Psychoanalysis and the invention of the ‘neuroses’, past and present ian Parker Learning outcomes



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A simplified and reorganised version of this chapter was published as: Parker, I. (2010) ‘Psychoanalysis: the “talking cure”’, in M. Barker, A. Vossler and D. Langdridge (eds) Understanding Counselling and Psychotherapy (pp. 77-99). London: Sage. [ISBN: 978-1-84920-476-7].


PSYCHOANALYSIS AND THE INVENTION OF THE ‘NEUROSES’, PAST AND PRESENT
Ian Parker
Learning outcomes
When you have read this chapter you will be able to:


  • Understand the basic psychoanalytic principles and the way they took shape in a particular historical context;




  • Reflect on the role of the unconscious, speech and representations of the past in psychoanalytic theory and practice;




  • Understand how psychoanalytic practitioners work with the themes of fear and sadness;




  • Apply psychoanalytic ideas to case vignettes;




  • Explore the way that relationships are structured and given meaning in such a way that neurotic distress reflects present-day relations of power between men and women;


Introducing the unconscious
One of the problems a psychoanalyst faces today when they are introducing the theoretical framework to the general public, to a student of psychology, or indeed to their ‘analysand’ (the technical term for the client or patient in analysis) is that their audience already thinks it knows what they mean by ‘psychoanalysis’. Freud’s work historically is forerunner and powerful influence on other counselling and psychotherapy approaches. Indeed, many of the key figures in the field trained first as analysts and then developed their own approaches. This means that other later theories that are indebted to Freud take pains to distance themselves from psychoanalysis and they often provide a caricatured picture of what he said. Those in neighbouring competing disciplines, such as psychology, have also played their part in presenting an account of his work that bears little resemblance to the historical facts (Richards, 1989). In addition, Freudian themes have been a popular motif in films, magazines and novels, and psychoanalysis circulates in ‘discourses’ or ‘social representations’ that people relay to each other when they notice ‘Freudian slips’, puzzle about the meaning of their dreams or trace their problems to traumatic childhood events (Parker, 1997; Moscovici, 2008).

So let us begin with some stories about psychoanalysis: Freud was born in 1856; he based his theories on the experiences of middle-class Viennese Jewish women; he thought the subconscious mind contained repressed feelings; he outlined a series of normal stages of development and saw failure to pass through these stages resulting in mental disorders; he argued that boys pass through the Oedipus complex, and later conceded that girls went instead through an ‘Electra complex’; and he claimed that symptoms could be cleared up if the contents of the unconscious mind were made conscious. Each and every one of these statements is false, save that there is good evidence that Freud was born in 1856. So we need another starting point, to wipe away these false impressions and start from scratch. There is a little model of the mind that Freud described in 1925 that can help us do that.

The ‘mystic writing pad’ Freud (1925) describes is a children’s toy that we can still find on sale. A cardboard frame encloses a cellophane layer, and when we press a plastic stylus against it we can draw or write something; an image appears because we press the layer of greaseproof paper behind the cellophane against a thin wax tablet. And then, if we pull the slide across which breaks the contact between greaseproof paper and the wax tablet, the image disappears so we can start again. It is tempting to think of this model of the mind as being like the black slate that empiricist philosophers posited, but Freud shows us that the lesson of the ‘mystic writing pad’ actually shows us something important about the work of the unconscious. The image disappears, but it leaves behind a trace when then affects later images. If we were to tear off the cellophane and greaseproof paper layers and hold the wax tablet up to the light we would see a pitted surface, which is the result of the stylus pressing against it. This means that lines that are drawn later have breaks, gaps, imperfections.

We can treat the images that we make with the stylus as ‘consciousness’ and the wax tablet as the ‘unconscious’, but there are three lessons to learnt from the device. One is that the unconscious is not a place, but a jumble of historical traces pressed together in a way that is quite unlike forms of representation in everyday reality. Secondly, consciousness, which appears by virtue of the wax tablet touching the greaseproof paper, is not possible unless the unconscious is at work. The third lesson is that we know about the unconscious by way of what is missing, through the gaps and distortions that mark the way we perceive the world and the way we describe it, and in the way we represent the past to ourselves and reflect on who we are.


