On This Day … 21 February

People (Births)

  • 1892 – Harry Stack Sullivan, American psychiatrist and psychoanalyst (d. 1949).
  • 1914 – Jean Tatlock, American psychiatrist and physician (d. 1944).
  • 1961 – Elliot Hirshman, American psychologist and academic.

Harry Stack Sullivan

Herbert “Harry” Stack Sullivan (21 February 1892 to 14 January 1949) was an American Neo-Freudian psychiatrist and psychoanalyst who held that “personality can never be isolated from the complex interpersonal relationships in which [a] person lives” and that “[t]he field of psychiatry is the field of interpersonal relations under any and all circumstances in which [such] relations exist”. Having studied therapists Sigmund Freud, Adolf Meyer, and William Alanson White, he devoted years of clinical and research work to helping people with psychotic illness.

Jean Tatlock

Jean Frances Tatlock (21 February 1914 to 04 January 1944) was an American psychiatrist and physician. She was a member of the Communist Party of the United States of America and was a reporter and writer for the party’s publication Western Worker. She is most widely known for her romantic relationship with Robert Oppenheimer, the director of the Manhattan Project’s Los Alamos Laboratory during World War II.

The daughter of John Strong Perry Tatlock, a prominent Old English philologist and an expert on Geoffrey Chaucer, Tatlock was a graduate of Vassar College and the Stanford Medical School, where she studied to become a psychiatrist. Tatlock began seeing Oppenheimer in 1936, when she was a graduate student at Stanford and Oppenheimer was a professor of physics at the University of California, Berkeley. As a result of their relationship and her membership of the Communist Party, she was placed under surveillance by the FBI and her phone was tapped.

She suffered from clinical depression and committed suicide on 04 January 1944.

Elliot Hirshman

Elliot Lee Hirshman (21 February 1961) is an American psychologist and academic who is the president of Stevenson University in Owings Mills, Maryland since 03 July 2017. Prior to Stevenson University he served as president at San Diego State University and served as the provost and senior vice president of the University of Maryland, Baltimore County.

On This Day … 11 February

People (Births)

  • 1925 – Virginia E. Johnson, American psychologist and academic (d. 2013).

People (Deaths)

  • 1958 – Ernest Jones, Welsh neurologist and psychoanalyst (b. 1879).

Virginia E. Johnson

Virginia E. Johnson, born Mary Virginia Eshelman (11 February 1925 to 24 July 2013), was an American sexologist, best known as a member of the Masters and Johnson sexuality research team. Along with her partner, William H. Masters, she pioneered research into the nature of human sexual response and the diagnosis and treatment of sexual dysfunctions and disorders from 1957 until the 1990s.

Early Life

Virginia Johnson was born in Springfield, Missouri, the daughter of Edna (née Evans) and Hershel “Harry” Eshelman, a farmer. Her paternal grandparents were members of the LDS Church, and her father had Hessian ancestry. When she was five, her family moved to Palo Alto, California, where her father worked as a groundskeeper for a hospital. The family later returned to Missouri and farming. Virginia enrolled at her hometown’s Drury College at age 16, but dropped out and spent four years working in the Missouri state insurance office. She eventually returned to school, studying at the University of Missouri and the Kansas City Conservatory of Music, and during World War II began a music career as a band singer. She sang country music for radio station KWTO in Springfield, where she adopted the stage name Virginia Gibson.

Johnson moved to St. Louis, Missouri, where she became a business writer for the St. Louis Daily Record. Eschewing a singing career, Johnson enrolled at Washington University in St. Louis, intending to earn a degree in sociology but never attaining one.

Sexological Works

Johnson met William H. Masters in 1957 when he hired her as a research assistant at the Department of Obstetrics and Gynecology at Washington University in St. Louis. Masters trained her in medical terminology, therapy, and research during the years she worked as his assistant. Together they developed polygraph-like instruments that were designed to measure sexual arousal in humans. Using these tools, Masters and Johnson observed and measured about 700 men and women who agreed to engage in sexual activity with other participants or masturbate in Masters’ laboratory. By observing these subjects, Johnson helped Masters identify the four stages of sexual response. This came to be known as the human sexual response cycle. The cycle consists of the excitement phase, plateau phase, orgasmic phase, and resolution phase. In 1964, Masters and Johnson established their own independent non-profit research institution in St. Louis called the Reproductive Biology Research Foundation. The centre was renamed the Masters and Johnson Institute in 1978.

In April 2009, Thomas Maier reported in Scientific American that Johnson had serious reservations about the Masters and Johnson Institute’s programme to convert homosexuals into heterosexuals, a programme which ran from 1968 to 1977.

Personal Life

By her early 20s, Johnson had married a Missouri politician; the marriage lasted two days. She then married a much older attorney, whom she also divorced. In 1950, Johnson married bandleader George Johnson, with whom she had a boy and a girl, before divorcing in 1956. In 1971, Johnson married William Masters after he divorced his first wife. They were divorced in 1993, though they continued to collaborate professionally. Johnson died in July 2013 “of complications from several illnesses”.

Masters, who married again after his divorce from Johnson, died in 2001.

In Popular Culture

The American cable network Showtime debuted Masters of Sex, a dramatic television series based on the 2009 biography of the same name, on September 29, 2013. The series stars Lizzy Caplan as Johnson.

Ernest Jones

Alfred Ernest Jones FRCP MRCS (01 January 1879 to 11 February 1958) was a Welsh neurologist and psychoanalyst. A lifelong friend and colleague of Sigmund Freud from their first meeting in 1908, he became his official biographer. Jones was the first English-speaking practitioner of psychoanalysis and became its leading exponent in the English-speaking world. As President of both the International Psychoanalytical Association and the British Psycho-Analytical Society in the 1920s and 1930s, Jones exercised a formative influence in the establishment of their organisations, institutions and publications.

Early Career

After obtaining his medical degrees, Jones specialised in neurology and took a number of posts in London hospitals. It was through his association with the surgeon Wilfred Trotter that Jones first heard of Freud’s work. Having worked together as surgeons at University College Hospital, he and Trotter became close friends, with Trotter taking the role of mentor and confidant to his younger colleague. They had in common a wide-ranging interest in philosophy and literature, as well as a growing interest in Continental psychiatric literature and the new forms of clinical therapy it surveyed. By 1905 they were sharing accommodation above Harley Street consulting rooms with Jones’s sister, Elizabeth, installed as housekeeper. Trotter and Elizabeth Jones later married. Appalled by the treatment of the mentally ill in institutions, Jones began experimenting with hypnotic techniques in his clinical work.

Jones first encountered Freud’s writings directly in 1905, in a German psychiatric journal in which Freud published the famous Dora case-history. It was thus he formed “the deep impression of there being a man in Vienna who actually listened with attention to every word his patients said to him…a revolutionary difference from the attitude of previous physicians…”

Jones’s early attempts to combine his interest in Freud’s ideas with his clinical work with children resulted in adverse effects on his career. In 1906 he was arrested and charged with two counts of indecent assault on two adolescent girls whom he had interviewed in his capacity as an inspector of schools for “mentally defective” children. At the court hearing Jones maintained his innocence, claiming the girls were fantasising about any inappropriate actions by him. The magistrate concluded that no jury would believe the testimony of such children and Jones was acquitted. In 1908, employed as a pathologist at a London hospital, Jones accepted a colleague’s challenge to demonstrate the repressed sexual memory underlying the hysterical paralysis of a young girl’s arm. Jones duly obliged but, before conducting the interview, he omitted to inform the girl’s consultant or arrange for a chaperone. Subsequently, he faced complaints from the girl’s parents over the nature of the interview and he was forced to resign his hospital post.

Psychoanalytical Career

Whilst attending a congress of neurologists in Amsterdam in 1907, Jones met Carl Jung, from whom he received a first-hand account of the work of Freud and his circle in Vienna. Confirmed in his judgement of the importance of Freud’s work, Jones joined Jung in Zurich to plan the inaugural Psychoanalytical Congress. This was held in 1908 in Salzburg, where Jones met Freud for the first time. Jones travelled to Vienna for further discussions with Freud and introductions to the members of the Vienna Psychoanalytic Society. Thus began a personal and professional relationship which, to the acknowledged benefit of both, would survive the many dissensions and rivalries which marked the first decades of the psychoanalytic movement, and would last until Freud’s death in 1939.

With his career prospects in Britain in serious difficulty, Jones sought refuge in Canada in 1908. He took up teaching duties in the Department of Psychiatry of the University of Toronto (from 1911, as Associate Professor of Psychiatry). In addition to building a private psychoanalytic practice, he worked as pathologist to the Toronto Asylum and Director of its psychiatric outpatient clinic. Following further meetings with Freud in 1909 at Clark University in Worcester, Massachusetts, where Freud gave a series of lectures on psychoanalysis, and in the Netherlands the following year, Jones set about forging strong working relationships with the nascent American psychoanalytic movement. He gave some 20 papers or addresses to American professional societies at venues ranging from Boston, to Washington and Chicago. In 1910 he co-founded the American Psychopathological Association and the following year the American Psychoanalytic Association, serving as its first Secretary until 1913.

Jones undertook an intensive programme of writing and research, which produced the first of what were to be many significant contributions to psychoanalytic literature, notably monographs on Hamlet and On the Nightmare. A number of these were published in German in the main psychoanalytic periodicals published in Vienna; these secured his status in Freud’s inner circle during the period of the latter’s increasing estrangement from Jung. In this context in 1912 Jones initiated, with Freud’s agreement, the formation of a Committee of loyalists charged with safeguarding the theoretical and institutional legacy of the psychoanalytic movement. This development also served the more immediate purpose of isolating Jung and, with Jones in strategic control, eventually manoeuvring him out of the Presidency of the International Psychoanalytical Association, a post he had held since its inception. When Jung’s resignation came in 1914, it was only the outbreak of the Great War that prevented Jones from taking his place.

Returning to London in 1913, Jones set up in practice as a psychoanalyst, founded the London Psychoanalytic Society, and continued to write and lecture on psychoanalytic theory. A collection of his papers was published as Papers on Psychoanalysis, the first account of psychoanalytic theory and practice by a practising analyst in the English language.

By 1919, the year he founded the British Psychoanalytical Society, Jones could report proudly to Freud that psychoanalysis in Britain “stands in the forefront of medical, literary and psychological interest” (letter 27 January 1919 (Paskauskas 1993)). As President of the Society – a post he would hold until 1944 – Jones secured funding for and supervised the establishment in London of a Clinic offering subsidised fees, and an Institute of Psychoanalysis, which provided administrative, publishing and training facilities for the growing network of professional psychoanalysts.

Jones went on to serve two periods as President of the International Psychoanalytic Association from 1920 to 1924 and 1932 to 1949, where he had significant influence. In 1920 he founded the International Journal of Psychoanalysis, serving as its editor until 1939. The following year he established the International Psychoanalytic Library, which published some 50 books under his editorship. Jones soon obtained from Freud rights to the English translation of his work. In 1924 the first two volumes of Freud’s Collected Papers was published in translations edited by Jones and supervised by Joan Riviere, his former analysand and, at one stage, ardent suitor. After a period in analysis with Freud, Riviere worked with Jones as the translation editor of the International Journal of Psychoanalysis. She then was part of a working group Jones set up to plan and deliver James Strachey’s translations for the standard edition of Freud’s work. Largely through Jones’ energetic advocacy, the British Medical Association officially recognised psychoanalysis in 1929. The BBC subsequently removed him from a list of speakers declared to be dangerous to public morality. In the 1930s Jones and his colleagues made a series of radio broadcasts on psychoanalysis.

After Adolf Hitler took power in Germany, Jones helped many displaced and endangered Jewish analysts to resettle in England and other countries. Following the Anschluss of March 1938, Jones flew into Vienna at considerable personal risk to play a crucial role in negotiating and organising the emigration of Freud and his circle to London.

The Jones-Freud Controversy

Jones’s early published work on psychoanalysis had been devoted to expositions of the fundamentals of Freudian theory, an elaboration of its theory of symbolism, and its application to the analysis of religion, mythology, folklore and literary and artistic works. Under the influence of Melanie Klein, Jones’ work took a new direction.

Klein had made an impact in Berlin in the new field of child analysis and had impressed Jones in 1925 when he attended her series of lectures to the British Society in London. At Jones’s invitation she moved to London the following year; she soon acquired a number of devoted and influential followers. Her work had a dramatic effect on the British Society, polarising its members into rival factions as it became clear that her approach to child analysis was seriously at odds with that of Anna Freud, as set out in her 1927 book An Introduction to the Technique of Child Analysis. The disagreement centred around the clinical approach to the pre-Oedipal child; Klein argued for play as an equivalent to free association in adult analyses. Anna Freud opposed any such equivalence, proposing an educative intervention with the child until an appropriate level of ego development was reached at the Oedipal stage. Klein held this to be a collusive inhibition of analytical work with the child.

