ovaries when a quick resolution to a hysterical fit was required.
By historical coincidence, Freud was studying with Charcot as Charcot was formulating his theory. We move next to Freud but need to point out that another of Charcot’s colleagues at the Salpˆetri`ere, Pierre Janet (1859–1947) developed the theory of dissociation even further and soon came to study and publish on the occurrence of multiple personalities or those with co-consciousness. It was Janet’s ideas on this that had the first powerful impact on American thought, especially in the medical establishment, as well as among psychologists like William James (1842–1910). It was the French clinical tradition that initially most influenced the theory and treatment of mental disorders in the United States.
SIGMUND FREUD (1856–1939)
The Austrian neurologist Sigmund Freud bor- rowed from the theories ofCharcot, Li´ebeault, and Bernheim and the French clinical tradi- tion of which they were a part. He also drew upon writers and philosophers from his own excellent education in Vienna, although he was sometimes reluctant to acknowledge their con- tributions to his theoretical and clinical work.
Freud borrowed from these theories and com- bined them with insights from philosophy and his own clinical work to forge what he termed psychoanalysis. In doing so, Freud, a figure of the Jewish Enlightenment, used reason to show the limits of reason (R. Smith, 1997). The theory and praxis he constructed over his long career were major influences on the forging of a psycholog- ical subjectivity in western Europe and North America during the 20th century. Although later theorists and practitioners often disagreed with his theory or methods, Freud had shown it was possible to offer a workable theory of treatment
FIGURE 5.4 Sigmund Freud
predicated upon purely psychological grounds.
In this section, we place the work of Freud in its historical context and show how his work came to be so influential in the development of the practice of Psychology in the delivery of mental health services. We then examine his influence in the United States, India, and Argentina.
Freud was born in what is now Pribor, a city in the eastern section of the Czech Republic.
His father, Jakob, was a wool merchant, who had had two sons from a previous marriage, one of whom had his own first child just before Sigmund was born. Sigmund’s mother, Amalie, was 20 years younger than her husband, and Sigmund was her firstborn; she and Jakob eventually had eight children. When Sigmund was four years old, Jakob moved his family to Vienna, Austria, a little more than 200 miles to the west. The family’s migration was part of a general movement of Eastern European Jews to points further west, due primarily to centuries of persecution and pogroms in Eastern Europe.
Vienna also represented greater opportunity for the children of the Freuds, as the restrictions on Jews were less onerous there than in Pribor or other Eastern Europe locations.
Sigmund Freud flourished in Vienna, showing strong academic skills and a voracious intellectual curiosity. His interests at school came to center on history and literature. During his last year
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ofGymnasium, however, he read the essay, On Nature,by the great German dramatist scientist, and intellectual, Johann Wolfgang von Goethe (1749–1832), and decided that science would be his endeavor at university. The options available to young Viennese Jews were limited, and Freud chose medicine at the University of Vienna.
In his early years at medical school, Freud was much impressed by the young philosopher Franz Brentano (1838–1917). Brentano, a priest at the time (although he soon left the priest- hood over the issue of papal infallibility), had developed an approach that he called act psy- chology. His 1874 volume, Psychology from an Empirical Standpoint,stressed the importance of motivational factors on human action and argued that human thought and action are dynamic, that is, characterized by direction, intention, and desire. Freud took five courses with Brentano and even considered earning a philosophy degree with him after he completed medical school.
Although Freud ultimately did not earn a phi- losophy degree, it is clear that Brentano sen- sitized Freud to the importance of motivation and the dynamic character of human cognition and behavior.
Freud came under the influence of the physiol- ogist Ernst Br ¨ucke (1819–1892) in his third year of medical school. Br ¨ucke, like Hermann von Helmholtz (seeChapter 1), held that all physio- logical processes could be explained by ultimate reference to their physical–chemical properties;
thus, no invisible, secret, or ‘‘vital’’ forces an- imated living beings. All events have causes, thus the principle of determinism in science.