[BEGIN BOX]—
Activity X.1: ‘Happiness’
Think of a positive moment in your life or of someone you know well, and spend a few minutes noting other descriptive terms that could be applied to that moment. Terms might include, for example, ‘ecstatic’, ‘satisfying’ or ‘poignant’. Now note down the terms that might be used to describe that same moment by other people who know you or know that other person. Those other terms might be from the standpoint of someone who is, for example, disapproving, rivalrous or proud of that positive moment.
Comment
This is one way of opening up the complexity of what is meant by ‘happiness’. There are two psychoanalytic points which are relevant here.

The first is that our definition of what happiness is depends on the particular position of the person experiencing it and the context in which they experience it, and the crucial psychoanalytic argument is that there are multiple definitions which are contradictory. Psychoanalysis attends to how human beings are both internally divided and always connected to others (and this is one reason why ‘individual’, which tends to describe someone undivided and separate, is not often used in psychoanalytic debate). There are always a number of vantage points on a positive experience, and psychoanalytic practice explores how those vantage points of other people enter into our internal world tingeing what we feel. One agency within us that tells us to be happy, but with a lot of small print concerning the conditions under which we might feel so, is what Freud calls the ‘superego’.

The second point is that our awareness of others and what they want of us is always at some level, conscious or unconscious, and others have an impact on what we think of as ‘happiness’. There are serious consequences of this point for counselling and psychotherapy. One is that there is a danger that people will be made to conform to an ideal of ‘happiness’ that is defined by governmental bodies, and there is a powerful pharmaceutical industry promising to deliver medication to make people happy, but happy in a way that is not defined by the person themselves. The other is that human life is not necessarily happy at all. Psychoanalysis brings to our attention a more tragic vision which is captured in Freud’s comment that the most that can be hoped for is what he called ‘common unhappiness’. While this may seem pessimistic, it draws attention to the concern psychoanalysis has with the complexity of human life and with personal truth as being more important than what may amount to banal shallow ‘positive psychology’.
[END BOX]—
Fear and Sadness
There are problems with the individual reflection that psychoanalysis promotes, and we should pause for a moment to take stock of these problems. A particular form of alienated subjectivity that emerged with the development of capitalism now has the name ‘psychoanalysis’, and as a therapeutic approach it has become an indispensable part of capitalist society. Nineteenth-century industrialisation in Europe saw the new workforce gathered together in factories, and even if workers had not actually been wrenched from the land and from an intimate temporal relationship with nature, their abstracted life conditions in the capitalist economy invited a hearkening back to what, they sensed, was lost. Workers were forced to sell their labour power in competition with others in order to survive, and to submit to the rule of a clock-time with parameters set by others. In the early socialist movements there were attempts to look outward, collectively and historically, to account for how such self-destructive processes emerged and how they could be ended. This is the context for the development of certain conceptions of science, a context in which psychoanalysis had to argue for status (Schwarz, 1999). Against this background of industrialisation under capitalism it would be possible to argue that fear and sadness became an intrinsic part of everyday life, and that the popularity of psychoanalysis and psychology more generally is a sign of the failure of the socialist movements. People have come to look inside themselves for solutions to social problems, and in this light psychoanalysis is part of the problem (Parker, 2007, 2009).

Psychoanalysis is such an important enduring influence on counselling and psychotherapy through the course of the twentieth century because it operates historically as a kind of translation mechanism. In this way old psychiatric categories could be reworked and turned from being seen as organic dysfunctions to being grasped in terms of the meaning they have for the patient. Psychoanalysis translates categories of distress from a medical frame into a therapeutic frame. There are two aspects to this process.

First, looking back to psychiatry, Freud retains distinctions between ‘neuroses’, which can be treated in analysis as a talking cure and ‘psychoses’ in which the disorder is so deep that psychiatric treatment is still necessary. It is within the psychoanalytic frame of neurosis that we find discussion of different elements of fear and sadness. With respect to fear, for example, Freud (1895) focuses on ‘anxiety’ as core experiential state which may then be given form as panic or phobia. In the case of sadness, Freud homes in on the phenomenon of ‘loss’ and this loss of the first love object haunts the person and will give rise to particular forms of grief and depression. These specific names for fear and sadness are treated as being part of neurotic unhappiness, but Freud (1917a) still insists that anxiety and loss can give rise to psychotic disorders, that the person may engage in such drastic forms of defence that they shut out the possibility of psychoanalytic exploration.