Influenced by Klein, and initiating what became known as the Jones-Freud controversy, Jones set out to explore a range of interlinked topics in the theory of early psychic development. These included the structure and genesis of the superego and the nature of the feminine castration complex. He coined the term phallocentrism in a critique of Freud’s account of sexual difference. He argued together with Klein and her Berlin colleague, Karen Horney, for a primary femininity, saying that penis envy arose as a defensive formation rather than arising from the fact, or “injury”, of biological asymmetry. In a corresponding reformulation of the castration complex, Jones introduced the concept of “aphanisis” to refer to the fear of “the permanent extinction of the capacity (including opportunity) for sexual enjoyment”.

These departures from orthodoxy were noted in Vienna and were topics that were featured in the regular Freud-Jones correspondence, the tone of which became increasingly fractious. Faced with accusations from Freud of orchestrating a campaign against him and his daughter, Jones sought to allay Freud’s concerns without abandoning his new critical standpoint. Eventually, following a series of exchange lectures between the Vienna and London societies, which Jones arranged with Anna Freud, Freud and Jones resumed their usual cordial exchanges.

With the arrival in Britain of refugee German and Viennese analysts in the 1930s, including Anna Freud in 1938, the hostility between the orthodox Freudians and Kleinians in the British Society grew more intense. Jones chaired a number of “extraordinary business meetings” with the aim of defusing the conflict, and these continued into the war years. The meetings, which became known as the controversial discussions, were established on a more regular basis from 1942. By that time, Jones had removed himself from direct participation, owing to ill health and the difficulties of war-time travel from his home in Elsted, West Sussex. He resigned from the presidency of the British Society in 1944, the year in which, under the presidency of Sylvia Payne, there finally emerged a compromise agreement which established parallel training courses providing options to satisfy the concerns of the rival groups that had formed: followers of Anna Freud, followers of Melanie Klein and a non-aligned group of Middle or Independent Group analysts. It was agreed further that all the key policy making committees of the BPS should have representatives from the three groups.

Later Life

After the end of the war, Jones gradually relinquished his many official posts whilst continuing his psychoanalytic practice, writings and lecturing. The major undertaking of his final years was his monumental account of Freud’s life and work, published to widespread acclaim in three volumes between 1953 and 1957. In this he was ably assisted by his German-speaking wife, who translated much of Freud’s early correspondence and other archive documentation made available by Anna Freud. His uncompleted autobiography, Free Associations, was published posthumously in 1959.

Jones was made a Fellow of the Royal College of Physicians (FRCP) in 1942, Honorary President of the International Psychoanalytical Association in 1949, and was awarded an Honorary Doctor of Science degree at Swansea University (Wales) in 1954.

Jones died in London on 11 February 1958, and was cremated at Golders Green Crematorium. His ashes were buried in the grave of the oldest of his four children in the churchyard of St Cadoc’s Cheriton on the Gower Peninsula.

On This Day … 28 January

People (Deaths)

  • 1971 – Donald Winnicott, English paediatrician and psychoanalyst (b. 1896).

Donald Winnicott

Donald Woods Winnicott FRCP (07 April 1896 to 25 January 1971) was an English paediatrician and psychoanalyst who was especially influential in the field of object relations theory and developmental psychology. He was a leading member of the British Independent Group of the British Psychoanalytical Society, President of the British Psychoanalytical Society twice (1956-1959 and 1965-1968), and a close associate of Marion Milner.

Winnicott is best known for his ideas on the true self and false self, the “good enough” parent, and borrowed from his second wife, Clare Winnicott, arguably his chief professional collaborator, the notion of the transitional object. He wrote several books, including Playing and Reality, and over 200 papers.

Career

Winnicott completed his medical studies in 1920, and in 1923, the same year as his marriage to the artist Alice Buxton Winnicott (born Taylor). She was a potter and they married on 07 July 1923 in St Mary’s Church, Frensham. Alice had “severe psychological difficulties” and Winnicott arranged for her, and his own therapy, to address the difficulties this condition created. He obtained a post as physician at the Paddington Green Children’s Hospital in London, where he was to work as a paediatrician and child psychoanalyst for 40 years. In 1923 he began a ten-year psychoanalysis with James Strachey, and in 1927 he began training as an analytic candidate. Strachey discussed Winnicott’s case with his wife Alix Strachey, apparently reporting that Winnicott’s sex life was affected by his anxieties. Winnicott’s second analysis, beginning in 1936, was with Joan Riviere.

Winnicott rose to prominence as a psychoanalyst just as the followers of Anna Freud were in conflict with those of Melanie Klein for the right to be called Sigmund Freud’s “true intellectual heirs”. Out of the Controversial discussions during World War II, a compromise was reached with three more-or-less amicable groups within the psychoanalytic movement: the “Freudians”, the “Kleinians”, and the “Middle Group” of the British Psychoanalytical Society (the latter being called the “Independent Group”), to which Winnicott belonged, along with Ronald Fairbairn, Michael Balint, Masud Khan, John Bowlby, Marion Milner, and Margaret Little.

During the Second World War, Winnicott served as consultant paediatrician to the children’s evacuation programme. During the war, he met and worked with Clare Britton, a psychiatric social worker who became his colleague in treating children displaced from their homes by wartime evacuation. Winnicott was lecturing after the war and Janet Quigley and Isa Benzie of the BBC asked him to give over sixty talks on the radio between 1943 and 1966. His first series of talks in 1943 was titled “Happy Children.” As a result of the success of these talks, Quigley offered him total control over the content of his talks but this soon became more consultative as Quigley advised him on the correct pitch.

After the war, he also saw patients in his private practice. Among contemporaries influenced by Winnicott was R.D. Laing, who wrote to Winnicott in 1958 acknowledging his help.

Winnicott divorced his first wife in 1949 and married Clare Britton (1907-1984) in 1951. A keen observer of children as a social worker and a psychoanalyst in her own right, she had an important influence on the development of his theories and likely acted as midwife to his prolific publications after they met.

Except for one book published in 1931 (Clinical Notes on Disorders of Childhood), all of Winnicott’s books were published after 1944, including The Ordinary Devoted Mother and Her Baby (1949), The Child and the Family (1957), Playing and Reality (1971), and Holding and Interpretation: Fragment of an Analysis (1986).

Winnicott died on 25 January 1971, following the last of a series of heart attacks and was cremated in London. Clare Winnicott oversaw the posthumous publication of several of his works.

What is Multiple Impact Therapy?

Introduction

Multiple impact therapy (MIT) is a group psychotherapy technique most often used with families in extreme crisis.

It was one of the first group therapy programmes developed in the United States. In multiple impact therapy (MIT), families are seen concurrently by a number of multi-disciplinary medical professionals. The duration of the therapy is short, typically ranging from one to two full treatment days.

The focus of treatment is to find and evaluate structural patterns within the family, evaluate those patterns to see if they are the source of the problem, then modify the structure to alleviate the problem.

Background

MIT as a therapy technique was developed at the University of Texas Medical Branch in the 1950s. At the time, Texas had very few psychoanalysts and those that were available were unaffordable to most families. Because treatment was scarce, there were few specialised programmes for adolescents, many were admitted as patients to psychiatric hospitals. Beginning in 1957, parents began bringing their troubled kids to the University of Texas Medical Branch for treatment.

Dr. Robert MacGregor, the lead researcher of group psychotherapy at the University of Texas Medical Branch, began developing MIT by interviewing entire families together in a single session. MacGregor and his team established their main goal as highlighting and emphasizing the parent’s concern to the disturbed child. Between 1957 and 1958, the team saw 12 families as the procedures were being developed. The initial sessions showed that therapy with individual members, together with group sessions, produced the most effective results. The individual sessions gave members the opportunity to voice their personal resentments while the group sessions gave therapists the opportunity to repair poor communication between family members. The therapy’s short, intensive time frame was originally due to life constraints involving time and travel; however, researchers kept the structure because the momentum created in the two day meetings reduced the overall number of sessions needed for the family to improve.

Procedure

MIT may be prescribed to families as a treatment option for a number of reasons: when conventional therapy fails to show results, as an alternative to hospitalisation, as a final course of action before hospitalisation, or for families who were already in group therapy but were seeing few results.

Treatment occurs in approximately seven steps over a two-day period.

Planning

Because many families participating in MIT are unfamiliar with the treatment and with psychotherapy, the planning phase informs the family about what is to be expected over the two days of treatment. Therapists use this time to review current information about the child and interview the community representative (or inpatient staff member) to gather personal details.

Briefing

After the family arrives, the therapy team and family meet for an initial conference to establish why they are gathered there. Intergroup conflict may be high in this phase. Blaming, criticism and aggressive accusations are commonplace. Therapists typically look for signs of defective communication among the family members and make note for later meetings. At the end of this group meeting, each member meets with an individual therapist.

Pressurised Ventilation

In individual meetings with the parents, parents are under a high degree of stress from the full group meeting. Therapists specifically look for the hardships the parents have faced in dealing with their child’s delinquency.

Initial Interview with the Child

The brief initial interview with the child takes place to match family patterns with the child’s behaviour.

Multiple Therapist Situation

After the initial group meet and individual meetings, therapists meet with any member or any number of members together as they see fit. Notes and other data collected (some studies video recorded the group meetings) are used in this procedure to address behavioural patterns and breakdowns in communication. This phase takes up the majority of the first day.

Team-Family Conference

A final group meeting convenes at the end of day one. Family members face each other again for the first time since the initial meeting. The sharing of the revised attitudes the group have towards one another takes place. The shift from conflict in the initial interview to the improved attitudes in the final team conference leads to the creation of a climate of change among the group.

Second Day Procedures

The second day attempts to begin in the same climate that created in the first. Day one often illuminates many of the breakdowns the family has experienced while day two focuses on retention of improved attitudes and application to the family’s unique situation. On day two, logistical considerations are often discussed such as: should the child remain hospitalised, continue schooling, or consider a different method of treatment. A two-month and six month follow up appointment is typically scheduled.

Potential Positive and Negative Outcomes

The use of an interdisciplinary team allows the parents, the child and the group as a whole to be seen from multiple viewpoints and through the lens of professionals with different experience and expertise. A typical interdisciplinary team as used in Macgregor’s studies at the University of Texas consisted of a psychologist, an associate therapist, a social worker, a nurse, and a member of the family’s community or inpatient clinic, however, other researchers have used up to 9 therapists in a single session. By including the community or inpatient staff member in MIT, trust and respect with the child’s parents increases.

Fifty-five additional families were seen between 1958 and 1962 when MacGregor first published his findings on MIT. Within the fifty-five families, only seven were considered unsuccessful cases. Despite the apparent success of MIT, two major drawbacks, the relative efficiency of the programme and conflict between the interdisciplinary team, were noted.

On This Day … 22 January

People (Births)

  • 1913 – Henry Bauchau, Belgian psychoanalyst and author (d. 2012).
  • 1932 – Berthold Grünfeld, Norwegian psychiatrist and academic (d. 2007).

Henry Bauchau

Henry Bauchau (22 January 1913 to 21 September 2012) was a Belgian psychoanalyst, lawyer, and author of French prose and poetry.

He became a trial lawyer in Brussels in 1936 and was a member of the Belgian Resistance in the Ardennes during World War II.

Berthold Grunfeld

Berthold Grünfeld (22 January 1932 to 20 August 2007) was a Norwegian psychiatrist, sexologist, and professor of social medicine at the University of Oslo. He was also a recognised expert in forensic psychiatry, often employed by Norwegian courts to examine insanity defence pleas.

Grünfeld was born in Bratislava in what was then Czechoslovakia. In 1939, when he was seven, he and 34 other Jewish children were separated from their families in an attempt by Nansenhjelpen to rescue them from the early manifestations of the Holocaust. The group of children was sent by train to Norway via Berlin, after having been told they would never again see their parents.

Once in Norway, Grünfeld was first placed at the Jewish children’s home in Oslo, then lived as a foster child with a Jewish family in Trondheim before returning to the orphanage. During the occupation of Norway, Grünfeld avoided capture and deportation by fleeing with members of the Norwegian Resistance in 1942 to neutral Sweden, where he stayed until the war ended. He returned to the children’s home in 1946. The Jewish community funded his education.

Berthold Grünfeld earned his medical degree in 1960, when he also met his future wife Gunhild. He was awarded his doctorate in medicine in 1973 based on a dissertation on abortion. In 1993, he was made professor of social medicine at the University of Oslo.

