Who was Sigmund Freud?

Introduction

Sigmund Freud (born Sigismund Schlomo Freud; 06 May 1856 to 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for treating psychopathology through dialogue between a patient and a psychoanalyst.

Freud was born to Galician Jewish parents in the Moravian town of Freiberg, in the Austrian Empire. He qualified as a doctor of medicine in 1881 at the University of Vienna. Upon completing his habilitation in 1885, he was appointed a docent in neuropathology and became an affiliated professor in 1902. Freud lived and worked in Vienna, having set up his clinical practice there in 1886. In 1938, Freud left Austria to escape Nazi persecution. He died in exile in the United Kingdom in 1939.

In founding psychoanalysis, Freud developed therapeutic techniques such as the use of free association and discovered transference, establishing its central role in the analytic process. Freud’s redefinition of sexuality to include its infantile forms led him to formulate the Oedipus complex as the central tenet of psychoanalytical theory. His analysis of dreams as wish-fulfilments provided him with models for the clinical analysis of symptom formation and the underlying mechanisms of repression. On this basis, Freud elaborated his theory of the unconscious and went on to develop a model of psychic structure comprising id, ego and super-ego. Freud postulated the existence of libido, sexualised energy with which mental processes and structures are invested and which generates erotic attachments, and a death drive, the source of compulsive repetition, hate, aggression, and neurotic guilt. In his later works, Freud developed a wide-ranging interpretation and critique of religion and culture.

Though in overall decline as a diagnostic and clinical practice, psychoanalysis remains influential within psychology, psychiatry, and psychotherapy, and across the humanities. It thus continues to generate extensive and highly contested debate concerning its therapeutic efficacy, its scientific status, and whether it advances or hinders the feminist cause. Nonetheless, Freud’s work has suffused contemporary Western thought and popular culture. W.H. Auden’s 1940 poetic tribute to Freud describes him as having created “a whole climate of opinion / under whom we conduct our different lives”.

Biography

Early Life and Education

Freud was born to Jewish parents in the Moravian town of Freiberg, in the Austrian Empire (now Příbor, Czech Republic), the first of eight children. Both of his parents were from Galicia, a historic province straddling modern-day West Ukraine and southeast Poland. His father, Jakob Freud (1815-1896), a wool merchant, had two sons, Emanuel (1833-1914) and Philipp (1836-1911), by his first marriage. Jakob’s family were Hasidic Jews and, although Jakob himself had moved away from the tradition, he came to be known for his Torah study. He and Freud’s mother, Amalia Nathansohn, who was 20 years younger and his third wife, were married by Rabbi Isaac Noah Mannheimer on 29 July 1855. They were struggling financially and living in a rented room, in a locksmith’s house at Schlossergasse 117 when their son Sigmund was born. He was born with a caul, which his mother saw as a positive omen for the boy’s future.

In 1859, the Freud family left Freiberg. Freud’s half-brothers immigrated to Manchester, England, parting him from the “inseparable” playmate of his early childhood, Emanuel’s son, John. Jakob Freud took his wife and two children (Freud’s sister, Anna, was born in 1858; a brother, Julius born in 1857, had died in infancy) firstly to Leipzig and then in 1860 to Vienna where four sisters and a brother were born: Rosa (b. 1860), Marie (b. 1861), Adolfine (b. 1862), Paula (b. 1864), Alexander (b. 1866). In 1865, the nine-year-old Freud entered the Leopoldstädter Kommunal-Realgymnasium, a prominent high school. He proved to be an outstanding pupil and graduated from the Matura in 1873 with honours. He loved literature and was proficient in German, French, Italian, Spanish, English, Hebrew, Latin and Greek.

Freud entered the University of Vienna at age 17. He had planned to study law, but joined the medical faculty at the university, where his studies included philosophy under Franz Brentano, physiology under Ernst Brücke, and zoology under Darwinist professor Carl Claus. In 1876, Freud spent four weeks at Claus’s zoological research station in Trieste, dissecting hundreds of eels in an inconclusive search for their male reproductive organs. In 1877 Freud moved to Ernst Brücke’s physiology laboratory where he spent six years comparing the brains of humans and other vertebrates with those of frogs and invertebrates such as crayfish and lampreys. His research work on the biology of nervous tissue proved seminal for the subsequent discovery of the neuron in the 1890s. Freud’s research work was interrupted in 1879 by the obligation to undertake a year’s compulsory military service. The lengthy downtimes enabled him to complete a commission to translate four essays from John Stuart Mill’s collected works. He graduated with an MD in March 1881.

Early Career and Marriage

In 1882, Freud began his medical career at the Vienna General Hospital. His research work in cerebral anatomy led to the publication of an influential paper on the palliative effects of cocaine in 1884 and his work on aphasia would form the basis of his first book On Aphasia: A Critical Study, published in 1891. Over a three-year period, Freud worked in various departments of the hospital. His time spent in Theodor Meynert’s psychiatric clinic and as a locum in a local asylum led to an increased interest in clinical work. His substantial body of published research led to his appointment as a university lecturer or docent in neuropathology in 1885, a non-salaried post but one which entitled him to give lectures at the University of Vienna.

In 1886, Freud resigned his hospital post and entered private practice specializing in “nervous disorders”. The same year he married Martha Bernays, the granddaughter of Isaac Bernays, a chief rabbi in Hamburg. They had six children: Mathilde (b. 1887), Jean-Martin (b. 1889), Oliver (b. 1891), Ernst (b. 1892), Sophie (b. 1893), and Anna (b. 1895). From 1891 until they left Vienna in 1938, Freud and his family lived in an apartment at Berggasse 19, near Innere Stadt, a historical district of Vienna.

In 1896, Minna Bernays, Martha Freud’s sister, became a permanent member of the Freud household after the death of her fiancé. The close relationship she formed with Freud led to rumours, started by Carl Jung, of an affair. The discovery of a Swiss hotel guest-book entry for 13 August 1898, signed by Freud whilst travelling with his sister-in-law, has been presented as evidence of the affair.

Freud began smoking tobacco at age 24; initially a cigarette smoker, he became a cigar smoker. He believed smoking enhanced his capacity to work and that he could exercise self-control in moderating it. Despite health warnings from colleague Wilhelm Fliess, he remained a smoker, eventually suffering a buccal cancer.[29] Freud suggested to Fliess in 1897 that addictions, including that to tobacco, were substitutes for masturbation, “the one great habit.”

Freud had greatly admired his philosophy tutor, Brentano, who was known for his theories of perception and introspection. Brentano discussed the possible existence of the unconscious mind in his Psychology from an Empirical Standpoint (1874). Although Brentano denied its existence, his discussion of the unconscious probably helped introduce Freud to the concept. Freud owned and made use of Charles Darwin’s major evolutionary writings, and was also influenced by Eduard von Hartmann’s The Philosophy of the Unconscious (1869). Other texts of importance to Freud were by Fechner and Herbart, with the latter’s Psychology as Science arguably considered to be of underrated significance in this respect. Freud also drew on the work of Theodor Lipps, who was one of the main contemporary theorists of the concepts of the unconscious and empathy.

Though Freud was reluctant to associate his psychoanalytic insights with prior philosophical theories, attention has been drawn to analogies between his work and that of both Schopenhauer and Nietzsche. In 1908 Freud said that he occasionally read Nietzsche, and had a strong fascination for his writings, but did not study him, because he found Nietzsche’s “intuitive insights” resembled too much his own work at the time, and also because he was overwhelmed by the “wealth of ideas” he encountered when he read Nietzsche. Freud sometimes would deny the influence of Nietzsche’s ideas. One historian quotes Peter L. Rudnytsky, who says that based on Freud’s correspondence with his adolescent friend Eduard Silberstein, Freud read Nietzsche’s The Birth of Tragedy and probably the first two of the Untimely Meditations when he was seventeen. In 1900, the year of Nietzsche’s death, Freud bought his collected works; he told his friend, Fliess, that he hoped to find in Nietzsche’s works “the words for much that remains mute in me.” Later, he said he had not yet opened them. Freud came to treat Nietzsche’s writings “as texts to be resisted far more than to be studied.” His interest in philosophy declined after he had decided on a career in neurology.

Freud read William Shakespeare in English throughout his life, and it has been suggested that his understanding of human psychology may have been partially derived from Shakespeare’s plays.

Freud’s Jewish origins and his allegiance to his secular Jewish identity were of significant influence in the formation of his intellectual and moral outlook, especially concerning his intellectual non-conformism, as he was the first to point out in his Autobiographical Study. They would also have a substantial effect on the content of psychoanalytic ideas, particularly in respect of their common concerns with depth interpretation and “the bounding of desire by law”.

Development of Psychoanalysis

In October 1885, Freud went to Paris on a three-month fellowship to study with Jean-Martin Charcot, a renowned neurologist who was conducting scientific research into hypnosis. He was later to recall the experience of this stay as catalytic in turning him toward the practice of medical psychopathology and away from a less financially promising career in neurology research. Charcot specialised in the study of hysteria and susceptibility to hypnosis, which he frequently demonstrated with patients on stage in front of an audience.

Once he had set up in private practice back in Vienna in 1886, Freud began using hypnosis in his clinical work. He adopted the approach of his friend and collaborator, Josef Breuer, in a type of hypnosis that was different from the French methods he had studied, in that it did not use suggestion. The treatment of one particular patient of Breuer’s proved to be transformative for Freud’s clinical practice. Described as Anna O., she was invited to talk about her symptoms while under hypnosis (she would coin the phrase “talking cure” for her treatment). In the course of talking in this way, her symptoms became reduced in severity as she retrieved memories of traumatic incidents associated with their onset.

The inconsistent results of Freud’s early clinical work eventually led him to abandon hypnosis, having concluded that more consistent and effective symptom relief could be achieved by encouraging patients to talk freely, without censorship or inhibition, about whatever ideas or memories occurred to them. In conjunction with this procedure, which he called “free association”, Freud found that patients’ dreams could be fruitfully analysed to reveal the complex structuring of unconscious material and to demonstrate the psychic action of repression which, he had concluded, underlay symptom formation. By 1896 he was using the term “psychoanalysis” to refer to his new clinical method and the theories on which it was base

Freud’s development of these new theories took place during a period in which he experienced heart irregularities, disturbing dreams and periods of depression, a “neurasthenia” which he linked to the death of his father in 1896 and which prompted a “self-analysis” of his own dreams and memories of childhood. His explorations of his feelings of hostility to his father and rivalrous jealousy over his mother’s affections led him to fundamentally revise his theory of the origin of the neuroses.