The second aspect becomes apparent where, looking forward to therapy, we see psychoanalysis claiming expertise in a broader range of problems and acknowledging that there is no complete non-neurotic happiness to be had by human beings. Many psychoanalytic traditions of work after Freud now either see ‘psychotic’ aspects of experience in every person or find a way to support psychotic modes of being in analysis. And there is now widespread agreement that there is no such thing as a ‘normal’ individual, rather we are all neurotic in one way or another. Or, another way of putting it is to say that being neurotic is one way of being normal. This move takes us further away from old psychiatry and toward working with the complexity of subjectivity, and it gives an opening to a wide range of counseling and psychotherapeutic frameworks that work with the different ways that people cope with being in the world. In this way psychoanalysis as a translation mechanism functions at the beginning of the twentieth century to seize descriptions of distress from psychiatry and make them available to a range of non-medical practitioners.

There is, however, still a contradiction at work in psychoanalysis that continues to the present day. On the one hand there is opposition to the medical model, and Freud (1926) argued for the right of ‘lay analysts’ who were not also qualified as doctors to train and practice as psychoanalysts. On the other hand, Freud lost his arguments with his US medical colleagues (Jacoby, 1983), and today psychoanalysis still often perpetuates psychiatric expertise, and in this form it still has a malign influence on our understanding of gender and sexuality (Millett, 1977; O’Connor and Ryan, 1993). The battle of who is normal and who is abnormal is not over yet.
Representing ourselves
The gaps in the lines drawn on the ‘mystic writing pad’ give clues about the shape of the unconscious, and the psychoanalyst is trained to notice imperfections in speech as we skirt around certain things, as we slip up over certain phrases. Analysis is then designed to be a place where the analysand starts to notice such distortions themselves and then breaks in the conscious narrative are the opportunity to reflect on what the significance might be to the nature of the symptom, dream or fantasy they were describing to the analyst.

Psychoanalysis is concerned with speech, and the analysand’s attempt to ‘free associate’ reveals to them the limits of their freedom in language, and so they then have an opportunity to discover something about they limit themselves. This is why, against traditional psychiatric practice in the nineteenth century which tried to make pathology visible, psychoanalysis is a ‘talking cure’, it shifts attention from what can be seen to what can be heard, heard by the analyst and, most importantly, heard by the analysand themselves as they speak.

There is a very important aspect of this attention to speech which also sets psychoanalysis against some of the later ‘expressive’ or ‘body’ therapies which encourage the client to act out repressed experiences or combine talking with massage to break down ‘body armour’ defences. Psychoanalysis insists that the curative process comes through the putting of things into words, or, more accurately combining things with words, and when this is done in the presence of another person, the analyst, those connections can be reflected upon. This is why ‘acting out’ is viewed as a short-cut which will sabotage such reflection, it is a way of avoiding the more painful but more curative process of speaking. This is also where we have to introduce some complications into the ‘mystic writing pad’ model of the mind.

Freud argues that the unconscious and conscious parts of the mind are composed of ‘representations’. Words are one kind of representation of experience, the kind of representation that defines consciousness, and Freud argues that consciousness is built up out of a connection between ‘word presentations’ and ‘thing presentations’. He also argues that the unconscious is also built up out of representations, the ‘thing presentations’ but without any words to organise them in a narrative. This is why dreams are a chaotic jumble of images that we only put into some order as we represent them to ourselves connecting them with the word presentations we have available to us in consciousness, or when we describe them to someone else. When repression or some other defence is engaged in to protect the person from thinking about painful things that have happened or against fantasies that they would rather pretend they have never entertained, it bears on representations rather than feelings.



There are a number of important consequences for this insistence on ‘representations’ as the stuff of psychoanalysis. One consequence is that it is more accurate to refer to ‘drives’ rather than ‘instincts’, and recent work on the problems of translating Freud into English have drawn attention to the way Freud quite deliberately used the German word for ‘drive’ as something that was on the border of the physiological and the psychical (Bettelheim, 1986). A second consequence is that there is no direct access to feeling, only representations of feelings, and so psychoanalysis does not aim to release feelings as part of the curative process. Rather it attends to representations produced in speech and enables critical reflection on those representations. A third consequence is that there is no direct access to the unconscious or to formations of the unconscious like dreams. Our understanding of what may be unconscious to us is always mediated by the representations we have of what lies inside ourselves.
[BEGIN BOX]—
Information Box X.I: Defences
Freud’s daughter Anna, who was analysed by her father, which is something that would be considered rather odd nowadays, became a respected child analyst and leader of one of three training groups in the British Psycho-Analytical Society. Her outline of nine ‘defence Mechanisms’ is designed to identify which mechanisms the analysand uses to defend their ‘ego’, which ones the analyst should question and which they might support (Freud, 1936), and later analysts have built on the differentiation between a longer list of ‘mature’, ‘neurotic’, ‘immature’ and ‘narcissistic’ defences (Vaillant, 1971). The nine defences Anna Freud describes are as follows:


  • Denial. Refusal to acknowledge the anxiety (as affect connected with to the painful idea or event), or the sources of anxiety (the memory of the traumatic event), or an aspect of the self.