Grünfeld was noted for his academic contributions within sexology, on the issues of abortion and euthanasia, and within forensic psychology. In addition to his advocacy and teaching, he acted as an expert witness in criminal cases, and as a consultant on human relations and sexology for Oslo Helseråd. His dissertation influenced the reform of abortion laws in Norway.

Grünfeld and his wife had three children and six grandchildren. In 2005, his daughter Nina Grünfeld made a film, Origin Unknown, about her efforts to research her father’s background and heritage. Among other things, she found that his mother had worked as a prostitute and was murdered in the death camp at Sobibor.

On This Day … 17 January

People (Deaths)

  • 1881 – Harry Price, English psychologist and author (d. 1948).
  • 1887 – Ola Raknes, Norwegian psychoanalyst and philologist (d. 1975).
  • 1945 – Anne Cutler, Australian psychologist and academic.

Harry Price

Harry Price (17 January 1881 to 29 March 1948) was a British psychic researcher and author, who gained public prominence for his investigations into psychical phenomena and his exposing fraudulent spiritualist mediums. He is best known for his well-publicised investigation of the purportedly haunted Borley Rectory in Essex, England.

Ola Raknes

Ola Raknes (17 January 1887 to 28 January 1975) was a Norwegian psychologist, philologist and non-fiction writer. Born in Bergen, Norway, he was internationally known as a psychoanalyst in the Reichian tradition. He has been described as someone who spent his entire life working with the conveying of ideas through many languages and between different epistemological systems of reference, science and religion (Dannevig, 1975). For large portions of his life he was actively contributing to the public discourse in Norway. He has also been credited for his contributions to strengthening and enriching the Nynorsk language and its use in the public sphere.

Raknes was known as a thorough philologist and a controversial therapist. Internationally he was known as one of Wilhelm Reich’s closest students and defenders.

Anne Cutler

(Elizabeth) Anne Cutler (1945 to Present) FRS is a Research Professor at the MARCS Institute for Brain, Behaviour and Development, Western Sydney University and Emeritus Director of the Max Planck Institute for Psycholinguistics in Nijmegen.

On This Day … 14 January

People (Deaths)

Harry Stack Sullivan

Herbert “Harry” Stack Sullivan (21 February 1892 to 14 January 1949) was an American Neo-Freudian psychiatrist and psychoanalyst who held that “personality can never be isolated from the complex interpersonal relationships in which [a] person lives” and that “[t]he field of psychiatry is the field of interpersonal relations under any and all circumstances in which [such] relations exist”.

Having studied therapists Sigmund Freud, Adolf Meyer, and William Alanson White, he devoted years of clinical and research work to helping people with psychotic illness.

Early Life

Sullivan was a child of Irish immigrants and grew up in the then anti-Catholic town of Norwich, New York, resulting in a social isolation which may have inspired his later interest in psychiatry. He attended the Smyrna Union School, then spent two years at Cornell University from 1909, receiving his medical degree in Chicago College of Medicine and Surgery in 1917.

Work

Along with Clara Thompson, Karen Horney, Erich Fromm, Otto Allen Will, Jr., Erik H. Erikson, and Frieda Fromm-Reichmann, Sullivan laid the groundwork for understanding the individual based on the network of relationships in which they are enmeshed. He developed a theory of psychiatry based on interpersonal relationships where cultural forces are largely responsible for mental illnesses (see also social psychiatry). In his words, one must pay attention to the “interactional”, not the “intrapsychic”. This search for satisfaction via personal involvement with others led Sullivan to characterise loneliness as the most painful of human experiences. He also extended the Freudian psychoanalysis to the treatment of patients with severe mental disorders, particularly schizophrenia.

Besides making the first mention of the significant other in psychological literature, Sullivan developed the idea of the “Self System”, a configuration of the personality traits developed in childhood and reinforced by positive affirmation and the security operations developed in childhood to avoid anxiety and threats to self-esteem. Sullivan further defined the Self System as a steering mechanism toward a series of I-You interlocking behaviours; that is, what an individual does is meant to elicit a particular reaction.

Sullivan called these behaviours Parataxical Integrations and he noted that such action-reaction combinations can become rigid and dominate an adult’s thinking pattern, limiting their actions and reactions toward the world as the adult sees the world and not as it really is. The resulting inaccuracies in judgment Sullivan termed parataxic distortion, when other persons are perceived or evaluated based on the patterns of previous experience, similar to Freud’s notion of transference. Sullivan also introduced the concept of “prototaxic communication” as a more primitive, needy, infantile form of psychic interchange and of “syntactic communication” as a mature style of emotional interaction.

Sullivan’s work on interpersonal relationships became the foundation of interpersonal psychoanalysis, a school of psychoanalytic theory and treatment that stresses the detailed exploration of the nuances of patients’ patterns of interacting with others.

Sullivan was the first to coin the term “problems in living” to describe the difficulties with self and others experienced by those with mental illnesses. This phrase was later picked up and popularised by Thomas Szasz, whose work was a foundational resource for the antipsychiatry movement. “Problems in living” went on to become the movement’s preferred way to refer to the manifestations of mental disturbances.

In 1927, he reviewed the controversial, anonymously published The Invert and his Social Adjustment and in 1929 called it “a remarkable document by a homosexual man of refinement; intended primarily as a guide to the unfortunate sufferers of sexual inversion, and much less open to criticism than anything else of the kind so far published.”

He was one of the founders of the William Alanson White Institute, considered by many to be the world’s leading independent psychoanalytic institute, and of the journal Psychiatry in 1937. He headed the Washington, DC School of Psychiatry from 1936 to 1947.

In 1940, he and colleague Winfred Overholser, serving on the American Psychiatric Society’s committee on Military Mobilisation, formulated guidelines for the psychological screening of inductees to the United States military. He believed, writes one historian, “that sexuality played a minimal role in causing mental disorders and that adult homosexuals should be accepted and left alone.” Despite his best efforts, others included homosexuality as a disqualification for military service.

Beginning on 05 December 1940, Sullivan served as psychiatric adviser to Selective Service director Clarence A. Dykstra, but resigned in November 1941 after General Lewis B. Hershey, who was hostile to psychiatry, became the director. Sullivan then took part in establishing the Office of War Information in 1942. Beginning in 1927, Sullivan had a 22-year relationship with James Inscoe Sullivan, known as “Jimmie”, who was 20 years younger than Sullivan.

Although some contemporaries and historians have regarded Inscoe as an unofficially adopted son, and Sullivan as closeted, one should remember that to be open about it would have made his professional interest in the area and further research very difficult. His colleague Helen Swick Perry’s biography of Sullivan mentions the relationship and it is clear his close friends were well aware they were partners.

Writings

Although Sullivan published little in his lifetime, he influenced generations of mental health professionals, especially through his lectures at Chestnut Lodge in Rockville, Maryland, outside Washington, DC. Leston Havens called him the most important underground influence in American psychoanalysis. His ideas were collected and published posthumously, edited by Helen Swick Perry, who also published a detailed biography in 1982 (Perry, 1982, Psychiatrist of America).

Works

The following works are in Special Collections (MSA SC 5547) at the Maryland State Archives in Annapolis: Conceptions of Modern Psychiatry, Soundscriber Transcriptions (February 1945 to May 1945); Lectures 1-97 (begins 02 October 1942); Georgetown University Medical School Lectures (1939); Personal Psychopathology (1929-1933); The Psychiatry of Character and its Deviations-undated notes.

His writings include:

  • The Interpersonal Theory of Psychiatry (1953).
  • “The Psychiatric Interview” (1954).
  • Conceptions of Modern Psychiatry (1947/1966).
  • Schizophrenia as a Human Process (1962).

Associates

After Sullivan’s death, Saul B. Newton and his wife Dr. Jane Pearce (a psychiatrist who studied with Sullivan in the late 1940s) established the Sullivan Institute for Research in Psychoanalysis in New York City.

On This Day … 06 January

People (Births)

  • 1915 – John C. Lilly, American psychoanalyst, physician, and philosopher (d. 2001).

People (Deaths)

  • 1852 – Louis Braille, French educator, invented Braille (b. 1809).
  • 2014 – Julian Rotter, American psychologist and academic (b. 1916).

John C. Lilly

John Cunningham Lilly (06 January 1915 to 30 September 2001) was an American physician, neuroscientist, psychoanalyst, psychonaut, philosopher, writer and inventor. He was a member of a generation of counterculture scientists and thinkers that included Ram Dass, Werner Erhard and Timothy Leary, all frequent visitors to the Lilly home. He often stirred controversy, especially among mainstream scientists.

Lilly conducted high-altitude research during World War II and later trained as a psychoanalyst. He gained renown in the 1950s after developing the isolation tank. He saw the tanks, in which users are isolated from almost all external stimuli, as a means to explore the nature of human consciousness. He later combined that work with his efforts to communicate with dolphins. He began studying how bottlenose dolphins vocalize, establishing centres in the US Virgin Islands and, later, San Francisco to study dolphins. A decade later, he began experimenting with psychedelics, including LSD, often while floating in isolation. His work inspired two Hollywood movies, The Day of the Dolphin (1973) and Altered States (1980).

Louis Braille

Louis Braille (04 January 1809 to 06 January 1852) was a French educator and inventor of a system of reading and writing for use by the blind or visually impaired. His system remains virtually unchanged to this day, and is known worldwide simply as braille.

Blinded at the age of three in one eye as a result of an accident with a Stitching awl in his father’s harness making shop, an infection set in and spread to both eyes, resulting in total blindness. He excelled in his education and received a scholarship to France’s Royal Institute for Blind Youth. While still a student there, he began developing a system of tactile code that could allow blind people to read and write quickly and efficiently. Inspired by the military cryptography of Charles Barbier, Braille constructed a new method built specifically for the needs of the blind. He presented his work to his peers for the first time in 1824.

In adulthood, Louis Braille served as a professor at the Institute and had an avocation as a musician, but he largely spent the remainder of his life refining and extending his system. It went unused by most educators for many years after his death, but posterity has recognised braille as a revolutionary invention, and it has been adapted for use in languages worldwide.

Julian Rotter

Julian B. Rotter (22 October 1916 to 06 January 2014) was an American psychologist known for developing influential theories, including social learning theory and locus of control. He was a faculty member at The Ohio State University and then the University of Connecticut. A Review of General Psychology survey, published in 2002, ranked Rotter as the 64th most cited psychologist of the 20th century.

Background

Rotter was born in 1916 in Brooklyn, New York, United States, as the third son of Jewish immigrant parents. In the years of elementary and secondary schools, he became interested with psychology and philosophy through readings. Rotter attended Brooklyn College in 1933, where he earned his undergraduate degree. He majored in Chemistry even though he found psychology to be more fascinating due to the fact that there were more opportunities to make money, while the economy was failing. While studying in Brooklyn College, Wood and Solomon Asch, teachers at the college, influenced his development as a psychologist. Wood inspired him by his lectures on the scientific method. Asch was intensely involved in the controversy between Gestalt and Thorndykian views of learning and thus he influenced Rotter’s interest in psychology. He then earned a master’s degree at the University of Iowa, studying there under Kurt Lewin.

After he earned his master’s degree at the University of Iowa, he was able to obtain an internship at the Worcester State Hospital. At the time it may have been the only formal internship in psychology. While at Worcester State Hospital, David Shakow, Saul Rosenzweig, and Elliot Rodnick provided stimulation and training in research and practice in clinical psychology. Worcester was also where he met Clara Barnes, another intern whom he later married. Through his work with Kurt Lewin, he became interested with a level of aspiration. Worcester was also where he had designed and built the Level of Aspiration Board as an individual personality measure. He continued his work at the Indiana University where he encountered success and failure using the level of aspiration paradigms at Indiana University; he earned a doctorate at Indiana in 1941. Through his education, Rotter was influenced by Alfred Adler, Clark Hull, B.F. Skinner, and Edward Tolman. He was influenced by Wendell Johnson, a general semanticist, who impressed on him the need for careful definitions in psychology and the myriad of pitfalls involved in poorly defined and poorly operationalised constructs. In 1963, Rotter moved to the University of Connecticut, and became the director of clinical training. The Interpersonal Trust Scale, a research measure of the stable individual difference in personality, was developed by Rotter around that time.

After earning his doctorate, Rotter became an adviser to the United States Army during World War II. In the Army, Rotter worked as a psychologist, except for 17 weeks in officer candidate training as a tank officer. He then went to Ohio State University, where he taught and served as the chairman of the clinical psychology programme. At Ohio State, Rotter was influenced by George Kelly. Rotter then went to the University of Connecticut, where he remained for his career. Rotter was also appointed as president of the American Psychological Association Division of Clinical Psychology, the Eastern Psychological Association, as well as the American Psychology Association Division of Social and Personality Psychology.