Once he came under the influence of Br ¨ucke, Freud set himself to become a great scientist.
To work toward his goal, he spent six years working in Br ¨ucke’s laboratory, doing micros- tudies of the nervous system of fish, among other creatures. He was able to publish in his area of research but soon came to realize that a career as a researcher would not pay the bills. He fi- nally earned his medical degree in 1881. The
following year Freud met and fell in love with Martha Bernays. Due to bourgeois expectations that a man could not marry until he could show that he was capable of supporting his wife in the manner commensurate with her social standing (an issue that Freud complained about for the rest of his life), Freud then decided to become a clin- ician, specializing in patients with diseases of the nervous system. For several years he treated cases of cerebral palsy, aphasia, and other disorders of the ‘‘nerves.’’ He brought with him, then, from his education and training, a humanist’s love of learning and the ambition of a scientist to under- stand the underlying causes of the phenomena he investigated. Both served him well.
Freud gained clinical experience in Vienna hospitals, particularly the General Hospital, where he worked with well-known neuro- anatomist Theodore Meynert (1833–1898).
Meynert was intensely involved in the scientific debates about localization of brain function (see Chapter 1) and argued that memories are contained in specific brain cells that are systematically connected with one another in what he called the ‘‘ego.’’ Under Meynert’s direction, Freud became known for his acumen in diagnosing brain disorders. To further his clinical understanding, Freud sought for and won, upon Meynert’s recommendation, a 6-month fellowship for the winter of 1885–1886 to study withCharcot in Paris.
Charcot by this time was perhaps the best- known neurologist in Europe. He had begun to treat hysterics with hypnosis a few years before Freud’s fellowship. Hysteria as a disease category had been recognized since the ancient Greeks, who used the term to describe the complaints of women (the term derives from the Greek word for uterus). By Freud’s time, it was known that both men and women could suffer from hys- teria. Hysterical symptoms were characterized by a mismatch between the complaint and the known functioning of the nervous system. Thus, a patient might report being unable to move fingers, but physical examination would reveal
SIGMUND FREUD (1856–1939) 103
that the nerves responsible for both sensation and movement of the hand were not damaged.
The patient’s symptoms followed popular con- ceptions of how the body or nervous system worked rather than how it actually works. Often, when the hysteric’s symptoms were successfully treated, within a short time (i.e., hours or days) other symptoms would reappear in some other part of the body. Needless to say, established clinicians sought to avoid taking on such cases.
Charcot, however, was determined to describe, classify, and understand hysteria, as we have dis- cussed earlier. While Freud was in Paris,Charcot suggested that trauma may play a role in hysteria in that it could lead to ideas becoming dissociated from rationality.
Freud took these ideas and Charcot’s tech- nique of hypnosis back with him to Vienna, where he began to fashion his own theory and treatments. He was finally able to marry and settle into his clinical practice. Still, as a young Jewish clinician, Freud was not in a position to dictate his patient load. As a result, he of- ten had to take as patients individuals who were suffering from complaints, such as hysteria, that more established clinicians sought to avoid. Like Charcot, Freud decided to understand the ori- gin of hysteria and find successful treatments.
Hysteria, then, was Freud’s testing ground for what became the theory and technique of psy- choanalysis.
After Freud opened his practice in 1886, he developed, over the next 15 years, the basic theoretical framework of psychoanalysis. He traveled, for example, to Nancy, France, in 1889, where he learned from Bernheim and Li´ebeault that the hypnotized state did not indicate pathology; rather, hypnosis could be used to treat such disorders as hysteria. Perhaps his most important collaborator in these early years was Josef Breuer (1842–1925), a neurologist some 14 years his senior. Breuer had been a friend, a confidant, and perhaps equally important, an important source of referrals to the young doctor.