  • Regression. Attempt to go back to earlier state or mode of functioning, enabling the subject to avoid anxiety by returning to a fixation point.




  • Reaction formation. An unacceptable impulse is warded off by way of exaggerating the opposing tendency, a strategy that may fail or may enable successful redirection of energy.




  • Projection. Impulses, wishes or aspects of the self which are experienced as painful and unpleasant, are attributed to others, and then experienced as a threat proceeding from the outside world.




  • Introjection. A representation of an external object, and so the relationship with that object, is taken in and so serves momentarily to alleviate separation anxiety.




  • Displacement. Affect is ‘re cathected’ (or re invested), shifted from one object to another, and this may then serve to mask the real object of anxiety, or to redirect attention to an acceptable substitute.




  • Rationalisation. A logical and reasonable account is given to others (and to the self) which justifies the slip, dream, action, joke or memory, and, in the process, the true motivation is concealed.




  • Sublimation. Energy is displaced from objects of primary importance, the accompanying pleasure is desexualised or shorn of aggression and it becomes more socially acceptable.




  • Intellectualisation. A sense of detachment is gained from threatening memories, situations or persons by re-describing them in abstract terms, which might include describing them in abstract psychoanalytic terms.

[END BOX]—


The defences that people use to protect themselves inside and outside psychoanalysis are concerned with the strategic use of representation. ‘Rationalisation’, for example, is a defence that helps people to explain away events that may otherwise reveal unconscious sources of their actions, and ‘intellectualisation’ enables them to weave a story about what they experience that links together conscious ‘word presentations’ in such a way as to avoid a connection with ‘thing presentations’ in the unconscious. The aim of psychoanalysis, in contrast, is to facilitate a reflection on these connections. It is much easier to engage in such defences if one is thinking about things on one’s own, and what psychoanalysis does is to provide a space in which there is another person who is a witness to what is being said, a witness who will not let the person off the hook so easily. So, speaking to another mobilises certain kinds of defence – one term for this is ‘transference’ as the repetition of relationships from the past in relation to the analyst – and facilitates critical reflection on our representations of experience. In this way speech is the material basis of psychoanalytic work as a ‘talking cure’. The fear of significant others may be replayed in the psychoanalytic relationship, for example, and it is the task of the psychoanalyst to contain and explore feelings of sadness that arise when painful memories from the past reappear.
Dreams, of our selves and others
Let us focus on the representation in dreams to illustrate how psychoanalysis treats the dream as ‘a royal road to an understanding of the unconscious’, as Freud put it, as against uncovering real meanings under the surface. Freud (1900) insisted that dreams and the associations to dreams that were relevant to the analyst were those that were particular to each person, and he spent some time differentiating what he had to say from authors who set out what the meanings of symbols in dreams were. There are two aspects to representation in dreams.

The first is that psychoanalysis is concerned with the ‘dream work’ and strategies of concealment, rather than with what is actually concealed. This dream work is composed of what Freud terms ‘condensation’ (in which images are combined), ‘displacement’ (in which affect is transferred from one image to another), ‘considerations of representability’ (in which the image is given some coherence to make it understandable), and ‘secondary revision’ (in which the telling of the dream introduces further distortions, another layer of concealment). The second aspect of is that the process of telling the dream to the analyst is within the ‘transference’, and this transference relationship itself introduces a further layer of distortion. Intentionally or not, the dreamer tells the dream for an audience, which is what they are doing when they think about it when they wake up and which is tailored to what they think are the interests of another person when they tell it later during the day.