Based on his early clinical work, Freud had postulated that unconscious memories of sexual molestation in early childhood were a necessary precondition for the psychoneuroses (hysteria and obsessional neurosis), a formulation now known as Freud’s seduction theory. In the light of his self-analysis, Freud abandoned the theory that every neurosis can be traced back to the effects of infantile sexual abuse, now arguing that infantile sexual scenarios still had a causative function, but it did not matter whether they were real or imagined and that in either case, they became pathogenic only when acting as repressed memories.

This transition from the theory of infantile sexual trauma as a general explanation of how all neuroses originate to one that presupposes autonomous infantile sexuality provided the basis for Freud’s subsequent formulation of the theory of the Oedipus complex.

Freud described the evolution of his clinical method and set out his theory of the psychogenetic origins of hysteria, demonstrated in several case histories, in Studies on Hysteria published in 1895 (co-authored with Josef Breuer). In 1899 he published The Interpretation of Dreams in which, following a critical review of existing theory, Freud gives detailed interpretations of his own and his patients’ dreams in terms of wish-fulfilments made subject to the repression and censorship of the “dream-work”. He then sets out the theoretical model of mental structure (the unconscious, pre-conscious and conscious) on which this account is based. An abridged version, On Dreams, was published in 1901. In works that would win him a more general readership, Freud applied his theories outside the clinical setting in The Psychopathology of Everyday Life (1901) and Jokes and their Relation to the Unconscious (1905). In Three Essays on the Theory of Sexuality, published in 1905, Freud elaborates his theory of infantile sexuality, describing its “polymorphous perverse” forms and the functioning of the “drives”, to which it gives rise, in the formation of sexual identity. The same year he published Fragment of an Analysis of a Case of Hysteria, which became one of his more famous and controversial case studies.

Relationship with Fliess

During this formative period of his work, Freud valued and came to rely on the intellectual and emotional support of his friend Wilhelm Fliess, a Berlin-based ear, nose, and throat specialist whom he had first met in 1887. Both men saw themselves as isolated from the prevailing clinical and theoretical mainstream because of their ambitions to develop radical new theories of sexuality. Fliess developed highly eccentric theories of human biorhythms and a nasogenital connection which are today considered pseudoscientific. He shared Freud’s views on the importance of certain aspects of sexuality – masturbation, coitus interruptus, and the use of condoms – in the aetiology of what was then called the “actual neuroses,” primarily neurasthenia and certain physically manifested anxiety symptoms. They maintained an extensive correspondence from which Freud drew on Fliess’s speculations on infantile sexuality and bisexuality to elaborate and revise his own ideas. His first attempt at a systematic theory of the mind, his Project for a Scientific Psychology was developed as a metapsychology with Fliess as interlocutor. However, Freud’s efforts to build a bridge between neurology and psychology were eventually abandoned after they had reached an impasse, as his letters to Fliess reveal, though some ideas of the Project were to be taken up again in the concluding chapter of The Interpretation of Dreams.

Freud had Fliess repeatedly operate on his nose and sinuses to treat “nasal reflex neurosis”, and subsequently referred his patient Emma Eckstein to him. According to Freud, her history of symptoms included severe leg pains with consequent restricted mobility, as well as stomach and menstrual pains. These pains were, according to Fliess’s theories, caused by habitual masturbation which, as the tissue of the nose and genitalia were linked, was curable by removal of part of the middle turbinate. Fliess’s surgery proved disastrous, resulting in profuse, recurrent nasal bleeding; he had left a half-metre of gauze in Eckstein’s nasal cavity whose subsequent removal left her permanently disfigured. At first, though aware of Fliess’s culpability and regarding the remedial surgery in horror, Freud could bring himself only to intimate delicately in his correspondence with Fliess the nature of his disastrous role, and in subsequent letters maintained a tactful silence on the matter or else returned to the face-saving topic of Eckstein’s hysteria. Freud ultimately, in light of Eckstein’s history of adolescent self-cutting and irregular nasal (and menstrual) bleeding, concluded that Fliess was “completely without blame”, as Eckstein’s post-operative haemorrhages were hysterical “wish-bleedings” linked to “an old wish to be loved in her illness” and triggered as a means of “rearousing [Freud’s] affection”. Eckstein nonetheless continued her analysis with Freud. She was restored to full mobility and went on to practice psychoanalysis herself.

Freud, who had called Fliess “the Kepler of biology”, later concluded that a combination of a homoerotic attachment and the residue of his “specifically Jewish mysticism” lay behind his loyalty to his Jewish friend and his consequent over-estimation of both his theoretical and clinical work. Their friendship came to an acrimonious end with Fliess angry at Freud’s unwillingness to endorse his general theory of sexual periodicity and accusing him of collusion in the plagiarism of his work. After Fliess failed to respond to Freud’s offer of collaboration over the publication of his Three Essays on the Theory of Sexuality in 1906, their relationship came to an end.

Early followers

In 1902, Freud, at last, realised his long-standing ambition to be made a university professor. The title “professor extraordinarius” was important to Freud for the recognition and prestige it conferred, there being no salary or teaching duties attached to the post (he would be granted the enhanced status of “professor ordinarius” in 1920). Despite support from the university, his appointment had been blocked in successive years by the political authorities and it was secured only with the intervention of one of his more influential ex-patients, a Baroness Marie Ferstel, who (supposedly) had to bribe the minister of education with a valuable painting.

With his prestige thus enhanced, Freud continued with the regular series of lectures on his work which, since the mid-1880s as a docent of Vienna University, he had been delivering to small audiences every Saturday evening at the lecture hall of the university’s psychiatric clinic.

From the autumn of 1902, a number of Viennese physicians who had expressed interest in Freud’s work were invited to meet at his apartment every Wednesday afternoon to discuss issues relating to psychology and neuropathology. This group was called the Wednesday Psychological Society (Psychologische Mittwochs-Gesellschaft) and it marked the beginnings of the worldwide psychoanalytic movement.

Freud founded this discussion group at the suggestion of the physician Wilhelm Stekel. Stekel had studied medicine at the University of Vienna under Richard von Krafft-Ebing. His conversion to psychoanalysis is variously attributed to his successful treatment by Freud for a sexual problem or as a result of his reading The Interpretation of Dreams, to which he subsequently gave a positive review in the Viennese daily newspaper Neues Wiener Tagblatt.

The other three original members whom Freud invited to attend, Alfred Adler, Max Kahane, and Rudolf Reitler, were also physicians and all five were Jewish by birth. Both Kahane and Reitler were childhood friends of Freud. Kahane had attended the same secondary school and both he and Reitler went to university with Freud. They had kept abreast of Freud’s developing ideas through their attendance at his Saturday evening lectures. In 1901, Kahane, who first introduced Stekel to Freud’s work, had opened an out-patient psychotherapy institute of which he was the director in Bauernmarkt, in Vienna. In the same year, his medical textbook, Outline of Internal Medicine for Students and Practicing Physicians, was published. In it, he provided an outline of Freud’s psychoanalytic method. Kahane broke with Freud and left the Wednesday Psychological Society in 1907 for unknown reasons and in 1923 committed suicide. Reitler was the director of an establishment providing thermal cures in Dorotheergasse which had been founded in 1901. He died prematurely in 1917. Adler, regarded as the most formidable intellect among the early Freud circle, was a socialist who in 1898 had written a health manual for the tailoring trade. He was particularly interested in the potential social impact of psychiatry.

Max Graf, a Viennese musicologist and father of “Little Hans”, who had first encountered Freud in 1900 and joined the Wednesday group soon after its initial inception, described the ritual and atmosphere of the early meetings of the society:

The gatherings followed a definite ritual. First one of the members would present a paper. Then, black coffee and cakes were served; cigars and cigarettes were on the table and were consumed in great quantities. After a social quarter of an hour, the discussion would begin. The last and decisive word was always spoken by Freud himself. There was the atmosphere of the foundation of a religion in that room. Freud himself was its new prophet who made the heretofore prevailing methods of psychological investigation appear superficial.

By 1906, the group had grown to sixteen members, including Otto Rank, who was employed as the group’s paid secretary. In the same year, Freud began a correspondence with Carl Gustav Jung who was by then already an academically acclaimed researcher into word-association and the Galvanic Skin Response, and a lecturer at Zurich University, although still only an assistant to Eugen Bleuler at the Burghölzli Mental Hospital in Zürich. In March 1907, Jung and Ludwig Binswanger, also a Swiss psychiatrist, travelled to Vienna to visit Freud and attend the discussion group. Thereafter, they established a small psychoanalytic group in Zürich. In 1908, reflecting its growing institutional status, the Wednesday group was reconstituted as the Vienna Psychoanalytic Society with Freud as president, a position he relinquished in 1910 in favour of Adler in the hope of neutralising his increasingly critical standpoint.

The first woman member, Margarete Hilferding, joined the Society in 1910 and the following year she was joined by Tatiana Rosenthal and Sabina Spielrein who were both Russian psychiatrists and graduates of the Zürich University medical school. Before the completion of her studies, Spielrein had been a patient of Jung at the Burghölzli and the clinical and personal details of their relationship became the subject of an extensive correspondence between Freud and Jung. Both women would go on to make important contributions to the work of the Russian Psychoanalytic Society founded in 1910.

Freud’s early followers met together formally for the first time at the Hotel Bristol, Salzburg on 27 April 1908. This meeting, which was retrospectively deemed to be the first International Psychoanalytic Congress, was convened at the suggestion of Ernest Jones, then a London-based neurologist who had discovered Freud’s writings and begun applying psychoanalytic methods in his clinical work. Jones had met Jung at a conference the previous year and they met up again in Zürich to organise the Congress. There were, as Jones records, “forty-two present, half of whom were or became practicing analysts.” In addition to Jones and the Viennese and Zürich contingents accompanying Freud and Jung, also present and notable for their subsequent importance in the psychoanalytic movement were Karl Abraham and Max Eitingon from Berlin, Sándor Ferenczi from Budapest and the New York-based Abraham Brill.

Important decisions were taken at the Congress to advance the impact of Freud’s work. A journal, the Jahrbuch für psychoanalytische und psychopathologishe Forschungen, was launched in 1909 under the editorship of Jung. This was followed in 1910 by the monthly Zentralblatt für Psychoanalyse edited by Adler and Stekel, in 1911 by Imago, a journal devoted to the application of psychoanalysis to the field of cultural and literary studies edited by Rank and in 1913 by the Internationale Zeitschrift für Psychoanalyse, also edited by Rank. Plans for an international association of psychoanalysts were put in place and these were implemented at the Nuremberg Congress of 1910 where Jung was elected, with Freud’s support, as its first president.

