to as blocking or loose associations (Bleuler), and are characteristic of the schizophrenias. Deficits in abstraction ability and self-preservation also suggest psychosis in adults. Deficits in orientation and sensorium are often indicative of a medical illness affecting the brain (and therefore, autonomous ego functions). Deficits in certain ego functions are routinely found in severely sexually or physically abused children, where powerful effects generated throughout childhood seem to have eroded some functional development.
Ego strengths, later described by Kernberg (1975), include the capacities to control oral, sexual, and destructive impulses; to tolerate painful effects without falling apart; and to prevent the eruption into consciousness of bizarre symbolic fantasy. Synthetic functions, in contrast to autonomous functions, arise from the development of the ego and serve the purpose of managing conflictual processes. Defenses are synthetic functions that protect the conscious mind from awareness of forbidden impulses and thoughts. One purpose of ego psychology has been to emphasize that some mental functions can be considered to be basic, rather than derivatives of wishes, affects, or defenses. However, autonomous ego functions can be secondarily affected because of unconscious conflict. For example, a patient may have an hysterical amnesia (memory being an autonomous function) because of intrapsychic conflict (wishing not to remember because it is too painful).
Taken together, the above theories present a group of metapsychological assumptions. Therefore, the inclusive group of the different classical theories provides a cross-sectional view of human mentation. There are six “points of view”, five described by Freud and a sixth added by Hartmann. Unconscious processes can therefore be evaluated from each of these six points of view. The “points of view” are: 1. Topographic 2. Dynamic (the theory of conflict) 3. Economic (the theory of energy flow) 4. Structural 5. Genetic (propositions concerning origin and development of psychological functions) and 6. Adaptational (psychological phenomena as it relates to the external world).
A variation of ego psychology, termed “modern conflict theory”, is more broadly an update and revision of structural theory (Freud, 1923, 1926); it does away with some of structural theory’s more arcane features, such as where repressed thoughts are stored. Modern conflict theory centres around how emotional symptoms and character traits are complex solutions to mental conflict. It dispenses with the concepts of a fixed id, ego and superego, and instead posits conscious and unconscious conflict among wishes (dependent, controlling, sexual, and aggressive), guilt and shame, emotions (especially anxiety and depressive affect), and defensive operations that shut off from consciousness some aspect of the others. Moreover, healthy functioning (adaptive) is also determined, to a great extent, by resolutions of conflict.
A major objective of modern conflict-theory psychoanalysis is to change the balance of conflict in a patient by making aspects of the less adaptive solutions (also called “compromise formations”) conscious so that they can be rethought, and more adaptive solutions found. Current theoreticians following Brenner’s many suggestions (see especially Brenner’s 1982 book, The Mind in Conflict) include Sandor Abend, MD (Abend, Porder, & Willick, (1983), Borderline Patients: Clinical Perspectives), Jacob Arlow (Arlow and Brenner (1964), Psychoanalytic Concepts and the Structural Theory), and Jerome Blackman (2003), 101 Defenses: How the Mind Shields Itself).
Object relations theory:
Object relations theory attempts to explain the ups and downs of human relationships through a study of how internal representations of the self and others are organised. The clinical symptoms that suggest object relations problems (typically developmental delays throughout life) include disturbances in an individual’s capacity to feel warmth, empathy, trust, sense of security, identity stability, consistent emotional closeness, and stability in relationships with significant others. (It is not suggested that one should trust everyone, for example.) Concepts regarding internal representations (also sometimes termed, “introjects,” “self and object representations,” or “internalizations of self and other”) although often attributed to Melanie Klein, were actually first mentioned by Sigmund Freud in his early concepts of drive theory (Three Essays on the Theory of Sexuality, 1905). Freud’s 1917 paper “Mourning and Melancholia”, for example, hypothesized that unresolved grief was caused by the survivor’s internalized image of the deceased becoming fused with that of the survivor, and then the survivor shifting unacceptable anger toward the deceased onto the now complex self-image.
Vamik Volkan, in “Linking Objects and Linking Phenomena”, expanded on Freud’s thoughts on this, describing the syndromes of “Established pathological mourning” vs. “reactive depression” based on similar dynamics. Melanie Klein’s hypotheses regarding internalizations during the first year of life, leading to paranoid and depressive positions, were later challenged by René Spitz (e.g., The First Year of Life, 1965), who divided the first year of life into a coenesthetic phase of the first six months, and then a diacritic phase for the second six months. Margaret Mahler (Mahler, Fine, and Bergman, “The Psychological Birth of the Human Infant”, 1975) and her group, first in New York, then in Philadelphia, described distinct phases and subphases of child development leading to “separation-individuation” during the first three years of life, stressing the importance of constancy of parental figures, in the face of the child’s destructive aggression, to the child’s internalizations, stability of affect management, and ability to develop healthy autonomy.
Later developers of the theory of self and object constancy as it affects adult psychiatric problems such as psychosis and borderline states have been John Frosch, Otto Kernberg, Salman Akhtar and Sheldon Bach. Peter Blos described (in a book called On Adolescence, 1960) how similar separation-individuation struggles occur during adolescence, of course with a different outcome from the first three years of life: the teen usually, eventually, leaves the parents’ house (this varies with the culture). During adolescence, Erik Erikson (1950–1960s) described the “identity crisis,” that involves identity-diffusion anxiety. In order for an adult to be able to experience “Warm-ETHICS” (warmth, empathy, trust, holding environment (Winnicott), identity, closeness, and stability) in relationships (see Blackman, 101 Defenses: How the Mind Shields Itself, 2001), the teenager must resolve the problems with identity and redevelop self and object constancy.
“Modern psychoanalysis” is a term coined by Hyman Spotnitz and his colleagues to describe a body of theoretical and clinical approaches that aim to extend Freud’s theories so as to make them applicable to the full spectrum of emotional disorders and broaden the potential for treatment to pathologies thought to be untreatable by classical methods. Interventions based on this approach are primarily intended to provide an emotional-maturational communication to the patient, rather than to promote intellectual insight. These interventions, beyond insight directed aims, are used to resolve resistances that are presented in the clinical setting. This school of psychoanalysis has fostered training opportunities for students in the United States and from countries worldwide. Its journal Modern Psychoanalysis has been published since 1976.