[BEGIN BOX]—
Illustrative case X.1: Dreams
Freud (1900) describes how a ‘clever woman patient’ challenged him over his claim that a dream represents the fulfilment of a wish, and how she then told him a dream that would prove him wrong. There is some background to the dream that Freud discusses in his analysis, and these relationships provide context for unravelling it. The dreamer loved caviar on bread, and she was in the habit of teasing her husband, who liked well-rounded women that much as she would like him to bring her caviar every morning he should not do this. Her husband meanwhile was putting on weight and had resolved to rise early, do exercises and refuse dinner invitations. He also had talked a lot recently about his wife’s thin friend. The thin friend very much liked smoked salmon, and had recently asked after being invited round for dinner, commenting that our clever woman patient always fed her guests so well. Here is the dream:
I wanted to give a supper-party, but I had nothing in the house but a little smoked salmon. I thought I would go out and buy something, but remembered then that it was a Sunday afternoon and all the shops would be shut. Next I tried to ring up some caterers, but the telephone was out of order. So I had to abandon my plan to give a supper-party.
Freud, 1900, p.147
Comment
There are a number of intriguing issues this dream raises, including about the nature of the dreamer’s desire and about transference.

There is indeed something in the dream which does not fulfil a wish. This is the caviar which is represented by smoked salmon in the dream, but the twist here is that dreamer has herself said that she tells her husband not to fulfil this desire, not to give her smoked salmon. The dream does not fulfil the wish to give a dinner party, but it by the same token represents a refusal to feed up the thin friend and turn her into someone more rounded, with the kind of figure that she knew her husband liked. In this way it does represent the fulfilment of a wish, to keep her husband to herself.

This neat explanation leads Freud to some further comments on what may be driving the dreamer, about her desire. This brings us to the question of ‘hysteria’, which was one of the key motifs of early work in psychoanalysis to identify a particular distressing combination of fear and sadness. Freud insisted that hysteria was not something peculiar to women in the way mainstream psychiatry had tended to assume. Notwithstanding this, in this case once again the hysteric is a woman, and Freud (1900, pp. 148-151) makes two points. One is that the hysteric is concerned with finding strategies for keeping desire unfulfilled, and in this respect we could say that the underlying structure of human experience is in some sense hysteric. We yearn after things, but in fantasy, and we want to keep them at a distance so we can keep on desiring. Obtaining objects of desire would spell the end of desire itself. The second point is that we can see the substitution of the caviar by smoked salmon as evidence of the ‘hysterical identification’ of the woman patient with her thin friend. She suspects that her husband desires her friend, and so at one of the deeper levels of the dream we can detect a representation of a relationship with the friend by which she is able to put herself in her friend’s place, to be her friend, and so to be the object of her husband’s desire.

There is something else, something which the analyst always attends to alongside the material that is brought to the session by the analysand, which is the peculiar relationship in which things are told. The clever woman patient wants to prove Freud wrong, to show that his claim that dreams represent the fulfilment of a wish is mistaken, and the dream itself therefore represents the fulfilment of a wish, that her analyst’s own desire is unfulfilled. The account is produced in the context of a transference relationship of a particular kind, one in which a hysteric wants to displace the analyst from his position of power. We should also notice, of course, that Freud’s triumphant interpretation which proves he is right thereby restores himself to the position of the analyst, and so he too is working in the transference.


[END BOX]—
We can now appreciate the significance of Freud’s (1900) argument that the dream represents the fulfilment of a wish. It does not fulfil the wish as such, but produces a representation of that fulfilment. In the process of telling it to another person, the analyst, representations of our past in the transference provides the setting for the analysand to repeat relationships from the past and bring them to life again in the present. They bring them to life again in such a way that they can then reflect on what they might mean. There is an opportunity here for the analysand to understand more about themselves, but there is also a risk, which is why a series of defensive strategies are often employed by the analysand to ‘rationalise’ or ‘intellectualise’ the dream or to treat the analyst as an idiot for daring to suggest that the dream might be concealing something significant.
Structure and power
One might understand psychoanalysis as a power relationship, as one which carries on into the twentieth century a long-standing psychiatric tradition of labelling people as suffering from different disorders and categorising them, as ‘hysteric’ or ‘obsessional’ perhaps, when they complain to the doctor (Masson, 1984). The psychiatric background then becomes all the more evident when other categories such as ‘psychotic’ or ‘perverse’ are used to identify more extreme ways of dealing with fear and sadness. It is against this history that contemporary psychoanalysis and other forms of psychotherapy and counseling have tried to balance that relation of power. That is one way of dealing with the problem, one that aims to dissolve it into a more equal relationship. There is another more authentically psychoanalytic argument, however, which says that it is the power relationship itself and the way it is played out in transference that gives the analysand an opportunity to ‘work through’ rather than avoid issues of power in their own lives.