Rotter’s seminal work, Social Learning and Clinical Psychology was published in 1954. In 1963, he became the Program Director of Clinical Psychology at the University of Connecticut.

He died at the age of 97 on January 6, 2014 at his home in Mansfield, Connecticut.

Social Learning Theory

Rotter moved away from theories based on psychoanalysis and behaviourism, and developed a social learning theory. In Social Learning and Clinical Psychology (1954), Rotter suggested that the expected effect or outcome of the behaviour influences the motivation of people to engage in that behaviour. People wish to avoid negative consequences, while desiring positive results or effects. If one expects a positive outcome from a behaviour, or thinks there is a high probability of a positive outcome, then they will be more likely to engage in the behaviour. The behaviour is reinforced, with positive outcomes, leading a person to repeat the behaviour. This social learning theory suggests that behaviour is influenced by social context or environmental factors, and not psychological factors alone.

Locus of Control

In 1966, Rotter published his famous I-E scale in the journal “Psychological Monographs”, to assess internal and external locus of control. This scale has been widely used in the psychology of personality, although its use of a two-alternative forced choice technique has made it subject to criticism. Rotter himself was astounded by how much attention this scale generated, claiming that it was like lighting a cigarette and seeing a forest fire. He himself believed that the scale was an adequate measure of just two concepts, achievement motivation (which he took to be linked with internal locus of control) and outer-directedeness, or tendency to conform to others (which he took to be associated with external locus of control). Critics of the scale have frequently voiced concern that locus of control is not as homogenous a concept as Rotter believed. According to him the locus of control of an individual’s behaviour in the case of ‘propagation’ lies within the individual whereas it lies outside the individual in the case of ‘conversion’. (Clearly depicting how religious propagation is different from religious conversion)

Legacy

Rotter has been reported as one of the most eminent psychologists of the 20th century. He was 18th in frequency of citations in journal articles and 64th in overall eminence. His seminal studies of the variable of internal versus external locus of control provided the foundation of prolific research into choice and perceived control in several disciplines. His pioneer social learning framework transformed behavioural approaches to personality and clinical psychology.

What is Psychoanalysis?

Introduction

Psychoanalysis (from Greek: ψυχή, psykhḗ, ‘soul’ + ἀνάλυσις, análysis, ‘investigate’) is a set of theories and therapeutic techniques used to study the unconscious mind, which together form a method of treatment for mental disorders. The discipline was established in the early 1890s by Austrian neurologist Sigmund Freud, who retained the term psychoanalysis for his own school of thought. Freud’s work stems partly from the clinical work of Josef Breuer and others. Psychoanalysis was later developed in different directions, mostly by students of Freud, such as Alfred Adler and his collaborator, Carl Gustav Jung, as well as by neo-Freudian thinkers, such as Erich Fromm, Karen Horney, and Harry Stack Sullivan.

Psychoanalysis has been known to be a controversial discipline, and its validity as a science is very contested. Nonetheless, it retains a relatively salient influence within psychiatry, albeit more so in some quarters than others. Psychoanalytic concepts are also widely used outside the therapeutic arena, in areas such as psychoanalytic literary criticism, as well as in the analysis of film, fairy tales, philosophical perspectives as Freudo-Marxism and other cultural phenomena.

Basic Tenets

The basic tenets of psychoanalysis include:

  • A person’s development is determined by often forgotten events in early childhood, rather than by inherited traits alone.
  • Human behaviour and cognition are largely determined by instinctual drives that are rooted in the unconscious.
  • Attempts to bring such drives into awareness triggers resistance in the form of defence mechanisms, particularly repression.
  • Conflicts between conscious and unconscious material can result in mental disturbances, such as neurosis, neurotic traits, anxiety, and depression.
  • Unconscious material can be found in dreams and unintentional acts, including mannerisms and slips of the tongue.
  • Liberation from the effects of the unconscious is achieved by bringing this material into the conscious mind through therapeutic intervention.
  • The “centrepiece of the psychoanalytic process” is the transference, whereby patients relive their infantile conflicts by projecting onto the analyst feelings of love, dependence and anger.

Practice

During psychoanalytic sessions, typically lasting 50 minutes, ideally 4-5 times a week, the patient (or analysand) may lie on a couch, with the analyst often sitting just behind and out of sight. The patient expresses their thoughts, including free associations, fantasies, and dreams, from which the analyst infers the unconscious conflicts causing the patient’s symptoms and character problems. Through the analysis of these conflicts, which includes interpreting the transference and countertransference (the analyst’s feelings for the patient), the analyst confronts the patient’s pathological defences to help the patient gain insight.

History

Sigmund Freud first used the term ‘psychoanalysis’ (French: psychoanalyse) in 1896, ultimately retaining the term for his own school of thought. In November 1899, he wrote the Interpretation of Dreams (German: Die Traumdeutung), which Freud thought of as his “most significant work.”

Psychoanalysis was later developed in different directions, mostly by students of Freud such as Alfred Adler and Carl Gustav Jung,] and by neo-Freudians such as Erich Fromm, Karen Horney and Harry Stack Sullivan.

1890s

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

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

Around the same time, Freud attempted to develop a neuro-physiological theory of unconscious mental mechanisms, which he soon gave up. It remained unpublished in his lifetime. The term ‘psychoanalysis’ (psychoanalyse) was first introduced by Freud in his essay titled “Heredity and aetiology of neuroses” (“L’hérédité et l’étiologie des névroses”), written and published in French in 1896.

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

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

1900 to 1940s

In 1905, Freud published Three Essays on the Theory of Sexuality in which he laid out his discovery of the psychosexual phases:

  • Oral (ages 0-2);
  • Anal (2-4);
  • Phallic-oedipal or First genital (3-6);
  • Latency (6-puberty); and
  • Mature genital (puberty-onward).

His early formulation included the idea that because of societal restrictions, sexual wishes were repressed into an unconscious state, and that the energy of these unconscious wishes could be turned into anxiety or physical symptoms. Therefore, the early treatment techniques, including hypnotism and abreaction, were designed to make the unconscious conscious in order to relieve the pressure and the apparently resulting symptoms. This method would later on be left aside by Freud, giving free association a bigger role.

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

Three years later, in 1923, he summarised the ideas of id, ego, and superego in “The Ego and the Id.” In the book, he revised the whole theory of mental functioning, now considering that repression was only one of many defence mechanisms, and that it occurred to reduce anxiety. Hence, Freud characterised repression as both a cause and a result of anxiety. In 1926, in “Inhibitions, Symptoms and Anxiety,” Freud characterised how intrapsychic conflict among drive and superego (wishes and guilt) caused anxiety, and how that anxiety could lead to an inhibition of mental functions, such as intellect and speech. “Inhibitions, Symptoms and Anxiety” was written in response to Otto Rank, who, in 1924, published Das Trauma der Geburt (The Trauma of Birth), analysing how art, myth, religion, philosophy and therapy were illuminated by separation anxiety in the “phase before the development of the Oedipus complex.” Freud’s theories, however, characterised no such phase. According to Freud, the Oedipus complex, was at the centre of neurosis, and was the foundational source of all art, myth, religion, philosophy, therapy – indeed of all human culture and civilisation. It was the first time that anyone in the inner circle had characterised something other than the Oedipus complex as contributing to intrapsychic development, a notion that was rejected by Freud and his followers at the time.

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

1940s to Present

When Hitler’s power grew, the Freud family and many of their colleagues fled to London. Within a year, Sigmund Freud died. In the United States, also following the death of Freud, a new group of psychoanalysts began to explore the function of the ego. Led by Heinz Hartmann, the group built upon understandings of the synthetic function of the ego as a mediator in psychic functioning, distinguishing such from autonomous ego functions (e.g. memory and intellect, which could be secondarily affected by conflict). These “Ego Psychologists” of the 1950s paved a way to focus analytic work by attending to the defences (mediated by the ego) before exploring the deeper roots to the unconscious conflicts.

In addition, there was burgeoning interest in child psychoanalysis. Although criticised since its inception, psychoanalysis has been used as a research tool into childhood development, and is still used to treat certain mental disturbances. In the 1960s, Freud’s early thoughts on the childhood development of female sexuality were challenged; this challenge led to the development of a variety of understandings of female sexual development, many of which modified the timing and normality of several of Freud’s theories (which had been gleaned from the treatment of women with mental disturbances). Several researchers followed Karen Horney’s studies of societal pressures that influence the development of women.

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

The Development of Alternatives to Psychotherapy

In the 1950s, psychoanalysis was the main modality of psychotherapy. Behavioural models of psychotherapy started to assume a more central role in psychotherapy in the 1960s. Aaron T. Beck a psychiatrist trained in a psychoanalytic tradition set out to test the psychoanalytic models of depression and found that conscious ruminations of loss and personal failing were correlated with depression. He suggested that distorted and biased beliefs were a causal factor of depression, publishing an influential paper in 1967 after a decade of research using the construct of schemas to explain the process. Beck developed this into a talking therapy in the early 1970s called cognitive behavioural therapy.

Theories

The predominant psychoanalytic theories can be organised into several theoretical schools. Although these perspectives differ, most of them emphasize the influence of unconscious elements on the conscious. There has also been considerable work done on consolidating elements of conflicting theories.

As in the field of medicine, there are some persistent conflicts regarding specific causes of certain syndromes, and disputes regarding the ideal treatment techniques. In the 21st century, psychoanalytic ideas are embedded in Western culture, especially in fields such as childcare, education, literary criticism, cultural studies, mental health, and particularly psychotherapy. Though there is a mainstream of evolved analytic ideas, there are groups who follow the precepts of one or more of the later theoreticians. Psychoanalytic ideas also play roles in some types of literary analysis such as Archetypal literary criticism.

Topographic Theory

Topographic theory was named and first described by Sigmund Freud in The Interpretation of Dreams (1899). The theory hypothesizes that the mental apparatus can be divided into the systems Conscious, Preconscious, and Unconscious. These systems are not anatomical structures of the brain but, rather, mental processes. Although Freud retained this theory throughout his life he largely replaced it with the structural theory. The Topographic theory remains as one of the meta-psychological points of view for describing how the mind functions in classical psychoanalytic theory.

Structural Theory

Structural theory divides the psyche into the id, the ego, and the super-ego. The id is present at birth as the repository of basic instincts, which Freud called “Triebe” (“drives”): unorganised and unconscious, it operates merely on the ‘pleasure principle’, without realism or foresight. The ego develops slowly and gradually, being concerned with mediating between the urging of the id and the realities of the external world; it thus operates on the ‘reality principle’. The super-ego is held to be the part of the ego in which self-observation, self-criticism and other reflective and judgmental faculties develop. The ego and the super-ego are both partly conscious and partly unconscious.

Theoretical and Clinical Approaches

During the twentieth century, many different clinical and theoretical models of psychoanalysis emerged.

Ego Psychology

Ego psychology was initially suggested by Freud in “Inhibitions, Symptoms and Anxiety” (1926), while major steps forward would be made through Anna Freud’s work on defence mechanisms, first published in her book The Ego and the Mechanisms of Defence (1936).

The theory was refined by Hartmann, Loewenstein, and Kris in a series of papers and books from 1939 through the late 1960s. Leo Bellak was a later contributor. This series of constructs, paralleling some of the later developments of cognitive theory, includes the notions of autonomous ego functions: mental functions not dependent, at least in origin, on intrapsychic conflict. Such functions include: sensory perception, motor control, symbolic thought, logical thought, speech, abstraction, integration (synthesis), orientation, concentration, judgment about danger, reality testing, adaptive ability, executive decision-making, hygiene, and self-preservation. Freud noted that inhibition is one method that the mind may utilise to interfere with any of these functions in order to avoid painful emotions. Hartmann (1950s) pointed out that there may be delays or deficits in such functions.

Frosch (1964) described differences in those people who demonstrated damage to their relationship to reality, but who seemed able to test it.

According to ego psychology, ego strengths, later described by Otto F. Kernberg (1975), include the capacities to control oral, sexual, and destructive impulses; to tolerate painful affects without falling apart; and to prevent the eruption into consciousness of bizarre symbolic fantasy. Synthetic functions, in contrast to autonomous functions, arise from the development of the ego and serve the purpose of managing conflict processes. Defences are synthetic functions that protect the conscious mind from awareness of forbidden impulses and thoughts. One purpose of ego psychology has been to emphasize that some mental functions can be considered to be basic, rather than derivatives of wishes, affects, or defences. However, autonomous ego functions can be secondarily affected because of unconscious conflict. For example, a patient may have an hysterical amnesia (memory being an autonomous function) because of intrapsychic conflict (wishing not to remember because it is too painful).