He related to Freud the curious case of a young woman named Bertha Pappenheim (1859–1936) who had come to him for treatment of hysterical symptoms in December 1880. Pappenheim, better known by her case name, Anna O., was treated by Breuer for approximately 18 months for symptoms that had arisen around the illness and death of her father, to whom she had been close. Breuer discovered that if he could induce Anna O. to talk about her emotions and her father that many of her hysteric symptoms would abate.
It was Anna O. who called this her ‘‘talking cure.’’
Sidebar 5.1 Focus on Bertha Pappenheim
FIGURE 5.5 Bertha Pappenheim, or ‘‘Anna O’’
Although Bertha Pappenheim’s private pain has become immortalized through her treatment with Josef Breuer and her place in the history of psychoanalysis, historians have also discovered the story of an incredibly accomplished and socially conscious Jewish feminist who recovered from her debilitating emotional condition and went on to devote herself to organized feminism and the social welfare of women and children. As historian of psychology Meredith Kimball has noted, in the years following her treatment, Pappenheim ‘‘actively struggled to reconstruct herself and moved successfully from her world of private fantasies into a world of political and social change’’ (2000, p. 31).
Born into an Orthodox Jewish family in Vienna in 1859, Pappenheim received the kind of education that was typical for her gender and class at that (Continued)
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time. She undertook both religious and secular training, the latter consisting of 10 years in a private Catholic school where she learned languages, music, and needlework. Her religious training was basic, with instruction in the running of an Orthodox Jewish kitchen and in Hebrew and Yiddish prayers but no formal education in Jewish laws and traditions.
This more serious study was reserved for male children and men. Nonetheless, upon leaving school at age 16, she was fluent in English, French, and Italian in addition to her native German. Suffice it to note that upon graduation, Pappenheim, like young women of her social standing, was expected to adopt the role of the young woman-in-waiting, occupying herself with pleasant but unstrenuous domestic and social diversions until marriage. Later in her life, Pappenheim denounced the practice of restricting young women in this way, and she was joined by several prominent German feminists who had also experienced the intellectual stultification produced by these social norms.
In 1888, when she was well on her way to recovery from the symptoms that had brought her into Breuer’s care, Pappenheim and her mother moved from Vienna to Frankfurt. There she continued her reconstruction by connecting with the city’s vibrant Jewish community, which had a tradition of charity work. She went on to become a leader in this community, devoting herself to improving the lives of women and children, especially unwed mothers.
In 1895, Pappenheim took a position as head of a Jewish girls’ orphanage. In 1902, she founded the organization Care by Women to bring the goals of the feminist movement to Jewish social work. In 1904, she and other Jewish feminists founded the League of Jewish Women, an umbrella organization that by the 1920s had 400 affiliates and 50,000 members. She served as the president of this organization for 20 years. In 1907, she established her own institution for unmarried Jewish mothers and their children, which, by the time it was destroyed by the Nazis in 1938, had housed 1,500 people.
In this brief biographical sketch of Pappenheim and her accomplishments, we suggest that her place in the history of psychology, as Breuer’s hysterical patient Anna O., has perhaps obfuscated the richer account of an extraordinary life that moved, as Kimball has put it, beyond ‘‘private pain’’ into ‘‘public action’’ (Kimball, 2000, p. 20).
In the early 1890s, Breuer and Freud collab- orated on a book,Studies on Hysteria,published in 1895, that reported five case studies of hys- teria. Freud proposed a theory of hysteria based on these cases in which he argued that hyster- ical symptoms begin in memories marked by such powerful emotions that they then become inaccessible to our recall. Thus, the famous statement from Breuer and Freud, that ‘‘the hys- teric suffers mainly from reminiscences’’ can be understood (Breuer & Freud, 1895/1957, p. 7).
The result is pathogenic ideas divorced from our rational state but that are full of the emo- tional energy from the suppressed memories that
can then be converted into hysterical symptoms (note the similarity here to Helmholtz’s work on the law of the conservation of energy; see Chapter 1). Hypnosis was the technique that Freud and Breuer used at this point to treat hys- terical symptoms, which seemed to allow for the energy associated with the pathogenic ideas to be discharged.