The argument here is that power is a feature of social relationships and our internal worlds, and psychoanalysis takes this seriously and addresses it as it lived out in therapy. This is how we can approach the importance of ‘structure’ in psychoanalysis, for if we can grasp the importance of structure then we can know something about power, in particular the way relationships are structured and given meaning, for how neurotic distress reflects present-day relations of power between men and women. Psychoanalysts name one key structure ‘Oedipus’, and this ‘Oedipus complex’ is certainly filled with different contents by Freud when he spells out what ‘gender’ is and when he tries to ground the Oedipus complex is prehistory with a rather dodgy argument that this is an instance of ontogeny recapitulating phylogeny (that the development of an individual plays out again the development of the species to which they belong).

However, there are tensions in Freud’s own account, and later analysts have argued that the Oedipus story is about the particular circumstances of the main character who fails to comprehend the predictions made about his life (Bettelheim, 1986). What is left after we take out these specific circumstances is a basic structure, and this structure is then filled with different contents, different meanings by each person. The basic structure is triangular, and the infant (point 1) is first helpless and cared for by another who they then love as their first love object (point 2), but they will need to be able to move around a world in which they have other relationships, to acknowledge that there are others in the world that they relate to and that even that their first object of love relates to, and the moment of reckoning appears in the form of a third figure (point 3). To speak of point 2 as ‘mother’ and point 3 as ‘father’ already fills the structure with content, and these structural points do not at all call for figures of one gender or another to occupy them. Contemporary psychoanalysis has been concerned with showing that there are many permutations in this structure, how, for example, point 2 and point 3 may be embodied in the same figure adopting different contradictory positions (O’Connor and Ryan, 1993).

This structure of human relationships is one that divides us from each other, and in present-day society it also tends to divide men from women for there is a powerful assumption built into the nuclear family that is the dominant model of care-giving (if not actually the reality of most people’s lives now) that mother should be primary care-givers and that the father should be the one who lays down the law. The question now is whether psychoanalysis gives a powerful description of patriarchal power relations, relations in which men dominate women and older men dominate younger men (Millett, 1977), or whether it also smuggles into its account a prescription for how things should be. The argument that there is no such thing as a ‘normal’ individual and that we are all neurotic in our own particular way would seem to speak for the first option. We are each fearful and sad in our own particular way, and psychoanalysis helps us to understand this particularity of ‘neurotic’ experience. That psychoanalysis provides a description of the world so we can better know how to change it is the reading of Freud that has been advanced by some feminist writers keen on psychoanalysis (Mitchell, 1974).


Conclusion: Context and the clinic
Freud took clinical categories from psychiatry and reinterpreted them, and he embedded them in a new theoretical framework that placed value on the meanings that people gave to their distress. The focus of psychoanalytic work is then on what someone means when they say they ‘fear’ something or that they are afflicted by a ‘sadness’ they cannot comprehend. As we have pointed out, one of the consequences of the psychiatric legacy has been that some extreme conditions such as ‘psychosis’ and ‘perversion’ were seen as untreatable by psychoanalysis. For many years this tended to maintain a psychiatric frame for understanding those conditions (Parker et al., 1995).

Psychoanalysis has proved influential in the clinic and in our everyday understanding of distress in the two categories it has continued to deploy since Freud, ‘hysteria’ and ‘obsessional neurosis’. These categories have been powerful conceptual tools in the clinic but also raise questions about changing gender relations. For many years it was assumed that women tend to be ‘hysterics’ and men suffer from a form of distress that Freud described as a ‘dialect’ of hysteria as ‘obsessional neurotics’. We have seen that hysteria and hysterical identification presupposes a close tie with early love objects, and it is possible that women have been more predisposed to hysteria because the relationship between mother and daughter is closer than that between mother and son (Chodorow, 1978). Hysteria is characterised by accusation directed to others, and a sense of loss and anger that is sometimes turned inwards, and in Freud’s early cases ‘conversion’ of psychic conflict into bodily symptoms which were also produced in the context of the restricted lives of women at that time. The obsessional neurotic, on the other hand, tends to separate themselves from others and to enclose their problems in their mind in such a way as to feed the guilt they experience as part of their distress. This characteristic of obsessional neurosis does indeed correspond to stereotypically masculine ways of relating, or not relating to others.