Freud turned to Brill and Jones to further his ambition to spread the psychoanalytic cause in the English-speaking world. Both were invited to Vienna following the Salzburg Congress and a division of labour was agreed with Brill given the translation rights for Freud’s works, and Jones, who was to take up a post at the University of Toronto later in the year, tasked with establishing a platform for Freudian ideas in North American academic and medical life. Jones’s advocacy prepared the way for Freud’s visit to the United States, accompanied by Jung and Ferenczi, in September 1909 at the invitation of Stanley Hall, president of Clark University, Worcester, Massachusetts, where he gave five lectures on psychoanalysis.

The event, at which Freud was awarded an Honorary Doctorate, marked the first public recognition of Freud’s work and attracted widespread media interest. Freud’s audience included the distinguished neurologist and psychiatrist James Jackson Putnam, Professor of Diseases of the Nervous System at Harvard, who invited Freud to his country retreat where they held extensive discussions over a period of four days. Putnam’s subsequent public endorsement of Freud’s work represented a significant breakthrough for the psychoanalytic cause in the United States. When Putnam and Jones organised the founding of the American Psychoanalytic Association in May 1911 they were elected president and secretary respectively. Brill founded the New York Psychoanalytic Society the same year. His English translations of Freud’s work began to appear from 1909.

Resignations from the IPA

Some of Freud’s followers subsequently withdrew from the International Psychoanalytical Association (IPA) and founded their own schools.

From 1909, Adler’s views on topics such as neurosis began to differ markedly from those held by Freud. As Adler’s position appeared increasingly incompatible with Freudianism, a series of confrontations between their respective viewpoints took place at the meetings of the Viennese Psychoanalytic Society in January and February 1911. In February 1911, Adler, then the president of the society, resigned his position. At this time, Stekel also resigned from his position as vice president of the society. Adler finally left the Freudian group altogether in June 1911 to found his own organization with nine other members who had also resigned from the group. This new formation was initially called Society for Free Psychoanalysis but it was soon renamed the Society for Individual Psychology. In the period after World War I, Adler became increasingly associated with a psychological position he devised called individual psychology.

In 1912, Jung published Wandlungen und Symbole der Libido (published in English in 1916 as Psychology of the Unconscious) making it clear that his views were taking a direction quite different from those of Freud. To distinguish his system from psychoanalysis, Jung called it analytical psychology. Anticipating the final breakdown of the relationship between Freud and Jung, Ernest Jones initiated the formation of a Secret Committee of loyalists charged with safeguarding the theoretical coherence and institutional legacy of the psychoanalytic movement. Formed in the autumn of 1912, the Committee comprised Freud, Jones, Abraham, Ferenczi, Rank, and Hanns Sachs. Max Eitingon joined the committee in 1919. Each member pledged himself not to make any public departure from the fundamental tenets of psychoanalytic theory before he had discussed his views with the others. After this development, Jung recognised that his position was untenable and resigned as editor of the Jarhbuch and then as president of the IPA in April 1914. The Zürich Society withdrew from the IPA the following July.

Later the same year, Freud published a paper entitled “The History of the Psychoanalytic Movement”, the German original being first published in the Jahrbuch, giving his view on the birth and evolution of the psychoanalytic movement and the withdrawal of Adler and Jung from it.

The final defection from Freud’s inner circle occurred following the publication in 1924 of Rank’s The Trauma of Birth which other members of the committee read as, in effect, abandoning the Oedipus Complex as the central tenet of psychoanalytic theory. Abraham and Jones became increasingly forceful critics of Rank and though he and Freud were reluctant to end their close and long-standing relationship the break finally came in 1926 when Rank resigned from his official posts in the IPA and left Vienna for Paris. His place on the Committee was taken by Anna Freud. Rank eventually settled in the United States where his revisions of Freudian theory were to influence a new generation of therapists uncomfortable with the orthodoxies of the IPA.

Early Psychoanalytic Movement

After the founding of the IPA in 1910, an international network of psychoanalytical societies, training institutes, and clinics became well established and a regular schedule of biannual Congresses commenced after the end of World War I to coordinate their activities.

Abraham and Eitingon founded the Berlin Psychoanalytic Society in 1910 and then the Berlin Psychoanalytic Institute and the Poliklinik in 1920. The Poliklinik’s innovations of free treatment, and child analysis, and the Berlin Institute’s standardisation of psychoanalytic training had a major influence on the wider psychoanalytic movement. In 1927 Ernst Simmel founded the Schloss Tegel Sanatorium on the outskirts of Berlin, the first such establishment to provide psychoanalytic treatment in an institutional framework. Freud organised a fund to help finance its activities and his architect son, Ernst, was commissioned to refurbish the building. It was forced to close in 1931 for economic reasons.

The 1910 Moscow Psychoanalytic Society became the Russian Psychoanalytic Society and Institute in 1922. Freud’s Russian followers were the first to benefit from translations of his work, the 1904 Russian translation of The Interpretation of Dreams appearing nine years before Brill’s English edition. The Russian Institute was unique in receiving state support for its activities, including publication of translations of Freud’s works. Support was abruptly annulled in 1924, when Joseph Stalin came to power, after which psychoanalysis was denounced on ideological grounds.

After helping found the American Psychoanalytic Association in 1911, Ernest Jones returned to Britain from Canada in 1913 and founded the London Psychoanalytic Society the same year. In 1919, he dissolved this organisation and, with its core membership purged of Jungian adherents, founded the British Psychoanalytical Society, serving as its president until 1944. The Institute of Psychoanalysis was established in 1924 and the London Clinic of Psychoanalysis was established in 1926, both under Jones’s directorship.

The Vienna Ambulatorium (Clinic) was established in 1922 and the Vienna Psychoanalytic Institute was founded in 1924 under the directorship of Helene Deutsch. Ferenczi founded the Budapest Psychoanalytic Institute in 1913 and a clinic in 1929.

Psychoanalytic societies and institutes were established in Switzerland (1919), France (1926), Italy (1932), the Netherlands (1933), Norway (1933), and in Palestine (Jerusalem, 1933) by Eitingon, who had fled Berlin after Adolf Hitler came to power. The New York Psychoanalytic Institute was founded in 1931.

The 1922 Berlin Congress was the last Freud attended. By this time his speech had become seriously impaired by the prosthetic device he needed as a result of a series of operations on his cancerous jaw. He kept abreast of developments through regular correspondence with his principal followers and via the circular letters and meetings of the Secret Committee which he continued to attend.

The Committee continued to function until 1927 by which time institutional developments within the IPA, such as the establishment of the International Training Commission, had addressed concerns about the transmission of psychoanalytic theory and practice. There remained, however, significant differences over the issue of lay analysis, i.e. the acceptance of non-medically qualified candidates for psychoanalytic training. Freud set out his case in favour in 1926 in his The Question of Lay Analysis. He was resolutely opposed by the American societies who expressed concerns over professional standards and the risk of litigation (though child analysts were made exempt). These concerns were also shared by some of his European colleagues. Eventually, an agreement was reached allowing societies autonomy in setting criteria for candidature.

In 1930 Freud received the Goethe Prize in recognition of his contributions to psychology and German literary culture.

Patients

Freud used pseudonyms in his case histories. Some patients known by pseudonyms were:

  • Cäcilie M. (Anna von Lieben);
  • Dora (Ida Bauer, 1882–1945);
  • Frau Emmy von N. (Fanny Moser);
  • Fräulein Elisabeth von R. (Ilona Weiss);
  • Fräulein Katharina (Aurelia Kronich);
  • Fräulein Lucy R.;
  • Little Hans (Herbert Graf, 1903-1973);
  • Rat Man (Ernst Lanzer, 1878-1914);
  • Enos Fingy (Joshua Wild, 1878-1920); and
  • Wolf Man (Sergei Pankejeff, 1887-1979).

Other famous patients included:

  • Prince Pedro Augusto of Brazil (1866-1934);
  • H.D. (1886-1961);
  • Emma Eckstein (1865-1924);
  • Gustav Mahler (1860-1911), with whom Freud had only a single, extended consultation;
  • Princess Marie Bonaparte;
  • Edith Banfield Jackson (1895-1977); and
  • Albert Hirst (1887-1974).

Cancer

In February 1923, Freud detected a leucoplakia, a benign growth associated with heavy smoking, on his mouth. He initially kept this secret, but in April 1923 he informed Ernest Jones, telling him that the growth had been removed. Freud consulted the dermatologist Maximilian Steiner, who advised him to quit smoking but lied about the growth’s seriousness, minimising its importance. Freud later saw Felix Deutsch, who saw that the growth was cancerous; he identified it to Freud using the euphemism “a bad leukoplakia” instead of the technical diagnosis epithelioma. Deutsch advised Freud to stop smoking and have the growth excised. Freud was treated by Marcus Hajek, a rhinologist whose competence he had previously questioned. Hajek performed an unnecessary cosmetic surgery in his clinic’s outpatient department. Freud bled during and after the operation, and may narrowly have escaped death. Freud subsequently saw Deutsch again. Deutsch saw that further surgery would be required, but did not tell Freud he had cancer because he was worried that Freud might wish to commit suicide.

Escape from Nazism

In January 1933, the Nazi Party took control of Germany, and Freud’s books were prominent among those they burned and destroyed. Freud remarked to Ernest Jones: “What progress we are making. In the Middle Ages they would have burned me. Now, they are content with burning my books.” Freud continued to underestimate the growing Nazi threat and remained determined to stay in Vienna, even following the Anschluss of 13 March 1938, in which Nazi Germany annexed Austria, and the outbreaks of violent antisemitism that ensued. Jones, the then president of the International Psychoanalytical Association (IPA), flew into Vienna from London via Prague on 15 March determined to get Freud to change his mind and seek exile in Britain. This prospect and the shock of the arrest and interrogation of Anna Freud by the Gestapo finally convinced Freud it was time to leave Austria. Jones left for London the following week with a list provided by Freud of the party of émigrés for whom immigration permits would be required. Back in London, Jones used his personal acquaintance with the Home Secretary, Sir Samuel Hoare, to expedite the granting of permits. There were seventeen in all and work permits were provided where relevant. Jones also used his influence in scientific circles, persuading the president of the Royal Society, Sir William Bragg, to write to the Foreign Secretary Lord Halifax, requesting to good effect that diplomatic pressure be applied in Berlin and Vienna on Freud’s behalf. Freud also had support from American diplomats, notably his ex-patient and American ambassador to France, William Bullitt. Bullitt alerted US President Roosevelt to the increased dangers facing the Freuds, resulting in the American consul-general in Vienna, John Cooper Wiley, arranging regular monitoring of Berggasse 19. He also intervened by phone call during the Gestapo interrogation of Anna Freud.