Taken together, the above theories present a group of metapsychological assumptions. Therefore, the inclusive group of the different classical theories provides a cross-sectional view of human mentation. There are six “points of view”, five described by Freud and a sixth added by Hartmann. Unconscious processes can therefore be evaluated from each of these six points of view:

  • Topographic.
  • Dynamic (the theory of conflict).
  • Economic (the theory of energy flow).
  • Structural.
  • Genetic (i.e. propositions concerning origin and development of psychological functions).
  • Adaptational (i.e. psychological phenomena as it relates to the external world).

Modern Conflict Theory

Modern conflict theory, a variation of ego psychology, is a revised version of structural theory, most notably different by altering concepts related to where repressed thoughts were stored. Modern conflict theory addresses emotional symptoms and character traits as complex solutions to mental conflict. It dispenses with the concepts of a fixed id, ego and superego, and instead posits conscious and unconscious conflict among wishes (dependent, controlling, sexual, and aggressive), guilt and shame, emotions (especially anxiety and depressive affect), and defensive operations that shut off from consciousness some aspect of the others. Moreover, healthy functioning (adaptive) is also determined, to a great extent, by resolutions of conflict.

A major objective of modern conflict-theory psychoanalysis is to change the balance of conflict in a patient by making aspects of the less adaptive solutions (also called “compromise formations”) conscious so that they can be rethought, and more adaptive solutions found. Current theoreticians who follow the work of Charles Brenner, especially The Mind in Conflict (1982), include Sandor Abend, Jacob Arlow, and Jerome Blackman.

Object Relations Theory

Object relations theory attempts to explain the ups and downs of human relationships through a study of how internal representations of the self and others are organised. The clinical symptoms that suggest object relations problems (typically developmental delays throughout life) include disturbances in an individual’s capacity to feel: warmth, empathy, trust, sense of security, identity stability, consistent emotional closeness, and stability in relationships with significant others

Concepts regarding internal representation (aka ‘introspect,’ ‘self and object representation,’ or ‘internalization of self and other’), although often attributed to Melanie Klein, were actually first mentioned by Sigmund Freud in his early concepts of drive theory (Three Essays on the Theory of Sexuality, 1905). Freud’s 1917 paper “Mourning and Melancholia,” for example, hypothesized that unresolved grief was caused by the survivor’s internalised image of the deceased becoming fused with that of the survivor, and then the survivor shifting unacceptable anger toward the deceased onto the now complex self-image.

Vamik Volkan, in “Linking Objects and Linking Phenomena,” expanded on Freud’s thoughts on this, describing the syndromes of “established pathological mourning” vs. “reactive depression” based on similar dynamics. Melanie Klein’s hypotheses regarding internalisation during the first year of life, leading to paranoid and depressive positions, were later challenged by René Spitz (e.g., The First Year of Life, 1965), who divided the first year of life into a coenesthetic phase of the first six months, and then a diacritic phase for the second six months. Mahler, Fine, and Bergman (1975) describe distinct phases and sub-phases of child development leading to “separation-individuation” during the first three years of life, stressing the importance of constancy of parental figures in the face of the child’s destructive aggression, internalisations, stability of affect management, and ability to develop healthy autonomy.

John Frosch, Otto Kernberg, Salman Akhtar, and Sheldon Bach have developed the theory of self and object constancy as it affects adult psychiatric problems such as psychosis and borderline states. Blos (1960) described how similar separation-individuation struggles occur during adolescence, of course with a different outcome from the first three years of life: the teen usually, eventually, leaves the parents’ house (varying with culture).

During adolescence, Erik Erikson (1950-1960s) described the ‘identity crisis,’ that involves identity-diffusion anxiety. In order for an adult to be able to experience “Warm-ETHICS: (warmth, Empathy, Trust, Holding environment, Identity, Closeness, and Stability) in relationships, the teenager must resolve the problems with identity and redevelop self and object constancy.

Self Psychology

Self psychology emphasizes the development of a stable and integrated sense of self through empathic contacts with other humans, primary significant others conceived of as ‘selfobjects.’ Selfobjects meet the developing self’s needs for mirroring, idealisation, and twinship, and thereby strengthen the developing self. The process of treatment proceeds through “transmuting internalisations” in which the patient gradually internalizes the selfobject functions provided by the therapist. Self psychology was proposed originally by Heinz Kohut, and has been further developed by Arnold Goldberg, Frank Lachmann, Paul and Anna Ornstein, Marian Tolpin, and others.

Lacanian Psychoanalysis

Lacanian psychoanalysis, which integrates psychoanalysis with structural linguistics and Hegelian philosophy, is especially popular in France and parts of Latin America. Lacanian psychoanalysis is a departure from the traditional British and American psychoanalysis. Jacques Lacan frequently used the phrase “retourner à Freud” (“return to Freud”) in his seminars and writings, as he claimed that his theories were an extension of Freud’s own, contrary to those of Anna Freud, the Ego Psychology, object relations and “self” theories and also claims the necessity of reading Freud’s complete works, not only a part of them. Lacan’s concepts concern the “mirror stage”, the “Real”, the “Imaginary”, and the “Symbolic”, and the claim that “the unconscious is structured as a language.”

Though a major influence on psychoanalysis in France and parts of Latin America, Lacan and his ideas have taken longer to be translated into English and he has thus had a lesser impact on psychoanalysis and psychotherapy in the English-speaking world. In the United Kingdom and the United States, his ideas are most widely used to analyse texts in literary theory. Due to his increasingly critical stance towards the deviation from Freud’s thought, often singling out particular texts and readings from his colleagues, Lacan was excluded from acting as a training analyst in the IPA, thus leading him to create his own school in order to maintain an institutional structure for the many candidates who desired to continue their analysis with him.

Adaptive Paradigm

The adaptive paradigm of psychotherapy develops out of the work of Robert Langs. The adaptive paradigm interprets psychic conflict primarily in terms of conscious and unconscious adaptation to reality. Langs’ recent work in some measure returns to the earlier Freud, in that Langs prefers a modified version of the topographic model of the mind (conscious, preconscious, and unconscious) over the structural model (id, ego, and super-ego), including the former’s emphasis on trauma (though Langs looks to death-related traumas rather than sexual traumas). At the same time, Langs’ model of the mind differs from Freud’s in that it understands the mind in terms of evolutionary biological principles.

Relational Psychoanalysis

Relational psychoanalysis combines interpersonal psychoanalysis with object-relations theory and with inter-subjective theory as critical for mental health. It was introduced by Stephen Mitchell. Relational psychoanalysis stresses how the individual’s personality is shaped by both real and imagined relationships with others, and how these relationship patterns are re-enacted in the interactions between analyst and patient. In New York, key proponents of relational psychoanalysis include Lew Aron, Jessica Benjamin, and Adrienne Harris. Fonagy and Target, in London, have propounded their view of the necessity of helping certain detached, isolated patients, develop the capacity for “mentalization” associated with thinking about relationships and themselves. Arietta Slade, Susan Coates, and Daniel Schechter in New York have additionally contributed to the application of relational psychoanalysis to treatment of the adult patient-as-parent, the clinical study of mentalisation in parent-infant relationships, and the intergenerational transmission of attachment and trauma.

Interpersonal-Relational Psychoanalysis

The term interpersonal-relational psychoanalysis is often used as a professional identification. Psychoanalysts under this broader umbrella debate about what precisely are the differences between the two schools, without any current clear consensus.

Psychopathology (Mental Disturbances)

Adults

The various psychoses involve deficits in the autonomous ego functions (see above) of integration (organization) of thought, in abstraction ability, in relationship to reality and in reality testing. In depressions with psychotic features, the self-preservation function may also be damaged (sometimes by overwhelming depressive affect). Because of the integrative deficits (often causing what general psychiatrists call “loose associations,” “blocking,” “flight of ideas,” “verbigeration,” and “thought withdrawal”), the development of self and object representations is also impaired. Clinically, therefore, psychotic individuals manifest limitations in warmth, empathy, trust, identity, closeness and/or stability in relationships (due to problems with self-object fusion anxiety) as well.

In patients whose autonomous ego functions are more intact, but who still show problems with object relations, the diagnosis often falls into the category known as “borderline”. Borderline patients also show deficits, often in controlling impulses, affects, or fantasies – but their ability to test reality remains more or less intact. Adults who do not experience guilt and shame, and who indulge in criminal behaviour, are usually diagnosed as psychopaths, or, using DSM-IV-TR, antisocial personality disorder.

Neurotic symptoms – including panic, phobias, conversions, obsessions, compulsions and depressions – are not usually caused by deficits in functions. Instead, they are caused by intrapsychic conflicts. The conflicts are generally among sexual and hostile-aggressive wishes, guilt and shame, and reality factors. The conflicts may be conscious or unconscious, but create anxiety, depressive affect, and anger. Finally, the various elements are managed by defensive operations – essentially shut-off brain mechanisms that make people unaware of that element of conflict.

Repression is the term given to the mechanism that shuts thoughts out of consciousness. Isolation of affect is the term used for the mechanism that shuts sensations out of consciousness. Neurotic symptoms may occur with or without deficits in ego functions, object relations, and ego strengths. Therefore, it is not uncommon to encounter obsessive-compulsive schizophrenics, panic patients who also suffer with borderline personality disorder, etc.

This section above is partial to ego psychoanalytic theory autonomous ego functions.

Childhood Origins

Freudian theories hold that adult problems can be traced to unresolved conflicts from certain phases of childhood and adolescence, caused by fantasy, stemming from their own drives. Freud, based on the data gathered from his patients early in his career, suspected that neurotic disturbances occurred when children were sexually abused in childhood (i.e. seduction theory). Later, Freud came to believe that, although child abuse occurs, neurotic symptoms were not associated with this. He believed that neurotic people often had unconscious conflicts that involved incestuous fantasies deriving from different stages of development. He found the stage from about three to six years of age (preschool years, today called the “first genital stage”) to be filled with fantasies of having romantic relationships with both parents. Arguments were quickly generated in early 20th-century Vienna about whether adult seduction of children, i.e. child sexual abuse, was the basis of neurotic illness. There still is no complete agreement, although nowadays professionals recognize the negative effects of child sexual abuse on mental health.

Oedipal Conflicts

Many psychoanalysts who work with children have studied the actual effects of child abuse, which include ego and object relations deficits and severe neurotic conflicts. Much research has been done on these types of trauma in childhood, and the adult sequelae of those. In studying the childhood factors that start neurotic symptom development, Freud found a constellation of factors that, for literary reasons, he termed the Oedipus complex, based on the play by Sophocles, Oedipus Rex, in which the protagonist unwittingly kills his father and marries his mother. The validity of the Oedipus complex is now widely disputed and rejected.

The shorthand term, oedipal – later explicated by Joseph J. Sandler in “On the Concept Superego” (1960) and modified by Charles Brenner in The Mind in Conflict (1982) – refers to the powerful attachments that children make to their parents in the preschool years. These attachments involve fantasies of sexual relationships with either (or both) parent, and, therefore, competitive fantasies toward either (or both) parents. Humberto Nagera (1975) has been particularly helpful in clarifying many of the complexities of the child through these years.

“Positive” and “negative” oedipal conflicts have been attached to the heterosexual and homosexual aspects, respectively. Both seem to occur in development of most children. Eventually, the developing child’s concessions to reality (that they will neither marry one parent nor eliminate the other) lead to identifications with parental values. These identifications generally create a new set of mental operations regarding values and guilt, subsumed under the term superego. Besides superego development, children “resolve” their preschool oedipal conflicts through channelling wishes into something their parents approve of (“sublimation”) and the development, during the school-age years (“latency”) of age-appropriate obsessive-compulsive defensive manoeuvres (rules, repetitive games).

Treatment

Using the various analytic and psychological techniques to assess mental problems, some believe that there are particular constellations of problems that are especially suited for analytic treatment (see below) whereas other problems might respond better to medicines and other interpersonal interventions. To be treated with psychoanalysis, whatever the presenting problem, the person requesting help must demonstrate a desire to start an analysis. The person wishing to start an analysis must have some capacity for speech and communication. As well, they need to be able to have or develop trust and insight within the psychoanalytic session. Potential patients must undergo a preliminary stage of treatment to assess their amenability to psychoanalysis at that time, and also to enable the analyst to form a working psychological model, which the analyst will use to direct the treatment. Psychoanalysts mainly work with neurosis and hysteria in particular; however, adapted forms of psychoanalysis are used in working with schizophrenia and other forms of psychosis or mental disorder. Finally, if a prospective patient is severely suicidal a longer preliminary stage may be employed, sometimes with sessions which have a twenty-minute break in the middle. There are numerous modifications in technique under the heading of psychoanalysis due to the individualistic nature of personality in both analyst and patient.