It is often said that obsessional neurosis is more difficult to tackle in the clinic than hysteria because the obsessional neurotic tries to keep the problem private, and they are less willing to speak about it. The process of analysis therefore has to ‘hystericise’ the analysand, to enable them to speak, perhaps to accuse others and then to reflect on their own place in what they complain about. One could say that a consequence of this process, one which fits with the popular image of psychotherapy as being more ‘feminine’, is that the analysand is ‘feminised’. Psychoanalysis therefore describes these relationships between men and women, and although it sometimes seems to endorse them, it also provides the setting and the conceptual resources for changing them (Mitchell, 1974).
[BEGIN BOX]—
Activity X.2: Discourse
Take a break and read an advice column in a popular magazine where people write in about their problems and are told by the ‘agony aunt’ figure how to resolve them. Switch on the television and watch one of the ‘confessional’ programmes where people with problems, or people who are problems for others, are brought on to be given advice. Note the ways in which problems are defined and people are invited to take responsibility for changing themselves, how they are encouraged to face up to their fears or work their way through they sadness, for example.
Comment
Psychoanalytic terminology is very much alive as a commonsensical resource, and it is possible to see references to trauma, repression and the importance of acknowledging feelings in many popular media advice forums. However, psychoanalytic discourse also has to compete with other forms of psychologised knowledge about the nature of individuals. There are other specifications for the self which also comprise therapeutic discourse that we can notice that circulate through culture and carry with them certain notions about anxiety and rational self-management. There are cognitive ideas that build on psychoanalytic theory and take it in a quite different direction. Notions of thought interference, in which there is an assumption that the mind operates as a parallel-processing mechanism in which certain thoughts stray from their proper place and cause trouble with rational thinking about the self. We will find references to the disruption of thinking in which we are reminded that if we shut away emotions there is a risk that those emotions may come to the surface and disrupt clear thought.

Turning to behavioural notions, we can notice assumptions that there is a behavioural problem for which a behavioural solution will be found, and we often find this in popular psychology concerned with addiction or eating disorders. These behavioural narratives sometimes rest on the idea of reinforcement, in which there is also reference to the gratification that the therapeutic subject gains from being in a self-destructive relationship or situation. Sometimes there is the implication that they are also engaged in some deliberate manipulation of the situation and sometimes the person is portrayed as locked into a pattern of relationships or into an oppressive and self-oppressive institutional network, and that nothing can be done to help them unless they are removed. This appeal to the social determination of behaviour is a rhetorical device which is sometimes used to explain why nothing can be done to help, but it also operates therapeutically when there are calls for people to break from a pattern and thereby release themselves from something that had locked them into a place that they could later recognise they did not at all want to be in.

Here we notice how psychoanalysis circulates in contemporary culture as a form of ‘myth’ about the self that is powerful because it feels as if it is true, and a counsellor or psychotherapist who is aware of this myth, and the other forms of myth that circulate in our culture about ‘cognition’ and ‘behaviour’ is in a better position to understand, work with and sometimes challenge the theories that the client has about the problem.
[END BOX]—
Freud’s earliest case studies published jointly with his colleague Josef Breuer in Studies on Hysteria (Breuer and Freud, 1895) are still an invaluable resource for counsellors and psychotherapists. This is partly because there is a focus on the specific symptom and exploration of its link to a traumatic moment (Parker, 2003a), partly because even the first ‘full-length’ session is quite brief at less than a year (Parker, 2003b), and partly because we can see the importance ‘structure’ in the way the problem is defined and the context in which Freud interprets the problem (Parker, 2006). These case studies then provide the background for Freud’s puzzling over the nature of gender identity and the way this is formed within the nuclear family (Parker, 2003c).

One theme of this chapter has been that psychoanalysis carries traces from the past, from psychiatry, but that its invention of the ‘neuroses’ opened up new ways of thinking about distress which gives a particular slant on everyday terms like ‘fear’ and ‘sadness’. This leads us to some concluding questions for you to think about in relation to the issues we have explored as we followed this theme.




  • Should there be a separation between the clinic, how relationships are questioned and changed there, and the world of politics?




  • Is a psychoanalytic view of human life too pessimistic or is it necessary to be realistic about what can be changed and what cannot?




  • Does Freud end up providing an account of distress that is normative, that presupposes a healthy standard, or is it questioning of that standard?




  • Does this approach empower when it offers a space for people to experience power again in transference or does it disempower?


Further reading
Bettelheim, B. (1986). Freud and Man’s Soul. Harmondsworth: Pelican.
A passionately argued defence of psychoanalysis which emphasises the humanistic aspects of Freud’s work and the importance of the specific meanings of the words we use to describe the therapeutic process with each individual.
Masson, J. M. (1984). The Assault on Truth: Freud’s Suppression of the Seduction Theory. Harmondsworth: Penguin.
A strong case is made that the turn to unconscious fantasy in psychoanalysis risks turning attention away from the reality of child sexual abuse and an understanding of the traumatic consequences of real events.
References
Bettelheim, B. (1986). Freud and Man’s Soul. Harmondsworth: Pelican.