The departure from Vienna began in stages throughout April and May 1938. Freud’s grandson, Ernst Halberstadt, and Freud’s son Martin’s wife and children left for Paris in April. Freud’s sister-in-law, Minna Bernays, left for London on 05 May, Martin Freud the following week and Freud’s daughter Mathilde and her husband, Robert Hollitscher, on 24 May.

By the end of the month, arrangements for Freud’s own departure for London had become stalled, mired in a legally tortuous and financially extortionate process of negotiation with the Nazi authorities. Under regulations imposed on its Jewish population by the new Nazi regime, a Kommissar was appointed to manage Freud’s assets and those of the IPA whose headquarters were near Freud’s home. Freud was allocated to Dr. Anton Sauerwald, who had studied chemistry at Vienna University under Professor Josef Herzig, an old friend of Freud’s. Sauerwald read Freud’s books to further learn about him and became sympathetic towards his situation. Though required to disclose details of all Freud’s bank accounts to his superiors and to arrange the destruction of the historic library of books housed in the offices of the IPA, Sauerwald did neither. Instead, he removed evidence of Freud’s foreign bank accounts to his own safe-keeping and arranged the storage of the IPA library in the Austrian National Library, where it remained until the end of the war.

Though Sauerwald’s intervention lessened the financial burden of the “flight” tax on Freud’s declared assets, other substantial charges were levied concerning the debts of the IPA and the valuable collection of antiquities Freud possessed. Unable to access his own accounts, Freud turned to Princess Marie Bonaparte, the most eminent and wealthy of his French followers, who had travelled to Vienna to offer her support, and it was she who made the necessary funds available. This allowed Sauerwald to sign the necessary exit visas for Freud, his wife Martha, and daughter Anna. They left Vienna on the Orient Express on 04 June, accompanied by their housekeeper and a doctor, arriving in Paris the following day, where they stayed as guests of Marie Bonaparte, before travelling overnight to London, arriving at London Victoria station on 06 June.

Among those soon to call on Freud to pay their respects were Salvador Dalí, Stefan Zweig, Leonard Woolf, Virginia Woolf, and H.G. Wells. Representatives of the Royal Society called with the Society’s Charter for Freud, who had been elected a Foreign Member in 1936, to sign himself into membership. Marie Bonaparte arrived near the end of June to discuss the fate of Freud’s four elderly sisters left behind in Vienna. Her subsequent attempts to get them exit visas failed, and they would all die in Nazi concentration camps.

In early 1939, Sauerwald arrived in London in mysterious circumstances, where he met Freud’s brother Alexander. He was tried and imprisoned in 1945 by an Austrian court for his activities as a Nazi Party official. Responding to a plea from his wife, Anna Freud wrote to confirm that Sauerwald “used his office as our appointed commissar in such a manner as to protect my father”. Her intervention helped secure his release from jail in 1947.

In the Freuds’ new home, 20 Maresfield Gardens, Hampstead, North London, Freud’s Vienna consulting room was recreated in faithful detail. He continued to see patients there until the terminal stages of his illness. He also worked on his last books, Moses and Monotheism, published in German in 1938 and in English the following year and the uncompleted An Outline of Psychoanalysis, which was published posthumously.

Death

By mid-September 1939, Freud’s cancer of the jaw was causing him increasingly severe pain and had been declared inoperable. The last book he read, Balzac’s La Peau de chagrin, prompted reflections on his own increasing frailty, and a few days later he turned to his doctor, friend, and fellow refugee, Max Schur, reminding him that they had previously discussed the terminal stages of his illness: “Schur, you remember our ‘contract’ not to leave me in the lurch when the time had come. Now it is nothing but torture and makes no sense.” When Schur replied that he had not forgotten, Freud said, “I thank you,” and then “Talk it over with Anna, and if she thinks it’s right, then make an end of it.” Anna Freud wanted to postpone her father’s death, but Schur convinced her it was pointless to keep him alive; on 21 and 22 September, he administered doses of morphine that resulted in Freud’s death at around 3 am on 23 September 1939. However, discrepancies in the various accounts Schur gave of his role in Freud’s final hours, which have in turn led to inconsistencies between Freud’s main biographers, has led to further research and a revised account. This proposes that Schur was absent from Freud’s deathbed when a third and final dose of morphine was administered by Dr. Josephine Stross, a colleague of Anna Freud, leading to Freud’s death at around midnight on 23 September 1939.

Three days after his death, Freud’s body was cremated at the Golders Green Crematorium in North London, with Harrods acting as funeral directors, on the instructions of his son, Ernst. Funeral orations were given by Ernest Jones and the Austrian author Stefan Zweig. Freud’s ashes were later placed in the crematorium’s Ernest George Columbarium (see “Freud Corner”). They rest on a plinth designed by his son, Ernst, in a sealed ancient Greek bell krater painted with Dionysian scenes that Freud had received as a gift from Marie Bonaparte, and which he had kept in his study in Vienna for many years. After his wife, Martha, died in 1951, her ashes were also placed in the urn.

On This Day … 12 September

People (Births)

  • 1914 – Rais Amrohvi, Pakistani psychoanalyst, poet, and scholar (d. 1988).
  • 1922 – Mark Rosenzweig, American psychologist and academic (d. 2009).

People (Deaths)

  • 1986 – Charlotte Wolff, German-English psychotherapist and physician (b. 1897).

Rais Amrohvi

Rais Amrohvi (Urdu: رئیس امروہوی‎), whose real name was Syed Muhammad Mehdi (1914-1988) was a Pakistani scholar, Urdu poet and psychoanalyst and elder brother of Jaun Elia. He was known for his style of qatanigari (quatrain writing). He wrote quatrains for Pakistani newspaper Jang for several decade. He promoted the Urdu language and supported the Urdu-speaking people of Pakistan. His family is regarded as family of poets.

The Sindh Assembly passed The Sind Teaching, Promotion and Use of Sindhi Language Bill, 1972 that created conflict and language violence in the regime of Prime Minister Zulfikar Ali Bhutto, he wrote his famous poem Urdu ka janaza hai zara dhoom say niklay (It is the funeral of Urdu, carry it out with fanfare). He also intended to translate the Bhagavad Gita into standard Urdu.

Mark Rosenzweig

Mark Richard Rosenzweig (12 September 1922 to 20 July 2009) was an American research psychologist whose research on neuroplasticity in animals indicated that the adult brain remains capable of anatomical remodelling and reorganisation based on life experiences, overturning the conventional wisdom that the brain reached full maturity in childhood.

Charlotte Wolff

Charlotte Wolff (30 September 1897 to 12 September 1986) was a German-British physician who worked as a psychotherapist and wrote on sexology and hand analysis. Her writings on lesbianism and bisexuality were influential early works in the field.

What is Metapsychology?

Introduction

Metapsychology (Greek: meta ‘beyond, transcending’, and ψυχολογία ‘psychology‘) is that aspect of any psychological theory which refers to the structure of the theory itself (hence the prefix “meta”) rather than to the entity it describes.

The psychology is about the psyche; the metapsychology is about the psychology. The term is used mostly in discourse about psychoanalysis, the psychology developed by Sigmund Freud, which was at its time regarded as a branch of science (with roots in the work of Freud’s scientific mentors and predecessors, especially Helmholtz, Brucke, Charcot, and Janet), or, more recently, as a hermeneutics of understanding (with roots in Freud’s literary sources, especially Sophocles and, to a lesser extent, Goethe and Shakespeare). Interest on the possible scientific status of psychoanalysis has been renewed in the emerging discipline of neuropsychoanalysis, whose major exemplar is Mark Solms. The hermeneutic vision of psychoanalysis is the focus of influential works by Donna Orange.

Freud and the als ob Problem

Psychoanalytic metapsychology is concerned with the fundamental structure and concepts of Freudian theory. Sigmund Freud first used the term on 13 February 1896 in a letter to Wilhelm Fliess, to refer to his addition of unconscious processes to the conscious ones of traditional psychology. On 10 March 1898, he wrote to Fiess: “It seems to me that (German: als ob) the theory of wish fulfilment has brought only the psychological solution and not the biological – or, rather, metapsychical – one. (I am going to ask you seriously, by the way, whether I may use the name metapsychology for my psychology that leads behind consciousness).”

Three years after completing his unpublished Project for a Scientific Psychology, Freud’s optimism had completely vanished. In a letter dated September 22 of that year he told Fliess: “I am not at all in disagreement with you, not at all inclined to leave psychology hanging in the air without an organic basis. But apart from this conviction, I do not know how to go on, neither theoretically nor therapeutically, and therefore must behave as if [als läge] only the psychological were under consideration. Why I cannot fit it together [the organic and the psychological] I have not even begun to fathom”. “When, in his ‘Autobiographical Study’ of 1925, Freud called his metapsychology a ‘speculative superstructure’…the elements of which could be abandoned or changed once proven inadequate, he was, in the terminology of Kant’s Critique of Judgement, proposing a psychology als ob or as if – a heuristic model of mental functioning that did not necessarily correspond with external reality.”

A salient example of Freud’s own metapsychology is his characterisation of psychoanalysis as a “simultaneously closed system, fundamentally unrelated and impervious to the external world and as an open system inherently connected and responsive to environmental influence.

In the 1910s, Freud wrote a series of twelve essays, to be collected as Preliminaries to a Metapsychology. Five of these were published independently under the titles: “Instincts and Their Vicissitudes,” “Repression,” “The Unconscious,” “A Metapsychological Supplement to the Theory of Dreams,” and “Mourning and Melancholia.” The remaining seven remained unpublished, an expression of Freud’s ambivalence about his own attempts to articulate the whole of his vision of psychoanalysis. In 1919 he wrote to Lou Andreas-Salome, “Where is my Metapsychology? In the first place it remains unwritten”. In 1920 he published Beyond the Pleasure Principle, a text with metaphysical ambitions.

Midcentury psychoanalyst David Rapaport defined the term thus: “Books on psychoanalysis usually deal with its clinical theory… there exists, however, a fragmentary—yet consistent—general theory of psychoanalysis, which comprises the premises of the special (clinical) theory, the concepts built on it, and the generalizations derived from it… named metapsychology.”

Freud’s Metapsychology

  • The topographical point of view: the psyche operates at different levels of consciousness – unconscious, preconscious, and conscious.
  • The dynamic point of view: the notion that there are psychological forces which may conflict with one another at work in the psyche.
  • The economic point of view: the psyche contains charges of energy which are transferred from one element of the psyche to another.
  • The structural point of view: the psyche consists of configurations of psychological processes which operate in different ways and reveal different rates of change – the ego, the id, and the superego.
  • The genetic point of view: the origins – or “genesis” – of psychological processes can be found in developmentally previous psychological processes.