The most common problems treatable with psychoanalysis include: phobias, conversions, compulsions, obsessions, anxiety attacks, depressions, sexual dysfunctions, a wide variety of relationship problems (such as dating and marital strife), and a wide variety of character problems (for example, painful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness). The fact that many of such patients also demonstrate deficits above makes diagnosis and treatment selection difficult.

Analytical organizations such as the IPA, APsaA and the European Federation for Psychoanalytic Psychotherapy have established procedures and models for the indication and practice of psychoanalytical therapy for trainees in analysis. The match between the analyst and the patient can be viewed as another contributing factor for the indication and contraindication for psychoanalytic treatment. The analyst decides whether the patient is suitable for psychoanalysis. This decision made by the analyst, besides made on the usual indications and pathology, is also based to a certain degree by the “fit” between analyst and patient. A person’s suitability for analysis at any particular time is based on their desire to know something about where their illness has come from. Someone who is not suitable for analysis expresses no desire to know more about the root causes of their illness.

An evaluation may include one or more other analysts’ independent opinions and will include discussion of the patient’s financial situation and insurances.

Techniques

The basic method of psychoanalysis is interpretation of the patient’s unconscious conflicts that are interfering with current-day functioning – conflicts that are causing painful symptoms such as phobias, anxiety, depression, and compulsions. Strachey (1936) stressed that figuring out ways the patient distorted perceptions about the analyst led to understanding what may have been forgotten. In particular, unconscious hostile feelings toward the analyst could be found in symbolic, negative reactions to what Robert Langs later called the “frame” of the therapy – the setup that included times of the sessions, payment of fees, and necessity of talking. In patients who made mistakes, forgot, or showed other peculiarities regarding time, fees, and talking, the analyst can usually find various unconscious “resistances” to the flow of thoughts (aka free association).

When the patient reclines on a couch with the analyst out of view, the patient tends to remember more experiences, more resistance and transference, and is able to reorganise thoughts after the development of insight – through the interpretive work of the analyst. Although fantasy life can be understood through the examination of dreams, masturbation fantasies are also important. The analyst is interested in how the patient reacts to and avoids such fantasies. Various memories of early life are generally distorted – what Freud called screen memories – and in any case, very early experiences (before age two) – cannot be remembered.

Variations in Technique

There is what is known among psychoanalysts as classical technique, although Freud throughout his writings deviated from this considerably, depending on the problems of any given patient.

Classical technique was summarized by Allan Compton as comprising:

  • Instructions: telling the patient to try to say what is on their mind, including interferences;
  • Exploration: asking questions; and
  • Clarification: rephrasing and summarizing what the patient has been describing.

As well, the analyst can also use confrontation to bringing an aspect of functioning, usually a defence, to the patient’s attention. The analyst then uses a variety of interpretation methods, such as:

  • Dynamic interpretation: explaining how being too nice guards against guilt (e.g. defence vs. affect);
  • Genetic interpretation: explaining how a past event is influencing the present;
  • Resistance interpretation: showing the patient how they are avoiding their problems;
  • Transference interpretation: showing the patient ways old conflicts arise in current relationships, including that with the analyst; or
  • Dream interpretation: obtaining the patient’s thoughts about their dreams and connecting this with their current problems.

Analysts can also use reconstruction to estimate what may have happened in the past that created some current issue. These techniques are primarily based on conflict theory (see above). As object relations theory evolved, supplemented by the work of John Bowlby and Mary Ainsworth, techniques with patients who had more severe problems with basic trust (Erikson, 1950) and a history of maternal deprivation (see the works of Augusta Alpert) led to new techniques with adults. These have sometimes been called interpersonal, intersubjective (cf. Stolorow), relational, or corrective object relations techniques. These techniques include expressing an empathic attunement to the patient or warmth; exposing a bit of the analyst’s personal life or attitudes to the patient; allowing the patient autonomy in the form of disagreement with the analyst (cf. I. H. Paul, Letters to Simon); and explaining the motivations of others which the patient misperceives.

Ego psychological concepts of deficit in functioning led to refinements in supportive therapy. These techniques are particularly applicable to psychotic and near-psychotic (cf., Eric Marcus, “Psychosis and Near-psychosis”) patients. These supportive therapy techniques include discussions of reality; encouragement to stay alive (including hospitalisation); psychotropic medicines to relieve overwhelming depressive affect or overwhelming fantasies (hallucinations and delusions); and advice about the meanings of things (to counter abstraction failures).

The notion of the “silent analyst” has been criticized. Actually, the analyst listens using Arlow’s approach as set out in “The Genesis of Interpretation”, using active intervention to interpret resistances, defences creating pathology, and fantasies. Silence is not a technique of psychoanalysis (see also the studies and opinion papers of Owen Renik). “Analytic neutrality” is a concept that does not mean the analyst is silent. It refers to the analyst’s position of not taking sides in the internal struggles of the patient. For example, if a patient feels guilty, the analyst might explore what the patient has been doing or thinking that causes the guilt, but not reassure the patient not to feel guilty. The analyst might also explore the identifications with parents and others that led to the guilt.

Interpersonal–relational psychoanalysts emphasize the notion that it is impossible to be neutral. Sullivan introduced the term participant-observer to indicate the analyst inevitably interacts with the analysand, and suggested the detailed inquiry as an alternative to interpretation. The detailed inquiry involves noting where the analysand is leaving out important elements of an account and noting when the story is obfuscated, and asking careful questions to open up the dialogue.

Group Therapy and Play Therapy

Although single-client sessions remain the norm, psychoanalytic theory has been used to develop other types of psychological treatment. Psychoanalytic group therapy was pioneered by Trigant Burrow, Joseph Pratt, Paul F. Schilder, Samuel R. Slavson, Harry Stack Sullivan, and Wolfe. Child-centred counselling for parents was instituted early in analytic history by Freud, and was later further developed by Irwin Marcus, Edith Schulhofer, and Gilbert Kliman. Psychoanalytically based couples therapy has been promulgated and explicated by Fred Sander. Techniques and tools developed in the first decade of the 21st century have made psychoanalysis available to patients who were not treatable by earlier techniques. This meant that the analytic situation was modified so that it would be more suitable and more likely to be helpful for these patients. Eagle (2007) believes that psychoanalysis cannot be a self-contained discipline but instead must be open to influence from and integration with findings and theory from other disciplines.

Psychoanalytic constructs have been adapted for use with children with treatments such as play therapy, art therapy, and storytelling. Throughout her career, from the 1920s through the 1970s, Anna Freud adapted psychoanalysis for children through play. This is still used today for children, especially those who are preadolescent. Using toys and games, children are able to symbolically demonstrate their fears, fantasies, and defences; although not identical, this technique, in children, is analogous to the aim of free association in adults. Psychoanalytic play therapy allows the child and analyst to understand children’s conflicts, particularly defences such as disobedience and withdrawal, that have been guarding against various unpleasant feelings and hostile wishes. In art therapy, the counsellor may have a child draw a portrait and then tell a story about the portrait. The counsellor watches for recurring themes – regardless of whether it is with art or toys.

Cultural Variations

Psychoanalysis can be adapted to different cultures, as long as the therapist or counsellor understands the client’s culture. For example, Tori and Blimes found that defence mechanisms were valid in a normative sample of 2,624 Thais. The use of certain defence mechanisms was related to cultural values. For example, Thais value calmness and collectiveness (because of Buddhist beliefs), so they were low on regressive emotionality. Psychoanalysis also applies because Freud used techniques that allowed him to get the subjective perceptions of his patients. He takes an objective approach by not facing his clients during his talk therapy sessions. He met with his patients wherever they were, such as when he used free association – where clients would say whatever came to mind without self-censorship. His treatments had little to no structure for most cultures, especially Asian cultures. Therefore, it is more likely that Freudian constructs will be used in structured therapy. In addition, Corey postulates that it will be necessary for a therapist to help clients develop a cultural identity as well as an ego identity.

Cost and Length of Treatment

The cost to the patient of psychoanalytic treatment ranges widely from place to place and between practitioners. Low-fee analysis is often available in a psychoanalytic training clinic and graduate schools. Otherwise, the fee set by each analyst varies with the analyst’s training and experience. Since, in most locations in the United States, unlike in Ontario and Germany, classical analysis (which usually requires sessions three to five times per week) is not covered by health insurance, many analysts may negotiate their fees with patients whom they feel they can help, but who have financial difficulties. The modifications of analysis, which include psychodynamic therapy, brief therapies, and certain types of group therapy, are carried out on a less frequent basis – usually once, twice, or three times a week – and usually the patient sits facing the therapist. As a result of the defence mechanisms and the lack of access to the unfathomable elements of the unconscious, psychoanalysis can be an expansive process that involves 2 to 5 sessions per week for several years. This type of therapy relies on the belief that reducing the symptoms will not actually help with the root causes or irrational drives. The analyst typically is a ‘blank screen’, disclosing very little about themselves in order that the client can use the space in the relationship to work on their unconscious without interference from outside.

The psychoanalyst uses various methods to help the patient to become more self-aware and to develop insights into their behaviour and into the meanings of symptoms. First and foremost, the psychoanalyst attempts to develop a confidential atmosphere in which the patient can feel safe reporting his feelings, thoughts and fantasies. Analysands (as people in analysis are called) are asked to report whatever comes to mind without fear of reprisal. Freud called this the “fundamental rule”. Analysands are asked to talk about their lives, including their early life, current life and hopes and aspirations for the future. They are encouraged to report their fantasies, “flash thoughts” and dreams. In fact, Freud believed that dreams were, “the royal road to the unconscious”; he devoted an entire volume to the interpretation of dreams. Freud had his patients lay on a couch in a dimly lit room and would sit out of sight, usually directly behind them, as to not influence the patients thoughts by his gestures or expressions.

The psychoanalyst’s task, in collaboration with the analysand, is to help deepen the analysand’s understanding of those factors, outside of his awareness, that drive his behaviours. In the safe environment of the psychoanalytic setting, the analysand becomes attached to the analyst and pretty soon he begins to experience the same conflicts with his analyst that he experiences with key figures in his life such as his parents, his boss, his significant other, etc. It is the psychoanalyst’s role to point out these conflicts and to interpret them. The transferring of these internal conflicts onto the analyst is called “transference”.

Many studies have also been done on briefer “dynamic” treatments; these are more expedient to measure, and shed light on the therapeutic process to some extent. Brief Relational Therapy (BRT), Brief Psychodynamic Therapy (BPT), and Time-Limited Dynamic Therapy (TLDP) limit treatment to 20–30 sessions. On average, classical analysis may last 5.7 years, but for phobias and depressions uncomplicated by ego deficits or object relations deficits, analysis may run for a shorter period of time. Longer analyses are indicated for those with more serious disturbances in object relations, more symptoms, and more ingrained character pathology.

Training and Research

Psychoanalysis continues to be practiced by psychiatrists, social workers, and other mental health professionals; however, its practice has declined.

In 2015, psychoanalyst Bradley Peterson, who is also a child psychiatrist and director of the Institute for the Developing Mind at Children’s Hospital Los Angeles, said: “I think most people would agree that psychoanalysis as a form of treatment is on its last legs.” However psychoanalytic approaches continue to be listed by the UK NHS as possibly helpful for depression.

United States

Psychoanalytic training in the United States involves a personal psychoanalysis for the trainee, approximately 600 hours of class instruction, with a standard curriculum, over a four or five-year period.

Typically, this psychoanalysis must be conducted by a Supervising and Training Analyst. Most institutes (but not all) within the American Psychoanalytic Association, require that Supervising and Training Analysts become certified by the American Board of Psychoanalysts. Certification entails a blind review in which the psychoanalyst’s work is vetted by psychoanalysts outside of their local community. After earning certification, these psychoanalysts undergo another hurdle in which they are specially vetted by senior members of their own institute. Supervising and Training analysts are held to the highest clinical and ethical standards. Moreover, they are required to have extensive experience conducting psychoanalyses.

Similarly, class instruction for psychoanalytic candidates is rigorous. Typically classes meet several hours a week, or for a full day or two every other weekend during the academic year; this varies with the institute.

Candidates generally have an hour of supervision each week, with a Supervising and Training Analyst, on each psychoanalytic case. The minimum number of cases varies between institutes, often two to four cases. Male and female cases are required. Supervision must go on for at least a few years on one or more cases. Supervision is done in the supervisor’s office, where the trainee presents material from the psychoanalytic work that week. In supervision, the patient’s unconscious conflicts are explored, also, transference-countertransference constellations are examined. Also, clinical technique is taught.