Breuer, J. & Freud, S. (1895). Studies on Hysteria. In J. Strachey (Ed) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. II. London: Vintage, The Hogarth Press and the Institute of Psycho-Analysis.

Chodorow, N. (1978). The Reproduction of Mothering. Berkeley: University of California Press.

Freud, A. (1936). The Ego and the Mechanisms of Defence. London: The Hogarth Press.

Freud, S. (1895). On the grounds for detaching a particular syndrome from neurosthenia under the description ‘anxiety neurosis. In J. Strachey (Ed) (1953) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. III. London: Vintage, The Hogarth Press and the Institute of Psycho-Analysis.

Freud, S. (1900). The Interpretation of Dreams (First Part). In J. Strachey (Ed) (1953) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. IV. London: Vintage, The Hogarth Press and the Institute of Psycho-Analysis.

Freud, S. (1915). The unconscious. In J. Strachey (Ed) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol XIV. London: Vintage, The Hogarth Press and the Institute of Psycho-Analysis.

Freud, S. (1917a). Mourning and melancholia. In J. Strachey (Ed) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. XIV. London: Vintage, The Hogarth Press and the Institute of Psycho-Analysis.

Freud, S. (1917b). The development of the libido and the sexual organisations. In J. Strachey (Ed) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. XVI. London: Vintage, The Hogarth Press and the Institute of Psycho-Analysis.

Freud, S. (1921). Group Psychology and the Analysis of the Ego. In J. Strachey (Ed) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. XVIII. London: Vintage, The Hogarth Press and the Institute of Psycho-Analysis.

Freud, S. (1925). A note upon the ‘mystic writing pad’. In J. Strachey (Ed) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. XIXI. London: Vintage, The Hogarth Press and the Institute of Psycho-Analysis.

Freud, S. (1926). The question of lay analysis: Conversations with an impartial person. In J. Strachey (Ed) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. XX. London: Vintage, The Hogarth Press and the Institute of Psycho-Analysis.

Jacoby, R. (1983). The Repression of Psychoanalysis. New York: Basic Books.

Masson, J. M. (1984). The Assault on Truth: Freud’s Suppression of the Seduction Theory. Harmondsworth: Penguin.

Millett, K. (1977). Sexual Politics. London: Virago.

Mitchell, J. (1974). Psychoanalysis and Feminism. Harmondsworth: Penguin.

Moscovici, S. (2008). Psychoanalysis: Its Image and Its Public. Cambridge: Polity Press.

O’Connor, N. and Ryan, J. (1993). Wild Desires and Mistaken Identities: Lesbianism and Psychoanalysis. London: Virago.

Parker, I. (1997). Psychoanalytic Culture: Psychoanalytic Myth in Western Culture. London: Sage.

Parker, I. (2003a). The ego in Lucy R: Notes on conflict in one of Freud’s first cases. Psychodynamic Practice, 9, pp. 61-70.

Parker, I. (2003b). The unconscious love of Elisabeth von R: Notes on Freud’s first full-length analysis. Psychodynamic Practice 9, 141-151.

Parker, I. (2003c). The psychogenesis of the ego: Notes on Freud’s ‘case of homosexuality in a woman’. Psychodynamic Practice, 9, pp. 71-80.

Parker, I. (2006). Katharina: Working out anxiety. Notes on Freud’s early case. Psychodynamic Practice, 12, pp. 281-291.

Parker, I. (2007). Revolution in Psychology: Alienation to Emancipation. London: Pluto Press.

Parker, I. (2009). Psychoanalytic Myth. London: Anthem Press.

Parker, I., Georgaca, E., Harper, D., McLaughlin, T. and Stowell Smith, M. (1995). Deconstructing Psychopathology. London: Sage

Richards, B. (1989). Images of Freud: Cultural Responses to Psychoanalysis. London: Weidenfeld Dent.

Schwarz, J. (1999). Cassandra’s Daughter: A History of Psychoanalysis in Europe and America. Harmondsworth: Penguin.



Vaillant, G. E. (1971). Theoretical hierarchy of adaptive ego mechanisms: A 30 year follow up of 30 men selected for psychological health. Archives of General Psychiatry 24, pp.107 18.



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