Ego psychologist Heinz Hartmann also added ‘the adaptive” point of view’ to Freud’s metapsychology, although Lacan who interpreted metapsychology as the symbolic, the Real, and the imaginary, said “the dimension discovered by analysis is the opposite of anything which progresses through adaptation”

Criticism

Freud’s metapsychology has faced criticism, mainly from ego psychology. Object relations theorists such as Melanie Klein, shifted the focus away from intrapsychic conflicts and towards the dynamics of interpersonal relationships, leading to a unifocal theory of development that focused on the mother-child relationship. Most ego psychologists saw the structural point of view, Freud’s latest metapsychology, as the most important. Some proposed that only the structural point of view be kept in metapsychology, because the topographical point of view made an unnecessary distinction between the unconscious and the preconscious (Arlow & Brenner) and because the economic point of view was viewed as redundant (Gill).

What is Denial (Psychoanalysis)?

Introduction

Denial or abnegation (German: Verneinung) is a psychological defense mechanism postulated by psychoanalyst Sigmund Freud, in which a person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence.

The subject may use:

  • Simple denial: deny the reality of the unpleasant fact altogether.
  • Minimisation: admit the fact but deny its seriousness (a combination of denial and rationalisation).
  • Projection: admit both the fact and seriousness but deny responsibility by blaming somebody or something else.

Description

The theory of denial was first researched seriously by Anna Freud. She classified denial as a mechanism of the immature mind because it conflicts with the ability to learn from and cope with reality. Where denial occurs in mature minds, it is most often associated with death, dying and rape. More recent research has significantly expanded the scope and utility of the concept. Elisabeth Kübler-Ross used denial as the first of five stages in the psychology of a dying patient, and the idea has been extended to include the reactions of survivors to news of a death.

Many contemporary psychoanalysts treat denial as the first stage of a coping cycle. When an unwelcome change occurs, a trauma of some sort, the first impulse to disbelieve begins the process of coping. That denial, in a healthy mind, slowly rises to greater consciousness. Gradually becoming a subconscious pressure, just beneath the surface of overt awareness, the mechanism of coping then involves repression, while the person accumulates the emotional resources to fully face the trauma. Once faced, the person deals with the trauma in a stage alternately called acceptance or enlightenment, depending on the scope of the issue and the therapist’s school of thought. After this stage, once sufficiently dealt with, or dealt with for the time being, the trauma must sink away from total conscious awareness again. Left out of the conscious mind, the process of sublimation involves a balance of neither quite forgetting nor quite remembering. This allows the trauma to re-emerge in consciousness if it involves an ongoing process such as a protracted illness. Alternately, sublimation may begin the full resolution process, where the trauma finally sinks away into eventual forgetfulness. Occasionally this entire cycle has been referred to in modern parlance as denial, confusing the full cycle with only one stage of it. To further muddy discourse, the terms denial and cycle of denial sometimes get used to refer to an unhealthy, dysfunctional cycle of unresolved coping, particularly with regard to addiction and compulsion.

Unlike some other defence mechanisms postulated by psychoanalytic theory (for instance, repression), the general existence of denial is fairly easy to verify, even for non-specialists. However, denial is one of the most controversial defence mechanisms, since it can be easily used to create unfalsifiable theories: anything the subject says or does that appears to disprove the interpreter’s theory is explained, not as evidence that the interpreter’s theory is wrong, but as the subject’s being “in denial”. However, researchers note that in some cases of corroborated child sexual abuse, the victims sometimes make a series of partial confessions and recantations as they struggle with their own denial and the denial of abusers or family members. Use of denial theory in a legal setting, therefore, is carefully regulated and experts’ credentials verified. “Formulaic guilt” simply by “being a denier” has been castigated by English judges and academics. The main objection is that denial theory is founded on the premise that which the supposed denier is denying the truth. This usurps the judge (and jury) as triers of fact.

Denial is especially characteristic of mania, hypomania, and generally of people with bipolar affective disorder in the manic stage – in this state, one can deny, remarkably a long period of time, the fact that one has fatigue, hunger, negative emotions and problems in general, until one is physically exhausted.

Denial and Disavowal

Freud employs the term Verleugnung (usually translated either as “disavowal” or as “denial”) as distinct from Verneinung (usually translated as “denial” or as “abnegation”). In Verleugnung, the defence consists of denying something that affects the individual and is a way of affirming what he or she is apparently denying. For Freud, Verleugnung is related to psychoses, whereas Verdrängung is a neurotic defense mechanism. Freud broadened his clinical work on disavowal beyond the realm of psychosis. In “Fetishism” (1927), he reported a case of two young men each of whom denied the death of his father. Freud notes that neither of them developed a psychosis, even though “a piece of reality which was undoubtedly important has been disavowed [verleugnet], just as the unwelcome fact of women’s castration is disavowed in fetishists.”

Types

Denial of Fact

In this form of denial, someone avoids a fact by utilising deception. This lying can take the form of an outright falsehood (commission), leaving out certain details to tailor a story (omission), or by falsely agreeing to something (assent). Someone who is in denial of fact is typically using lies to avoid facts they think may be painful to themselves or others.

Denial of Responsibility

This form of denial involves avoiding personal responsibility by:

  • Blaming: a direct statement shifting culpability and may overlap with denial of fact
  • Minimising: an attempt to make the effects or results of an action appear to be less harmful than they may actually be
  • Justifying: when someone takes a choice and attempts to make that choice appear acceptable due to their perception of what is right in a situation
  • Regression: when someone acts in a way unbecoming of their age.

Someone using denial of responsibility is usually attempting to avoid potential harm or pain by shifting attention away from themselves.

Denial of Impact

Denial of impact involves a person’s avoiding thinking about or understanding the harms of their behaviour has caused to self or others, i.e. denial of consequences. Doing this enables that person to avoid feeling a sense of guilt and it can prevent him or her from developing remorse or empathy for others. Denial of impact reduces or eliminates a sense of pain or harm from poor decisions.

Denial of Awareness

This form of denial attempts to divert pain by claiming that the level of awareness was inhibited by some mitigating variable. This is most typically seen in addiction situations where drug or alcohol abuse is a factor, though it also occasionally manifests itself in relation to mental health issues or the pharmaceutical substances used to treat mental health issues. This form of denial may also overlap with denial of responsibility.

What is Evenly-Suspended Attention?

Introduction

Evenly-suspended attention is the kind of direction-less listening – removed from both theoretical presuppositions and therapeutic goals – recommended by Sigmund Freud for use in psychoanalysis.

Outline

By attaching no preconceived importance to any particular part of the analyst’s discourse, and allowing their unconscious complete freedom to act, the analysand’s can best profit from the counterpart rule of free association on the part of the analysand.

Such “hovering” attention (as Freud put it in 1909 in the case of Little Hans) was a technical development on his part from the more aggressive listening and interpretation of the 1890s, as his shift from hypnosis to psychoanalysis took gradual shape.

Later Developments

Since Theodor Reik and his 1948 study Listening with the Third Ear, more analytic emphasis has been placed on the dialectic between evenly suspended attention, and the analyst’s cognitive working-over of what they hear. The part played by countertransference and by the analyst’s role responsiveness has also been highlighted.

What is Abstinence (Psychoanalysis)?

Introduction

Abstinence or the rule of abstinence is the principle of analytic reticence and/or frustration within a clinical situation.

It is a central feature of psychoanalytic theory – relating especially to the handling of the transference in analysis.

As Sigmund Freud wrote in 1914:

The cure must be carried through in abstinence. I mean by that not physical self-denial alone, nor the denial of every desire….But I want to state the principle that one must permit neediness and yearning to remain as forces favoring work and change.

Later Formulations

The validity of the abstinence principle has been rediscovered and re-affirmed in a variety of subsequent analytic traditions.

Jacques LacanRe-formulated the principle via the concept of ‘analytic bridge’ – the analyst necessarily playing the part of the unresponding dummy to bring the patient’s unconscious motivations out into the open.
Eric BerneSaw analytic frustration as a means of avoiding playing a part in the patient’s life script.
R.D. LaingIn the context of the false self saw analytic abstinence operating in opposition to false self collusion: “It is in terms of basic frustration of the self’s search for a collusive complement for false identity that Freud’s dictum that analysis should be conducted under conditions of maximal frustration takes on its most cogent meaning”.
D.W. WinnicottIn the context of his notion of ‘holding’ the patient emphasised that understanding through verbal interpretation gave a deeper sense of holding than the physical act, use of which by the therapist could blur the symbolic nature of the analytic space.

Debates

The rule of abstinence has come under increasing challenge by Interpersonal and Intersubjective psychoanalysis, concerned about the inflexibility of the rule, and the way its relentless application may provoke unnecessary hostility, even an iatrogenic transference neurosis.

Defenders of the rule, against the practice of the warm supportive analyst, argue against the easy seductiveness of being overly ‘helpful’ in a self-defeating way already sketched out by Freud himself. The concept of optimal responsiveness – balancing frustration and gratification from moment to moment – offers some mediation in the dispute.

What is Acting In?

Introduction

“Acting in” is a psychological term which has been given various meanings over the years, but which is most generally used in opposition to acting out to cover conflicts which are brought to life inside therapy, as opposed to outside.

One commentator, noting the variety of usages, points out that it is often “unclear whether ‘in’ refers to the internalisation into the personality, to the growth in insight, or to the acting within the session”.

Patients

With respect to patients, the term ‘acting in’ has been used to refer to the process of a client/patient bringing an issue from outside the therapy into the analytic situation, and acting upon it there.

The therapist is advised to respond to the issue immediately to prevent further and more disruptive acting in.

Hanna Segal distinguished positive acting in from destructive acting in – both being aimed however at affecting the analyst’s state of mind, whether to communicate or to confuse.

Posture

The term was used in 1957 by Meyer A. Zeligs to refer specifically to the postures taken by analysts in a psychoanalytic session.

Therapists

Psychoanalysis also describes as ‘acting in’ the process whereby the analyst brings his or her personal countertransference into the analytic situation – as opposed to the converse, the acting out of the patient’s transference.

The result is generally agreed to produce a chaotic analytic situation which hampers therapeutic progress.

The term was used rather differently however by Carl Whitaker in the 60’s, so as to refer to the technique whereby therapists increase their involvement in a session in such a way as to ramp up the patient’s anxiety for therapeutic ends.

What is Scotomisation?