Many psychoanalytic training centres in the United States have been accredited by special committees of the APsaA or the IPA. Because of theoretical differences, there are independent institutes, usually founded by psychologists, who until 1987 were not permitted access to psychoanalytic training institutes of the APsaA. Currently there are between 75 and 100 independent institutes in the United States. As well, other institutes are affiliated to other organisations such as the American Academy of Psychoanalysis and Dynamic Psychiatry, and the National Association for the Advancement of Psychoanalysis. At most psychoanalytic institutes in the United States, qualifications for entry include a terminal degree in a mental health field, such as Ph.D., Psy.D., M.S.W., or M.D. A few institutes restrict applicants to those already holding an M.D. or Ph.D., and most institutes in Southern California confer a Ph.D. or Psy.D. in psychoanalysis upon graduation, which involves completion of the necessary requirements for the state boards that confer that doctoral degree. The first training institute in America to educate non-medical psychoanalysts was The National Psychological Association for Psychoanalysis (1978) in New York City. It was founded by the analyst Theodor Reik. The Contemporary Freudian (originally the New York Freudian Society) an offshoot of the National Psychological Association has a branch in Washington, DC. It is a component society/institute or the IPA.

Some psychoanalytic training has been set up as a post-doctoral fellowship in university settings, such as at Duke University, Yale University, New York University, Adelphi University and Columbia University. Other psychoanalytic institutes may not be directly associated with universities, but the faculty at those institutes usually hold contemporaneous faculty positions with psychology Ph.D. programs and/or with medical school psychiatry residency programs.

The IPA is the world’s primary accrediting and regulatory body for psychoanalysis. Their mission is to assure the continued vigour and development of psychoanalysis for the benefit of psychoanalytic patients. It works in partnership with its 70 constituent organisations in 33 countries to support 11,500 members. In the US, there are 77 psychoanalytical organisations, institutes associations in the United States, which are spread across the states of America. APSaA has 38 affiliated societies which have 10 or more active members who practice in a given geographical area. The aims of APSaA and other psychoanalytical organisations are: provide ongoing educational opportunities for its members, stimulate the development and research of psychoanalysis, provide training and organise conferences. There are eight affiliated study groups in the United States. A study group is the first level of integration of a psychoanalytical body within the IPA, followed by a provisional society and finally a member society.

The Division of Psychoanalysis of the American Psychological Association (APA) was established in the early 1980s by several psychologists. Until the establishment of the Division of Psychoanalysis, psychologists who had trained in independent institutes had no national organisation. The Division of Psychoanalysis now has approximately 4,000 members and approximately 30 local chapters in the United States. The Division of Psychoanalysis holds two annual meetings or conferences and offers continuing education in theory, research and clinical technique, as do their affiliated local chapters. The European Psychoanalytical Federation (EPF) is the organisation which consolidates all European psychoanalytic societies. This organization is affiliated with the IPA. In 2002 there were approximately 3,900 individual members in 22 countries, speaking 18 different languages. There are also 25 psychoanalytic societies.

The American Association of Psychoanalysis in Clinical Social Work (AAPCSW) was established by Crayton Rowe in 1980 as a division of the Federation of Clinical Societies of Social Work and became an independent entity in 1990. Until 2007 it was known as the National Membership Committee on Psychoanalysis. The organisation was founded because although social workers represented the larger number of people who were training to be psychoanalysts, they were underrepresented as supervisors and teachers at the institutes they attended. AAPCSW now has over 1000 members and has over 20 chapters. It holds a bi-annual national conference and numerous annual local conferences.

Experiences of psychoanalysts and psychoanalytic psychotherapists and research into infant and child development have led to new insights. Theories have been further developed and the results of empirical research are now more integrated in the psychoanalytic theory.

United Kingdom

The London Psychoanalytical Society was founded by Ernest Jones on 30 October 1913. After World War I with the expansion of psychoanalysis in the United Kingdom, the Society was reconstituted and named the British Psychoanalytical Society in 1919. Soon after, the Institute of Psychoanalysis was established to administer the Society’s activities. These include: the training of psychoanalysts, the development of the theory and practice of psychoanalysis, the provision of treatment through The London Clinic of Psychoanalysis, the publication of books in The New Library of Psychoanalysis and Psychoanalytic Ideas. The Institute of Psychoanalysis also publishes The International Journal of Psychoanalysis, maintains a library, furthers research, and holds public lectures. The society has a Code of Ethics and an Ethical Committee. The society, the institute and the clinic are all located at Byron House in West London.

The Society is a constituent society of the International Psychoanalytical Association, IPA, a body with members on all five continents which safeguards professional and ethical practice. The Society is a member of the British Psychoanalytic Council (BPC); the BPC publishes a register of British psychoanalysts and psychoanalytical psychotherapists. All members of the British Psychoanalytic Council are required to undertake continuing professional development, CPD. Members of the Society teach and hold posts on other approved psychoanalytic courses, e.g.: British Psychotherapy Foundation and in academic departments, e.g. University College London.

Members of the Society have included: Michael Balint, Wilfred Bion, John Bowlby, Ronald Fairbairn, Anna Freud, Harry Guntrip, Melanie Klein, Donald Meltzer, Joseph J. Sandler, Hanna Segal, J.D. Sutherland and Donald Winnicott.

The Institute of Psychoanalysis is the foremost publisher of psychoanalytic literature. The 24-volume Standard Edition of the Complete Psychological Works of Sigmund Freud was conceived, translated, and produced under the direction of the British Psychoanalytical Society. The Society, in conjunction with Random House, will soon publish a new, revised and expanded Standard Edition. With the New Library of Psychoanalysis the Institute continues to publish the books of leading theorists and practitioners. The International Journal of Psychoanalysis is published by the Institute of Psychoanalysis. Now in its 84th year, it has one of the largest circulations of any psychoanalytic journal.

India

Psychoanalytical practice is emerging slowly in India, but is not yet recognised by the government. In 2016, India decriminalised suicide in its mental health bill.

Psychoanalytic Psychotherapy

There are different forms of psychoanalysis and psychotherapies in which psychoanalytic thinking is practiced. Besides classical psychoanalysis there is for example psychoanalytic psychotherapy, a therapeutic approach which widens “the accessibility of psychoanalytic theory and clinical practices that had evolved over 100 plus years to a larger number of individuals.” Other examples of well known therapies which also use insights of psychoanalysis are mentalisation-based treatment (MBT), and transference focused psychotherapy (TFP). There is also a continuing influence of psychoanalytic thinking in mental health care.

Research

Over a hundred years of case reports and studies in the journal Modern Psychoanalysis, the Psychoanalytic Quarterly, the International Journal of Psychoanalysis and the Journal of the American Psychoanalytic Association have analysed the efficacy of analysis in cases of neurosis and character or personality problems. Psychoanalysis modified by object relations techniques has been shown to be effective in many cases of ingrained problems of intimacy and relationship (cf. the many books of Otto Kernberg). Psychoanalytic treatment, in other situations, may run from about a year to many years, depending on the severity and complexity of the pathology.

Psychoanalytic theory has, from its inception, been the subject of criticism and controversy. Freud remarked on this early in his career, when other physicians in Vienna ostracised him for his findings that hysterical conversion symptoms were not limited to women. Challenges to analytic theory began with Otto Rank and Alfred Adler (turn of the 20th century), continued with behaviorists (e.g. Wolpe) into the 1940s and ’50s, and have persisted (e.g. Miller). Criticisms come from those who object to the notion that there are mechanisms, thoughts or feelings in the mind that could be unconscious. Criticisms also have been levelled against the idea of “infantile sexuality” (the recognition that children between ages two and six imagine things about procreation). Criticisms of theory have led to variations in analytic theories, such as the work of Ronald Fairbairn, Michael Balint, and John Bowlby. In the past 30 years or so, the criticisms have centred on the issue of empirical verification.

Psychoanalysis has been used as a research tool into childhood development (cf. the journal The Psychoanalytic Study of the Child), and has developed into a flexible, effective treatment for certain mental disturbances. In the 1960s, Freud’s early (1905) thoughts on the childhood development of female sexuality were challenged; this challenge led to major research in the 1970s and 80s, and then to a reformulation of female sexual development that corrected some of Freud’s concepts. Also see the various works of Eleanor Galenson, Nancy Chodorow, Karen Horney, Françoise Dolto, Melanie Klein, Selma Fraiberg, and others. Most recently, psychoanalytic researchers who have integrated attachment theory into their work, including Alicia Lieberman, Susan Coates, and Daniel Schechter have explored the role of parental traumatisation in the development of young children’s mental representations of self and others.

Effectiveness

The psychoanalytic profession has been resistant to researching efficacy. Evaluations of effectiveness based on the interpretation of the therapist alone cannot be proven.

Research Results

Meta-analyses in 2012 and 2013 found support or evidence for the efficacy of psychoanalytic therapy, thus further research is needed. Other meta-analyses published in the recent years showed psychoanalysis and psychodynamic therapy to be effective, with outcomes comparable or greater than other kinds of psychotherapy or antidepressant drugs, but these arguments have also been subjected to various criticisms. In particular, the inclusion of pre/post studies rather than randomized controlled trials, and the absence of adequate comparisons with control treatments is a serious limitation in interpreting the results.

In 2011, the American Psychological Association made 103 comparisons between psychodynamic treatment and a non-dynamic competitor and found that 6 were superior, 5 were inferior, 28 had no difference and 63 were adequate. The study found that this could be used as a basis “to make psychodynamic psychotherapy an ’empirically validated’ treatment.”

Meta-analyses of Short Term Psychodynamic Psychotherapy (STPP) have found effect sizes (Cohen’s d) ranging from .34 to .71 compared to no treatment and was found to be slightly better than other therapies in follow up. Other reviews have found an effect size of .78 to .91 for somatic disorders compared to no treatment and .69 for treating depression. A 2012 Harvard Review of Psychiatry meta-analysis of Intensive Short-Term Dynamic Psychotherapy (ISTDP) found effect sizes ranging from .84 for interpersonal problems to 1.51 for depression. Overall ISTDP had an effect size of 1.18 compared to no treatment.

A meta-analysis of Long Term Psychodynamic Psychotherapy in 2012 found an overall effect size of .33, which is modest. This study concluded the recovery rate following LTPP was equal to control treatments, including treatment as usual, and found the evidence for the effectiveness of LTPP to be limited and at best conflicting. Others have found effect sizes of .44 to .68.

According to a 2004 French review conducted by INSERM, psychoanalysis was presumed or proven effective at treating panic disorder, post-traumatic stress, and personality disorders, but did not find evidence of its effectiveness in treating schizophrenia, panic disorder, obsessive compulsive disorder, specific phobia, bulimia and anorexia.

A 2001 systematic review of the medical literature by the Cochrane Collaboration concluded that no data exist demonstrating that psychodynamic psychotherapy is effective in treating schizophrenia and severe mental illness, and cautioned that medication should always be used alongside any type of talk therapy in schizophrenia cases. A French review from 2004 found the same. The Schizophrenia Patient Outcomes Research Team advises against the use of psychodynamic therapy in cases of schizophrenia, arguing that more trials are necessary to verify its effectiveness.

Criticism

As a Field of Science

Both Freud and psychoanalysis have been criticised in extreme terms. Exchanges between critics and defenders of psychoanalysis have often been so heated that they have come to be characterised as the Freud Wars.

Early critics of psychoanalysis believed that its theories were based too little on quantitative and experimental research, and too much on the clinical case study method. Some have accused Freud of fabrication, most famously in the case of Anna O. Philosopher Frank Cioffi cites false claims of a sound scientific verification of the theory and its elements as the strongest basis for classifying the work of Freud and his school as pseudoscience.

Others have speculated that patients suffered from now easily identifiable conditions unrelated to psychoanalysis; for instance, Anna O. is thought to have suffered from an organic impairment such as tuberculous meningitis or temporal lobe epilepsy and not hysteria (see modern interpretations).

Karl Popper argued that psychoanalysis is a pseudoscience because its claims are not testable and cannot be refuted; that is, they are not falsifiable:

….those “clinical observations” which analysts naively believe confirm their theory cannot do this any more than the daily confirmations which astrologers find in their practice. And as for Freud’s epic of the Ego, the Super-ego, and the Id, no substantially stronger claim to scientific status can be made for it than for Homer’s collected stories from the Olympus.