However, Freud had already grown dissat- isfied with hypnosis as a therapeutic tool. For one, not every patient could be hypnotized. His search for an alternative led him to develop the technique of free association. In this technique, the patient is instructed to recall as much as
SIGMUND FREUD (1856–1939) 105
possible all thoughts and feelings associated with a symptom, without editing the flow of ideas.
This became an important breakthrough for Freud, especially when he used the technique on himself.
In 1896, Freud’s father died. Freud counted this as one of the most significant events of his life and one which led him to undertake an intense self-analysis. Free association and a new approach, dream analysis, were employed by Freud in his self-analysis to help him through the crisis brought on by his father’s death. Freud analyzed his own dreams and found in them, as is often said, the royal road to the unconscious.
With the use of these two techniques, he explored wishes and urges about his father that he termed the Oedipus complex, after the Greek myth of Oedipus, who killed his father and married his mother. His analysis revealed to him that he had wished for his father’s removal as a child so that he, Freud, could possess his mother for his own pleasure. This later was incorporated by Freud into his theory of psychological development.
His analysis of dreams led him to suggest that dreams have two levels of meaning, the manifest, which is superficial and does not contain the real psychological meaning of the dream, and the latent, which is the real meaning, dressed in symbolic form. Dreams, Freud suggested, are wish fulfillments whose latent meaning is intended to disguise their socially unacceptable nature. In this way, Freud said, dreams are like hysterical symptoms in that both represent ideas or wishes that are too dangerous to be expressed in everyday life. Freud brought together all of this material in what many scholars and historians, and even Freud himself, consider his greatest book, The Interpretation of Dreams (1900).
Freud continued to develop his theory, pub- lishing many elaborations and corrections to his ideas over the next four decades, as he con- stantly learned from the application of his ideas in an active clinical practice. Broadly, Freud the- orized about children’s development, the origin
of neuroses, the role of instinctual behavior, and the emergence and use of psychological defense mechanisms. He also wrote about the role of religion, the problematic role of the civilizing process on individual personalities, and even a psychoanalytic biography of American President Woodrow Wilson.
After 1900, a small group of Jewish intel- lectuals began to gather around Freud and met at Freud’s home every week as the Wednesday Psychological Society to discuss psychoanaly- sis. Some of these men, such as Otto Rank (1884–1939), Alfred Adler (1870–1937), and Wilhelm Stekel (1868–1940), went on to become leaders themselves of the psychoanalytical move- ment. In 1907, Carl Jung (1875–1961) and Ludwig Binswanger (1881–1966) visited from Switzerland, thus extending the geographic reach of psychoanalysis; Jung and Binswanger were also the first non-Jews to join the psychoanalytic cir- cle. Freud’s circle of influence grew but inevitably led to splits. Adler and Jung broke from the inner circle in 1911 and 1913, respectively. In 1909, Freud made his only visit to North America, where he gave a series of lectures on psycho- analysis at the celebration of the 20th anniversary of the founding ofClark University in Worces- ter, Massachusetts. Invited byClark’s president, G. Stanley Hall, Freud’s lectures were a public triumph. Major newspapers of the day covered the visit and wrote favorably about Freud’s lec- tures. This was crucial for the spread of Freud’s ideas, or at least a version of them, in America, a topic to which we return later. While atClark, Freud also met with American psychologists, in- cluding the ailing William James, who reportedly told Freud that the future of psychology lay with Freud’s ideas. Jung accompanied him and gave a series of lectures atClark on the word association technique.
After World War I, in which two of his sons served, Freud revised and expanded his theories to include his now-famous structural account of the psyche: id, ego, and superego.
Freud continued to revise and rework his theory
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and its therapeutic applications until his death.
Freud had resisted leaving Vienna even after the Nazis occupied the city. Finally, under threat of death and after large sums of money had been paid to the Nazis, Freud and his family moved to London in 1938. He had suffered from cancer of the jaw for many years. He died on September 23, 1939.