Introduction

Scotomisation is a psychological term for the mental blocking of unwanted perceptions, analogous to the visual blindness of an actual scotoma.

Controversies

Reviving in the 1920s a term initially used by Charcot in connection with hysteria, the French analysts Rene Laforgue and Edouard Pinchon introduced the idea of scotomisation into psychoanalysis – a move initially welcomed by Freud in 1926 as a useful description of the hysterical avoidance of distressing perceptions. The following year, however, he attacked the term for suggesting that the perception was wholly blotted out (as with a retina’s blind spot), whereas his clinical experience showed that on the contrary intense psychic measures had to be taken to keep the unwanted perception out of consciousness. A debate followed between Freud and Laforgue, further illuminated by Pinchon’s 1928 article on ‘The Psychological Significance of Negation in French’, where he argued that “The French language expresses the desire for scotomisation through the forclusif.”

Decades later in the 1950s, the question of scotomisation re-emerged in a phenological context under the influence of Jacques Lacan. Lacan used scotomisation to represent the ego’s relationship to the unconscious – speaking of “everything that the ego, neglects, scotomizes, misconstrues in…reality” – as well as to challenge Sartre’s concept of the gaze. Most significantly of all, however, he developed it into his influential update of Pinchon’s concept of foreclosure, thus endowing that idea with a conflation of visual and verbal elements.

What is Ego Psychology?

Introduction

Ego psychology is a school of psychoanalysis rooted in Sigmund Freud’s structural id-ego-superego model of the mind.

An individual interacts with the external world as well as responds to internal forces. Many psychoanalysts use a theoretical construct called the ego to explain how that is done through various ego functions. Adherents of ego psychology focus on the ego’s normal and pathological development, its management of libidinal and aggressive impulses, and its adaptation to reality.

Brief History

Early Conceptions of the Ego

Sigmund Freud initially considered the ego to be a sense organ for perception of both external and internal stimuli. He thought of the ego as synonymous with consciousness and contrasted it with the repressed unconscious. In 1910, Freud emphasized the attention to detail when referencing psychoanalytical matters, while predicting his theory to become essential in regards to everyday tasks with the Swiss psychoanalyst, Oscar Pfister. By 1911, he referenced ego instincts for the first time in Formulations on the Two Principles of Mental Functioning and contrasted them with sexual instincts: ego instincts responded to the reality principle while sexual instincts obeyed the pleasure principle. He also introduced attention and memory as ego functions.

Freud’s Ego Psychology

Freud later argued that not all unconscious phenomena can be attributed to the id, and that the ego has unconscious aspects as well. This posed a significant problem for his topographic theory, which he resolved in The Ego and the Id (1923).

In what came to be called the structural theory, the ego was now a formal component of a three-way system that also included the id and superego. The ego was still organised around conscious perceptual capacities, yet it now had unconscious features responsible for repression and other defensive operations. Freud’s ego at this stage was relatively passive and weak; he described it as the helpless rider on the id’s horse, more or less obliged to go where the id wished to go.

In Inhibitions, Symptoms, and Anxiety (1926), Freud revised his theory of anxiety as well as delineated a more robust ego. Freud argued that instinctual drives (id), moral and value judgments (superego), and requirements of external reality all make demands upon an individual. The ego mediates among conflicting pressures and creates the best compromise. Instead of being passive and reactive to the id, the ego was now a formidable counterweight to it, responsible for regulating id impulses, as well as integrating an individual’s functioning into a coherent whole. The modifications made by Freud in Inhibitions, Symptoms, and Anxiety formed the basis of a psychoanalytic psychology interested in the nature and functions of the ego. This marked the transition of psychoanalysis from being primarily an id psychology, focused on the vicissitudes of the libidinal and aggressive drives as the determinants of both normal and psychopathological functioning, to a period in which the ego was accorded equal importance and was regarded as the prime shaper and modulator of behaviour.

Systematisation

Following Sigmund Freud, the psychoanalysts most responsible for the development of ego psychology, and its systematization as a formal school of psychoanalytic thought, were Anna Freud, Heinz Hartmann, and David Rapaport. Other important contributors included Ernst Kris, Rudolph Loewenstein, René Spitz, Margaret Mahler, Edith Jacobson, Paul Federn, and Erik Erikson.

Anna Freud

Anna Freud focused her attention on the ego’s unconscious, defensive operations and introduced many important theoretical and clinical considerations. In The Ego and the Mechanisms of Defense (1936), Anna Freud argued the ego was predisposed to supervise, regulate, and oppose the id through a variety of defences. She described the defences available to the ego, linked them to the stages of psychosexual development during which they originated, and identified various psychopathological compromise formations in which they were prominent. Clinically, Anna Freud emphasized that the psychoanalyst’s attention should always be on the defensive functions of the ego, which could be observed in the manifest presentation of the patient’s associations. The analyst needed to be attuned to the moment-by-moment process of what the patient talked about in order to identify, label, and explore defences as they appeared. For Anna Freud, direct interpretation of repressed content was less important than understanding the ego’s methods by which it kept things out of consciousness. Her work provided a bridge between Freud’s structural theory and ego psychology.

Heinz Hartmann

Heinz Hartmann (1939/1958) believed the ego included innate capacities that facilitated an individual’s ability to adapt to his or her environment. These included perception, attention, memory, concentration, motor coordination, and language. Under normal conditions, which Hartmann called “an average expectable environment,” these capacities developed into ego functions with autonomy from the libidinal and aggressive drives; that is, they were not products of frustration and conflict as Freud (1911) believed. Hartmann recognised, however, that conflicts were part of the human condition and that certain ego functions may become conflicted by aggressive and libidinal impulses, as witnessed by conversion disorders (e.g., glove paralysis), speech impediments, eating disorders, and attention-deficit disorder.

A focus on ego functions and how an individual adapts to his or her environment led Hartmann to create both a general psychology and a clinical instrument with which an analyst could evaluate an individual’s functioning and formulate appropriate therapeutic interventions. Hartmann’s propositions imply that the task of the ego psychologist was to neutralize conflicted impulses and expand the conflict-free spheres of ego functions. Through such effects, Hartmann believed, psychoanalysis facilitated an individual’s adaptation to his or her environment. He claimed, however, that his aim was to understand the mutual regulation of the ego and environment rather than to promote adjustment of the ego to the environment; additionally, he proposed that diminishing conflict in an individual’s ego would help him or her to respond actively to, and shape rather than passively react to, the environment. Mitchell and Black (p.35) stated:

“Hartmann powerfully affected the course of psychoanalysis, opening up a crucial investigation of the key processes and vicissitudes of normal development. Hartmann’s contributions broadened the scope of psychoanalytic concerns, from psychopathology to general human development, and from an isolated, self-contained treatment method to a sweeping intellectual discipline among other disciplines”

David Rapaport

David Rapaport played a prominent role in the development of ego psychology, and his work likely represented its apex. In the influential monograph The Structure of Psychoanalytic Theory (1960), Rappaport organized ego psychology into an integrated, systematic, and hierarchical theory capable of generating empirically testable hypotheses. He proposed that psychoanalytic theory – as expressed through the principles of ego psychology – was a biologically based general psychology that could explain the entire range of human behaviour. For Rapaport, this endeavour was fully consistent with Freud’s attempts to do the same (e.g. Freud’s studies of dreams, jokes, and the “psychopathology of everyday life”).

Other Contributors

While Hartmann was the principal architect of ego psychology, he collaborated closely with Ernst Kris and Rudolph Loewenstein.

Subsequent psychoanalysts interested in ego psychology emphasized the importance of early-childhood experiences and socio-cultural influences on ego development. René Spitz (1965), Margaret Mahler (1968), Edith Jacobson (1964), and Erik Erikson studied infant and child behaviour, and their observations were integrated into ego psychology. Their observational and empirical research described and explained early attachment issues, successful and faulty ego development, and psychological development through interpersonal interactions.

Spitz identified the importance of mother-infant nonverbal emotional reciprocity; Mahler refined the traditional psychosexual developmental phases by adding the separation-individuation process; and Jacobson emphasized how libidinal and aggressive impulses unfolded within the context of early relationships and environmental factors. Finally, Erik Erikson provided a bold reformulation of Freud’s biologic, epigenetic psychosexual theory through his explorations of socio-cultural influences on ego development. For Erikson, an individual was pushed by his or her own biological urges and pulled by socio-cultural forces.

Decline

In the United States, ego psychology was the predominant psychoanalytic approach from the 1940s through the 1960s. Initially, this was due to the influx of European psychoanalysts, including prominent ego psychologists like Hartmann, Kris, and Loewenstein, during and after World War II. These European analysts settled throughout the United States and trained the next generation of American psychoanalysts.

By the 1970s, several challenges to the philosophical, theoretical, and clinical tenets of ego psychology emerged. The most prominent of which were: a “rebellion” led by Rapaport’s protégés (George Klein, Robert Holt, Roy Schafer, and Merton Gill); object relations theory; and self psychology.

Contemporary

Modern Conflict Theory

Charles Brenner (1982) attempted to revive ego psychology with a concise and incisive articulation of the fundamental focus of psychoanalysis: intrapsychic conflict and the resulting compromise formations. Over time, Brenner (2002) tried to develop a more clinically based theory, what came to be called “modern conflict theory.” He distanced himself from the formal components of the structural theory and its metapsychological assumptions, and focused entirely on compromise formations.

Heinz Kohut developed self psychology, a theoretical and therapeutic model related to ego psychology, in the late 1960s. Self psychology focuses on the mental model of the self as important in pathologies.