In addition, Imre Lakatos wrote that “Freudians have been nonplussed by Popper’s basic challenge concerning scientific honesty. Indeed, they have refused to specify experimental conditions under which they would give up their basic assumptions.” In Sexual Desire (1986), philosopher Roger Scruton rejects Popper’s arguments pointing to the theory of repression as an example of a Freudian theory that does have testable consequences. Scruton nevertheless concluded that psychoanalysis is not genuinely scientific, on the grounds that it involves an unacceptable dependence on metaphor. The philosopher and physicist Mario Bunge argued that psychoanalysis is a pseudoscience because it violates the ontology and methodology inherent to science. According to Bunge, most psychoanalytic theories are either untestable or unsupported by evidence. Cognitive scientists, in particular, have also weighed in. Martin Seligman, a prominent academic in positive psychology wrote that:

Thirty years ago, the cognitive revolution in psychology overthrew both Freud and the behaviorists, at least in academia.… [T]hinking…is not just a [result] of emotion or behavior.… [E]motion is always generated by cognition, not the other way around.

Linguist Noam Chomsky has criticized psychoanalysis for lacking a scientific basis. Steven Pinker considers Freudian theory unscientific for understanding the mind. Evolutionary biologist Stephen Jay Gould considered psychoanalysis influenced by pseudoscientific theories such as recapitulation theory. Psychologists Hans Eysenck (1985) and John F. Kihlstrom (2012/2000) have also criticised the field as pseudoscience.

Adolf Grünbaum argues in Validation in the Clinical Theory of Psychoanalysis (1993) that psychoanalytic based theories are falsifiable, but that the causal claims of psychoanalysis are unsupported by the available clinical evidence.

Richard Feynman wrote off psychoanalysts as mere “witch doctors:”

If you look at all of the complicated ideas that they have developed in an infinitesimal amount of time, if you compare to any other of the sciences how long it takes to get one idea after the other, if you consider all the structures and inventions and complicated things, the ids and the egos, the tensions and the forces, and the pushes and the pulls, I tell you they can’t all be there. It’s too much for one brain or a few brains to have cooked up in such a short time.

Likewise, psychiatrist E. Fuller Torrey, in Witchdoctors and Psychiatrists (1986), agreed that psychoanalytic theories have no more scientific basis than the theories of traditional native healers, “witchdoctors” or modern “cult” alternatives such as EST. Psychologist Alice Miller charged psychoanalysis with being similar to the poisonous pedagogies, which she described in her book For Your Own Good. She scrutinized and rejected the validity of Freud’s drive theory, including the Oedipus complex, which, according to her and Jeffrey Masson, blames the child for the abusive sexual behaviour of adults. Psychologist Joel Kupfersmid investigated the validity of the Oedipus complex, examining its nature and origins. He concluded that there is little evidence to support the existence of the Oedipus complex.

Michel Foucault and Gilles Deleuze claimed that the institution of psychoanalysis has become a centre of power and that its confessional techniques resemble the Christian tradition. Jacques Lacan criticised the emphasis of some American and British psychoanalytical traditions on what he has viewed as the suggestion of imaginary “causes” for symptoms, and recommended the return to Freud. Together with Deleuze, Félix Guattari criticised the Oedipal structure. Luce Irigaray criticised psychoanalysis, employing Jacques Derrida’s concept of phallogocentrism to describe the exclusion of the woman from Freudian and Lacanian psychoanalytical theories. Deleuze and Guattari (1972), in Anti-Œdipus, take the cases of Gérard Mendel, Bela Grunberger and Janine Chasseguet-Smirgel, prominent members of the most respected associations (IPA), to suggest that, traditionally, psychoanalysis enthusiastically embraces a police state.

The theoretical foundations of psychoanalysis lie in the same philosophical currents that lead to interpretive phenomenology rather than in those that lead to scientific positivism, making the theory largely incompatible with positivist approaches to the study of the mind.

Although numerous studies have shown that the efficacy of therapy is primarily related to the quality of the therapist, rather than the school or technique or training, a French 2004 report from INSERM concluded that psychoanalytic therapy is less effective than other psychotherapies (including cognitive behavioural therapy) for certain diseases. This report used a meta-analysis of numerous other studies to find whether the treatment was “proven” or “presumed” to be effective on different diseases.

Freudian Theory

A survey of scientific research suggested that while personality traits corresponding to Freud’s oral, anal, Oedipal, and genital phases can be observed, they do not necessarily manifest as stages in the development of children. These studies also have not confirmed that such traits in adults result from childhood experiences. However, these stages should not be viewed as crucial to modern psychoanalysis. What is crucial to modern psychoanalytic theory and practice is the power of the unconscious and the transference phenomenon.

The idea of “unconscious” is contested because human behavior can be observed while human mental activity has to be inferred. However, the unconscious is now a popular topic of study in the fields of experimental and social psychology (e.g., implicit attitude measures, fMRI, and PET scans, and other indirect tests). The idea of unconscious, and the transference phenomenon, have been widely researched and, it is claimed, validated in the fields of cognitive psychology and social psychology, though a Freudian interpretation of unconscious mental activity is not held by the majority of cognitive psychologists. Recent developments in neuroscience have resulted in one side arguing that it has provided a biological basis for unconscious emotional processing in line with psychoanalytic theory i.e., neuropsychoanalysis, while the other side argues that such findings make psychoanalytic theory obsolete and irrelevant.

Many aspects of Freudian theory are indeed out of date, and they should be: Freud died in 1939, and he has been slow to undertake further revisions. His critics, however, are equally behind the times, attacking Freudian views of the 1920s as if they continue to have some currency in their original form. Psychodynamic theory and therapy have evolved considerably since 1939 when Freud’s bearded countenance was last sighted in earnest. Contemporary psychoanalysts and psychodynamic therapists no longer write much about ids and egos, nor do they conceive of treatment for psychological disorders as an archaeological expedition in search of lost memories. (Drew Westen, 1998).

Shlomo Kalo explains that the scientific materialism that flourished in the 19th century severely harmed religion and rejected whatever called spiritual. The institution of the confession priest in particular was badly damaged. The empty void that this institution left behind was swiftly occupied by the newborn psychoanalysis. In his writings, Kalo claims that psychoanalysis basic approach is erroneous. It represents the mainline wrong assumptions that happiness is unreachable and that the natural desire of a human being is to exploit his fellow men for his own pleasure and benefit.

Jacques Derrida incorporated aspects of psychoanalytic theory into his theory of deconstruction in order to question what he called the ‘metaphysics of presence’. Derrida also turns some of these ideas against Freud, to reveal tensions and contradictions in his work. For example, although Freud defines religion and metaphysics as displacements of the identification with the father in the resolution of the Oedipal complex, Derrida (1987) insists that the prominence of the father in Freud’s own analysis is itself indebted to the prominence given to the father in Western metaphysics and theology since Plato.

On This Day … 25 December

People (Births)

  • 1875 – Francis Aveling, Canadian psychologist and priest (d. 1941).

People (Deaths)

  • 1925 – Karl Abraham, German psychoanalyst and author (b. 1877).

Francis Aveling

Francis Arthur Powell Aveling DD DSc PhD DLit MC ComC (25 December 1875 to 6 March 1941) was a Canadian psychologist and Catholic priest. He married Ethel Dancy of Steyning, Sussex in 1925.

Life

Francis Aveling was born at St. Catharines, Ontario 25 December 1875. He went to Bishop Ridley College in Ontario and McGill University before studying at Keble College at the Oxford University, England. Aveling was received into the Roman Catholic Church by Father Luke Rivington in 1896 and entered the Pontificio Collegio Canadese in Rome. There he earned his doctor of divinity degree. He was ordained to the priesthood in 1899, and served as a curate in Tottenham, before becoming first rector of Westminster Cathedral Choir School. He was also a chaplain at the Cathedral, and to St. Wilfrid’s Convent, Chelsea.

In 1910, Aveling obtained a doctor of philosophy degree at the age of 35 from the University of Louvain (his advisor was Albert Michotte), and in 1912 he was recipient of a doctor of science degree from the University of London, and received the Carpenter Medal following his work On the Consciousness of the Universal and the Individual: A Contribution to the Phenomenology of the Thought Process. Subsequently, Aveling received his doctor of letters degree from the University of London.

Career

Aveling taught at University College, London from 1912 as a Lecturer (Assistant Professor), under the leadership of Charles Spearman, until the First World War. During that war he served in France as a chaplain in the British Army, after which he returned to the University of London. In 1922, he transferred to King’s College, London where he was promoted to reader (associate professor), and later to professor of psychology. He was an extern examiner in philosophy at the National University of Ireland; and a lecturer in pedagogical methods for the London County Council.

Aveling authored several books. He was the doctoral advisor of Raymond Cattell From 1926 until 1929, Aveling was also a president of the British Psychological Society. Aveling was a member of the Council of the International Congresses, of the Aristotelian Society, of the council and advisory board of the National Institute of Industrial Psychology, of the council of the British Institute of Philosophical Studies and of the Child Guidance Council.

He was a contributor to the Dublin Review, The American Catholic Quarterly Review, Catholic World, The nineteenth Century, The Journal of Psychology, and the Catholic Encyclopaedia.

Karl Abraham

Karl Abraham 03 May 1877 to 25 December 1925) was an influential German psychoanalyst, and a collaborator of Sigmund Freud, who called him his ‘best pupil’.

Life

Abraham was born in Bremen, Germany. His parents were Nathan Abraham, a Jewish religion teacher (1842-1915) and his wife (and cousin) Ida (1847-1929). His studies in medicine enabled him to take a position at the Burghölzli Swiss Mental Hospital, where Eugen Bleuler practiced. The setting of this hospital initially introduced him to the psychoanalysis of Carl Gustav Jung.

Collaborations

In 1907, he had his first contact with Sigmund Freud, with whom he developed a lifetime relationship. Returning to Germany, he founded the Berliner Society of Psychoanalysis in 1910. He was the president of the International Psychoanalytical Association from 1914 to 1918 and again in 1925.

Karl Abraham collaborated with Freud on the understanding of manic-depressive illness, leading to Freud’s paper on ‘Mourning and Melancholia’ in 1917. He was the analyst of Melanie Klein during 1924–1925, and of a number of other British psychoanalysts, including Edward Glover, James Glover, and Alix Strachey. He was a mentor for an influential group of German analysts, including Karen Horney, Helene Deutsch, and Franz Alexander.

Karl Abraham studied the role of infant sexuality in character development and mental illness and, like Freud, suggested that if psychosexual development is fixated at some point, mental disorders will likely emerge. He described the personality traits and psychopathology that result from the oral and anal stages of development (1921). Abraham observed his only daughter Hilda Abraham reporting on her reaction to enemas and infantile masturbation by her brother. He asked that secrets be shared with him but he was careful to respect her privacy and some reports were not published until after Hilda.s death. Hilda was later to become a psychoanalyst.

In the oral stage of development, the first relationships children have with objects (caretakers) determine their subsequent relationship to reality. Oral satisfaction can result in self-assurance and optimism, whereas oral fixation can lead to pessimism and depression. Moreover, a person with an oral fixation will present a disinclination to take care of him/herself and will require others to look after him/her. This may be expressed through extreme passivity (corresponding to the oral benign suckling substage) or through a highly active oral-sadistic behaviour (corresponding to the later sadistic biting substage).

In the anal stage, when the training in cleanliness starts too early, conflicts may result between a conscious attitude of obedience and an unconscious desire for resistance. This can lead to traits such as frugality, orderliness and obstinacy, as well as to obsessional neurosis as a result of anal fixation (Abraham, 1921). In addition, Abraham based his understanding of manic-depressive illness on the study of the painter Segantini: an actual event of loss is not itself sufficient to bring the psychological disturbance involved in melancholic depression. This disturbance is linked with disappointing incidents of early childhood; in the case of men always with the mother (Abraham, 1911). This concept of the prooedipal “bad” mother was a new development in contrast to Freud’s oedipal mother and paved the way for the theories of Melanie Klein (May-Tolzmann, 1997).

Another important contribution is his work “A short study of the Development of the Libido”, where he elaborated on Freud’s “Mourning and Melancholia” (1917) and demonstrated the vicissitudes of normal and pathological object relations and reactions to object loss.

Moreover, Abraham investigated child sexual trauma and, like Freud, proposed that sexual abuse was common among psychotic and neurotic patients. Furthermore, he argued (1907) that dementia praecox is associated with child sexual trauma, based on the relationship between hysteria and child sexual trauma demonstrated by Freud.

Abraham (1920) also showed interest in cultural issues. He analysed various myths suggesting their relation to dreams (1909) and wrote an interpretation of the spiritual activities of the Egyptian monotheistic Pharaoh Amenhotep IV (1912).

Death

Abraham died prematurely on 25 December 1925 from complications of a lung infection and may have suffered from lung cancer.