Ego Functions

FunctionDescription
Reality Testing1. The ego’s capacity to distinguish what is occurring in one’s own mind from what is occurring in the external world.
2. It is perhaps the single most important ego function because negotiating with the outside world requires accurately perceiving and understanding stimuli.
3. Reality testing is often subject to temporary, mild distortion or deterioration under stressful conditions.
4. Such impairment can result in temporary delusions and hallucination and is generally selective, clustering along specific, psychodynamic lines.
5. Chronic deficiencies suggest either psychotic or organic interference.
Impulse Control1. The ability to manage aggressive and/or libidinal wishes without immediate discharge through behaviour or symptoms.
2. Problems with impulse control are common; for example: road rage; sexual promiscuity; excessive drug and alcohol use; and binge eating.
Affect Regulation1. The ability to modulate feelings without being overwhelmed.
Judgement1. The capacity to act responsibly.
2. This process includes identifying possible courses of action, anticipating and evaluating likely consequences, and making decisions as to what is appropriate in certain circumstances.
Object Relations1. The capacity for mutually satisfying relationship.
2. The individual can perceive himself and others as whole objects with three dimensional qualities.
Thought Processes1. The ability to have logical, coherent, and abstract thoughts.
2. In stressful situations, thought processes can become disorganised.
3. The presence of chronic or severe problems in conceptual thinking is frequently associated with schizophrenia and manic episodes.
Defensive Functioning1. A defence is an unconscious attempt to protect the individual from some powerful, identity-threatening feeling.
2. Initial defences develop in infancy and involve the boundary between the self and the outer world; they are considered primitive defences and include projection, denial, and splitting.
3. As the child grows up, more sophisticated defences that deal with internal boundaries such as those between ego and super ego or the id develop; these defences include repression, regression, displacement, and reaction formation.
4. All adults have, and use, primitive defences, but most people also have more mature ways of coping with reality and anxiety.
Synthesis1. The synthetic function is the ego’s capacity to organize and unify other functions within the personality.
2. It enables the individual to think, feel, and act in a coherent manner.
3. It includes the capacity to integrate potentially contradictory experiences, ideas, and feelings; for example, a child loves his or her mother yet also has angry feelings toward her at times.
4. The ability to synthesize these feelings is a pivotal developmental achievement.

Reality testing involves the individual’s capacity to understand and accept both physical and social reality as it is consensually defined within a given culture or cultural subgroup. In large measure, the function hinges on the individual’s capacity to distinguish between her own wishes or fears (internal reality) and events that occur in the real world (external reality). The ability to make distinctions that are consensually validated determines the ego’s capacity to distinguish and mediate between personal expectations, on the one hand, and social expectations or laws of nature on the other. Individuals vary considerably in how they manage this function. When the function is seriously compromised, individuals may withdraw from contact with reality for extended periods of time. This degree of withdrawal is most frequently seen in psychotic conditions. Most times, however, the function is mildly or moderately compromised for a limited period of time, with far less drastic consequences’ (Berzoff, 2011).

Judgment involves the capacity to reach “reasonable” conclusions about what is and what is not “appropriate” behaviour. Typically, arriving at a “reasonable” conclusion involves the following steps: (1) correlating wishes, feeling states, and memories about prior life experiences with current circumstances; (2) evaluating current circumstances in the context of social expectations and laws of nature (e.g. it is not possible to transport oneself instantly out of an embarrassing situation, no matter how much one wishes to do so); and (3) drawing realistic conclusions about the likely consequences of different possible courses of action. As the definition suggests, judgment is closely related to reality testing, and the two functions are usually evaluated in tandem (Berzoff, 2011).

Modulating and controlling impulses is based on the capacity to hold sexual and aggressive feelings in check with out acting on them until the ego has evaluated whether they meet the individual’s own moral standards and are acceptable in terms of social norms. Adequate functioning in this area depends on the individual’s capacity to tolerate frustration, to delay gratification, and to tolerate anxiety without immediately acting to ameliorate it. Impulse control also depends on the ability to exercise appropriate judgment in situations where the individual is strongly motivated to seek relief from psychological tension and/or to pursue some pleasurable activity (sex, power, fame, money, etc.). Problems in modulation may involve either too little or too much control over impulses (Berzoff, 2011).

Modulation of affect The ego performs this function by preventing painful or unacceptable emotional reactions from entering conscious awareness, or by managing the expression of such feelings in ways that do not disrupt either emotional equilibrium or social relationships. To adequately perform this function, the ego constantly monitors the source, intensity, and direction of feeling states, as well as the people toward whom feelings will be directed. Monitoring determines whether such states will be acknowledged or expressed and, if so, in what form. The basic principle to remember in evaluating how well the ego manages this function is that affect modulation may be problematic because of too much or too little expression. As an integral part of the monitoring process, the ego evaluates the type of expression that is most congruent with established social norms. For example, in white American culture it is assumed that individuals will contain themselves and maintain a high level of personal/vocational functioning except in extremely traumatic situations such as death of a family member, very serious illness or terrible accident. This standard is not necessarily the norm in other cultures (Berzhoff, Flanagan, & Hertz, 2011).

Object relations involves the ability to form and maintain coherent representations of others and of the self. The concept refers not only to the people one interacts with in the external world but also to significant others who are remembered and represented within the mind. Adequate functioning implies the ability to maintain a basically positive view of the other, even when one feels disappointed, frustrated, or angered by the other’s behaviour. Disturbances in object relations may manifest themselves through an inability to fall in love, emotional coldness, lack of interest in or withdrawal from interactions with others, intense dependency, and/or an excessive need to control relationships (Berzhoff, Flanagan, & Hertz, 2011).

Self-esteem regulation involves the capacity to maintain a steady and reasonable level of positive self-regard in the face of distressing or frustrating external events. Painful affective states, including anxiety, depression, shame, and guilt, as well as exhilarating emotions such as triumph, glee, and ecstasy may also undermine self-esteem. Generally speaking, in dominant American culture a measured expression of both pain and pleasure is expressed; excess in either direction is a cause for concern. White Western culture tends to assume that individuals will maintain a consistent and steadily level of self-esteem, regardless of external events or internally generated feeling states (Berzhoff, Flanagan, & Hertz, 2011).

Mastery when conceptualized as an ego function, mastery reflects the epigenetic view that individuals achieve more advanced levels of ego organization by mastering successive developmental challenges. Each stage of psychosexual development (oral, anal, phallic, genital) presents a particular challenge that must be adequately addressed before the individual can move on to the next higher stage. By mastering stage-specific challenges, the ego gains strength in relations to the other structures of the mind and thereby becomes more effective in organizing and synthesizing mental processes. Freud expressed this principle in his statement, “Where id was, shall ego be.” An undeveloped capacity for mastery can be seen, for example, in infants who have not been adequately nourished, stimulated, and protected during the first year of life, in the oral stage of development. When they enter the anal stage, such infants are not well prepared to learn socially acceptable behaviour or to control the pleasure they derive from defecating at will. As a result, some of them will experience delays in achieving bowel control and will have difficulty in controlling temper tantrums, while others will sink into a passive, joyless compliance with parental demands that compromises their ability to explore, learn, and become physically competent. Conversely, infants who have been well gratified and adequately stimulated during the oral stage enter the anal stage feeling relatively secure and confident. For the most part, they cooperate in curbing their anal desires, and are eager to win parental approval for doing so. In addition, they are physically active, free to learn and eager to explore. As they gain confidence in their increasingly autonomous physical and mental abilities, they also learn to follow the rules their parents establish and, in doing so, with parental approval. As they master the specific tasks related to the anal stage, they are well prepared to move on to the next stage of development and the next set of challenges. When adults have problems with mastery, they usually enact them in derivative or symbolic ways (Berzhoff, Flanagan, & Hertz, 2011).

Conflict, Defence and Resistance Analysis

According to Freud’s structural theory, an individual’s libidinal and aggressive impulses are continuously in conflict with his or her own conscience as well as with the limits imposed by reality. In certain circumstances, these conflicts may lead to neurotic symptoms. Thus, the goal of psychoanalytic treatment is to establish a balance between bodily needs, psychological wants, one’s own conscience, and social constraints. Ego psychologists argue that the conflict is best addressed by the psychological agency that has the closest relationship to consciousness, unconsciousness, and reality: the ego.

The clinical technique most commonly associated with ego psychology is defence analysis. Through clarifying, confronting, and interpreting the typical defence mechanisms a patient uses, ego psychologists hope to help the patient gain control over these mechanisms.

Cultural Influences

  • The classical scholar E. R. Dodds used ego psychology as the framework for his influential study The Greeks and the Irrational (1951).
  • The Sterbas relied on Hartmann’s conflict-free sphere to help explain the contradictions they found in Beethoven’s character in Beethoven and His Nephew (1954).

Criticisms

A number of authors have criticised Hartmann’s conception of a conflict-free sphere of ego functioning as both incoherent and inconsistent with Freud’s vision of psychoanalysis as a science of mental conflict. Freud believed that the ego itself takes shape as a result of the conflict between the id and the external world. The ego, therefore, is inherently a conflicting formation in the mind. To state, as Hartmann did, that the ego contains a conflict-free sphere may not be consistent with key propositions of Freud’s structural theory.

Ego psychology, and ‘Anna-Freudianism’, were together seen by Kleinians as maintaining a conformist, adaptative version of psychoanalysis inconsistent with Freud’s own views. Hartmann claimed, however, that his aim was to understand the mutual regulation of the ego and environment rather than to promote adjustment of the ego to the environment. Furthermore, an individual with a less-conflicted ego would be better able to actively respond and shape, rather than passively react to, his or her environment.

Jacques Lacan was if anything still more opposed to ego psychology, using his concept of the Imaginary to stress the role of identifications in building up the ego in the first place. Lacan saw in the “non-conflictual sphere…a down-at-heel mirage that had already been rejected as untenable by the most academic psychology of introspection’.

References

Berzoff, J., Flanagan, L.M. & Hertz, P (2011). Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts. (3rd ed. Lanham, MD: Rowman & Littlefield Publishers.

Mitchell, S.A. & Black, M.J. (1995). Freud and beyond: A history of modern psychoanalytic thought. New York: Basic Books.

What is Logotherapy?

Introduction

Logotherapy was developed by neurologist and psychiatrist Viktor Frankl, on a concept based on the premise that the primary motivational force of an individual is to find a meaning in life.

Frankl describes it as “the Third Viennese School of Psychotherapy” along with Freud’s psychoanalysis and Adler’s individual psychology. Logotherapy is based on an existential analysis focusing on Kierkegaard’s will to meaning as opposed to Alfred Adler’s Nietzschean doctrine of will to power or Freud’s will to pleasure. Rather than power or pleasure, logotherapy is founded upon the belief that striving to find meaning in life is the primary, most powerful motivating and driving force in humans.

A short introduction to this system is given in Frankl’s most famous book, Man’s Search for Meaning, in which he outlines how his theories helped him to survive his Holocaust experience and how that experience further developed and reinforced his theories. Presently, there are a number of logotherapy institutes around the world.

Basic Principles

The notion of Logotherapy was created with the Greek word logos (“reason”). Frankl’s concept is based on the premise that the primary motivational force of an individual is to find a meaning in life. The following list of tenets represents basic principles of logotherapy:

  • Life has meaning under all circumstances, even the most miserable ones.
  • Our main motivation for living is our will to find meaning in life.
  • We have freedom to find meaning in what we do, and what we experience, or at least in the stance we take when faced with a situation of unchangeable suffering.

The human spirit is referred to in several of the assumptions of logotherapy, but the use of the term spirit is not “spiritual” or “religious”. In Frankl’s view, the spirit is the will of the human being. The emphasis, therefore, is on the search for meaning, which is not necessarily the search for God or any other supernatural being. Frankl also noted the barriers to humanity’s quest for meaning in life. He warns against “…affluence, hedonism, [and] materialism…” in the search for meaning.

Purpose in life and meaning in life constructs appeared in Frankl’s logotherapy writings with relation to existential vacuum and will to meaning, as well as others who have theorised about and defined positive psychological functioning. Frankl observed that it may be psychologically damaging when a person’s search for meaning is blocked. Positive life purpose and meaning was associated with strong religious beliefs, membership in groups, dedication to a cause, life values, and clear goals. Adult development and maturity theories include the purpose in life concept. Maturity emphasizes a clear comprehension of life’s purpose, directedness, and intentionality which contributes to the feeling that life is meaningful.

Frankl’s ideas were operationalized by Crumbaugh and Maholick’s Purpose in Life (PIL) test, which measures an individual’s meaning and purpose in life. With the test, investigators found that meaning in life mediated the relationships between religiosity and well-being; uncontrollable stress and substance use; depression and self-derogation. Crumbaugh found that the Seeking of Noetic Goals Test (SONG) is a complementary measure of the PIL. While the PIL measures the presence of meaning, the SONG measures orientation towards meaning. A low score in the PIL but a high score in the SONG, would predict a better outcome in the application of Logotherapy.

Discovering Meaning

According to Frankl, “We can discover this meaning in life in three different ways: (1) by creating a work or doing a deed; (2) by experiencing something or encountering someone; and (3) by the attitude we take toward unavoidable suffering” and that “everything can be taken from a man but one thing: the last of the human freedoms – to choose one’s attitude in any given set of circumstances”. On the meaning of suffering, Frankl gives the following example:

“Once, an elderly general practitioner consulted me because of his severe depression. He could not overcome the loss of his wife who had died two years before and whom he had loved above all else. Now how could I help him? What should I tell him? I refrained from telling him anything, but instead confronted him with a question, “What would have happened, Doctor, if you had died first, and your wife would have had to survive without you?:” “Oh,” he said, “for her this would have been terrible; how she would have suffered!” Whereupon I replied, “You see, Doctor, such a suffering has been spared her, and it is you who have spared her this suffering; but now, you have to pay for it by surviving and mourning her.” He said no word but shook my hand and calmly left the office.

Frankl emphasized that realising the value of suffering is meaningful only when the first two creative possibilities are not available (for example, in a concentration camp) and only when such suffering is inevitable – he was not proposing that people suffer unnecessarily.

Philosophical Basis of Logotherapy

Frankl described the meta-clinical implications of logotherapy in his book The Will to Meaning: Foundations and Applications of Logotherapy. He believed that there is no psychotherapy apart from the theory of the individual. As an existential psychologist, he inherently disagreed with the “machine model” or “rat model”, as it undermines the human quality of humans. As a neurologist and psychiatrist, Frankl developed a unique view of determinism to coexist with the three basic pillars of logotherapy (the freedom of will). Though Frankl admitted that a person can never be free from every condition, such as, biological, sociological, or psychological determinants; based on his experience during his life in the Nazi concentration camps, he believed that a person is “capable of resisting and braving even the worst conditions”. In doing such, a person can detach from situations and themselves, choose an attitude about themselves, and determine their own determinants, thus shaping their own character and becoming responsible for themselves.

Logotherapeutic Views and Treatment

Overcoming Anxiety

By recognising the purpose of our circumstances, one can master anxiety. Anecdotes about this use of logotherapy are given by New York Times writer Tim Sanders, who explained how he uses its concept to relieve the stress of fellow airline travellers by asking them the purpose of their journey. When he does this, no matter how miserable they are, their whole demeanour changes, and they remain happy throughout the flight. Overall, Frankl believed that the anxious individual does not understand that their anxiety is the result of dealing with a sense of “unfulfilled responsibility” and ultimately a lack of meaning.

Treatment of Neurosis

Frankl cites two neurotic pathogens: hyper-intention, a forced intention toward some end which makes that end unattainable; and hyper-reflection, an excessive attention to oneself which stifles attempts to avoid the neurosis to which one thinks oneself predisposed. Frankl identified anticipatory anxiety, a fear of a given outcome which makes that outcome more likely. To relieve the anticipatory anxiety and treat the resulting neuroses, logotherapy offers paradoxical intention, wherein the patient intends to do the opposite of their hyper-intended goal.

A person, then, who fears (i.e. experiences anticipatory anxiety over) not getting a good night’s sleep may try too hard (that is, hyper-intend) to fall asleep, and this would hinder their ability to do so. A logotherapist would recommend, then, that the person go to bed and intentionally try not to fall asleep. This would relieve the anticipatory anxiety which kept the person awake in the first place, thus allowing them to fall asleep in an acceptable amount of time.

Depression

Viktor Frankl believed depression occurred at the psychological, physiological, and spiritual levels. At the psychological level, he believed that feelings of inadequacy stem from undertaking tasks beyond our abilities. At the physiological level, he recognised a “vital low”, which he defined as a “diminishment of physical energy”. Finally, Frankl believed that at the spiritual level, the depressed individual faces tension between who they actually are in relation to what they should be. Frankl refers to this as the gaping abyss. Finally Frankl suggests that if goals seem unreachable, an individual loses a sense of future and thus meaning resulting in depression. Thus logotherapy aims “to change the patient’s attitude toward their disease as well as toward their life as a task”.

Obsessive-Compulsive Disorder

Frankl believed that those suffering from obsessive-compulsive disorder lack the sense of completion that most other individuals possess. Instead of fighting the tendencies to repeat thoughts or actions, or focusing on changing the individual symptoms of the disease, the therapist should focus on “transform[ing] the neurotic’s attitude toward their neurosis”. Therefore, it is important to recognise that the patient is “not responsible for his obsessional ideas”, but that “he is certainly responsible for his attitude toward these ideas”. Frankl suggested that it is important for the patient to recognise their inclinations toward perfection as fate, and therefore, must learn to accept some degrees of uncertainty. Ultimately, following the premise of logotherapy, the patient must eventually ignore their obsessional thoughts and find meaning in their life despite such thoughts.

Schizophrenia

Though logotherapy was not intended to deal with severe disorders, Frankl believed that logotherapy could benefit even those suffering from schizophrenia. He recognised the roots of schizophrenia in physiological dysfunction. In this dysfunction, the person with schizophrenia “experiences himself as an object” rather than as a subject. Frankl suggested that a person with schizophrenia could be helped by logotherapy by first being taught to ignore voices and to end persistent self-observation. Then, during this same period, the person with schizophrenia must be led toward meaningful activity, as “even for the schizophrenic there remains that residue of freedom toward fate and toward the disease which man always possesses, no matter how ill he may be, in all situations and at every moment of life, to the very last”.

Terminally Ill Patients

In 1977, Terry Zuehlke and John Watkins conducted a study analysing the effectiveness of logotherapy in treating terminally ill patients. The study’s design used 20 male Veterans Administration volunteers who were randomly assigned to one of two possible treatments – (1) group that received 8 45-minute sessions over a 2-week period and (2) group used as control that received delayed treatment. Each group was tested on 5 scales – the MMPI K Scale, MMPI L Scale, Death Anxiety Scale, Brief Psychiatric Rating Scale, and the Purpose of Life Test. The results showed an overall significant difference between the control and treatment groups. While the univariate analyses showed that there were significant group differences in 3/5 of the dependent measures. These results confirm the idea that terminally ill patients can benefit from logotherapy in coping with death.

Forms of Treatment

Ecce Homo is a method used in logotherapy. It requires of the therapist to note the innate strengths that people have and how they have dealt with adversity and suffering in life. Despite everything a person may have gone through, they made the best of their suffering! Hence, Ecce Homo – Behold the Man!

Controversy

Authoritarianism

In 1969 Rollo May argued that logotherapy is, in essence, authoritarian. He suggested that Frankl’s therapy presents a plain solution to all of life’s problems, an assertion that would seem to undermine the complexity of human life itself. May contended that if a patient could not find their own meaning, Frankl would provide a goal for his patient. In effect, this would negate the patient’s personal responsibility, thus “diminish[ing] the patient as a person”. Frankl explicitly replied to May’s arguments through a written dialogue, sparked by Rabbi Reuven Bulka’s article “Is Logotherapy Authoritarian?”. Frankl responded that he combined the prescription of medication, if necessary, with logotherapy, to deal with the person’s psychological and emotional reaction to the illness, and highlighted areas of freedom and responsibility, where the person is free to search and to find meaning.

Religiousness

Critical views of the life of logotherapy’s founder and his work assume that Frankl’s religious background and experience of suffering guided his conception of meaning within the boundaries of the person and therefore that logotherapy is founded on Viktor Frankl’s worldview. Many researchers argue that logotherapy is not a “scientific” psychotherapeutic school in the traditional sense but a philosophy of life, a system of values, a secular religion which is not fully coherent and is based on questionable metaphysical premises.

Frankl openly spoke and wrote on religion and psychiatry, throughout his life, and specifically in his last book, Man’s Search for Ultimate Meaning (1997). He asserted that every person has a spiritual unconscious, independently of religious views or beliefs, yet Frankl’s conception of the spiritual unconscious does not necessarily entail religiosity. In Frankl’s words: “It is true, Logotherapy, deals with the Logos; it deals with Meaning. Specifically, I see Logotherapy in helping others to see meaning in life. But we cannot “give” meaning to the life of others. And if this is true of meaning per se, how much does it hold for Ultimate Meaning?” The American Psychiatric Association awarded Viktor Frankl the 1985 Oskar Pfister Award (for important contributions to religion and psychiatry).

Recent Developments

Since the 1990s, the number of institutes providing education and training in logotherapy continues to increase worldwide. Numerous logotherapeutic concepts have been integrated and applied in different fields, such as cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), and burnout prevention. The logotherapeutic concepts of noogenic neurosis and existential crisis were added to the ICD 11 under the name demoralisation crisis, i.e. a construct that features hopelessness, meaninglessness, and existential distress as first described by Frankl in the 1950s. Logotherapy has also been associated with psychosomatic and physiological health benefits. Besides Logotherapy, other meaning-centred psychotherapeutic approaches such as positive psychology and meaning therapy have emerged. Paul Wong’s meaning therapy attempts to translate logotherapy into psychological mechanisms, integrating CBT, positive psychotherapy and the positive psychology research on meaning. Logotherapy is also being applied in the field of oncology and palliative care (William Breitbart). These recent developments introduce Viktor Frankl’s logotherapy to a new generation and extend its impact to new areas of research.