Psychoanalysis : its history, theory, and practice

Front matter

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B9ST9N /A€bieflL LIBRARY

Preface

, There is no dearth of excellent books on psychoanci^ysis. For the general public, however, they are of litt/^ practical value. They presuppose a knowledge of the subject and a familiarity with medical and analytic terms which the average reader does not possess. Moreover, they are, in the majority of cases, special monographs dealing with some definite detail of theory or practice from the exclusive point of view of one of the various schools of analysis.

What I have attempted to do in the present volume is to sum up in a concise form the views of the greatest American and foreign analysts which at present are scattered in hundreds of books, pamphlets and magazine articles. I have, whenever possible, presented their thought in their own words, through either direct quotation or condensation.

This is to be an unpartlsan treatment of the subject. While I profess the deepest respect for Sigmund Freud, and believe that but for his scientific insight and his untiring labors, psychoanalysis would probably be to-day an undeveloped, inaccurate set of hypotheses, I hold that Jung's and Adler's theories are of inestimable value, and that no analysis would be complete which did not take into account the researches of the " Zurich School " and of the " Individual Psychologists."

An unprejudiced perusal of the history of the analytic

PREFACE

movement has convinced me that personal animus was in the main responsible for the fact that the three great European analysts struck diverging paths. There are, however, no irreconcilable differences separating their points of view.

It is most gratifying to note that no such unpleasant feelings have disturbed the relations existing between men like White, Jelliffe, Jones and Kempf in the United States and Canada.

Rising far above the level of personal likes and dislikes, the American analysts have done much to unify the analytic theories into a coherent and inclusive system and to make psychoanalysis a means of reinterpretation of life and behavior.

An effort has been made in the present book to avoid technical terms whenever the current vernacular offered adequate equivalents. The terminology of psychoanalysis being new and unusual, every analytical expression has been elucidated when first encountered. Should the reader's memory fail him, he will find at the end of the book a glossary explaining in the simplest possible way the meaning of every new word employed by the new science.

New York City.

October ii, 19 19.

Table Of Contents

CHAPTER *AGI

Preface . . vii

I The History of Psychoanalytic Research . i

Chapter I

Psychoanalysis is a very young science. The world knew nothing of it until Freud delivered his first lectures on the subject in 1895. ^^ those few years, however, psychoanalysis has made a deep impression on all the mental sciences and has especially revolutionized psychology, ethics and psychiatry.

Its terminology, at first forbidding, has enriched the language with entirely new expressions, without which the cultured would find themselves helpless in psychological discussions. It has supplied not only physicians but artists, thinkers, sociologists, educators and critics, with a new point of view. It offers to the average man and woman a new rational code of behavior based on science instead of faith.

A survey of the gradual development of psychoanalysis will make the novel point of view it has introduced into intellectual life more vital and more understandable.

Psychoanalysis is too accurate a scientific instrument to be mastered in one day. It requires close application rather than flights of fancy, a painstaking study of all details rather than broad and facile generalizations.

It was gradually brought into being by applying Claude

Bernard's method, " Look at facts over and over again, without previous bias, until they begin to tell you something/'

It must be studied In the same spirit.

Socrates was probably the first thinker who realized the importance of the unconscious and of self-knowledge. His commandment: "Know Thyself" and his theory of " intellectual midwifery '' remind one strangely of the modern analyst's creed and methods.

From Socrates to Charcot, however, very little progress was accomplished in the practical study of the unconscious. The Stoics' denial of pain, Kant's pamphlet on " The power of the mind, through simple determination, to master morbid ideas** Feuchtersleben's search for a harmony against which sickness could not prevail, merely paved the way for Mrs. Eddy's religious therapeutics.

At the end of the sixties, the study of the unconscious from a medical point of view suddenly spread over Europe. Dr. Charcot of the Salpetriere made valuable observations on the connection between suggestion and hysterical symptoms. He denied, however, that any therapeutic method could be established upon that basis. In Nancy, Dr. Berheim and Dr. Llebault came to the conclusion that hypnotism could always be relied upon to bring about some change, however slight, for the better, in the course of functional diseases. In Sweden, Wetterftrand, influenced by Liebault's writings, treated thousands of patients by the hypnotic rest cure and by suggestion in waking states.

Austrian scientists were destined to throw an entirely new light upon the study of mental states, and to devise a novel method of treatment for mental disturbances.

About 1880 an old Viennese physician, Dr. Breuer, had among his patients a young woman of twenty-one, suffering from curious hysterical symptoms, among them severe paralysis of the right arm, disturbance of eyemovements, a loss of the power to drink, almost complete aphasia, states of " absence," etc.

The disturbances first appeared while the patient was nursing her father, to whom she was greatly attached, during the severe illness which led to his death.

Dr. Breuer diagnosed the case as hysteria. He vainly tried to remove the symptoms through hypnotism, and for a while all he could do was to observe the development of the malady. This he did with unusual sympathy and interest. He noticed first that the patient in her states of " absence " mumbled strange words to herself; Breuer hypnotized her and made her repeat those words a great many times, causing her to reproduce for him the fancies which dominated her mind in her " absences." Those fancies were sad day dreams which commonly took as their starting-point the situation of a young girl beside the sick-bed of her father.

Whenever she told those fancies she was for several hours restored to a normal condition. A few hours later the " clouds " reappeared and the newly created obsession had to be removed under hypnosis.

One symptom, however, her inability to drink, vanished entirely, without recurrence, after the fancy connected with it had been told in detail and with a great deal of emotion.

She began to tell about her English governess whom she disliked greatly and of that woman's little dog whom she abhorred. One day she saw the dog drink out of a glass. She felt an Intense disgust which she repressed out of conventional respect for the governess.

After giving unrestrained expression in the hypnotic state to her hatred for the governess and the dog, and to her disgust over the dog's action, the patient felt considerably relieved. When awakened she could take a glass and drink a large quantity of water.

Her visual disturbances were also traced to a painful scene in which a strong emotion was repressed: The patient, with tears in her eyes, was sitting at the bedside of her dying father. The father suddenly asked what the time was. She tried to suppress the tears which blinded her, and to conceal them, and for that purpose raised her watch very close to her eyes, so that the dial seemed very large and distorted. The resultant symptoms were an abnormal enlarging of the objects she saw and severe strabism.

We come finally to the paralysis of her left arm.

One night, while waiting for the surgeon who was coming from Vienna to operate on her father, she fell asleep, exhausted, her arm hanging over the back of her chair.

She had a dream in which she saw a black snake coming out of the wall and creeping toward the bed. She tried to frighten the snake away by a motion of her right arm. But her arm had " gone to sleep " and she could not move it. Looking at the fingers of her right hand she saw them transformed into little snakes. Terrified by the combination of the dream and the anaesthesia of her arm, she tried to pray but could only utter a few English sentences which turned out to be scraps of nursery rhymes. After this she continued to think and speak in English, being unable to speak or understand her native tongue, which was German.

Repeated descriptions of that frightful scene gradually removed the disturbance of her speech power. A little later the paralysis of her right arm and all the other symptoms disappeared completely.

This method of Investigation under hypnosis which Breuer's patient called the " talking cure " or " chimney sweeping," and which Breuer designated as the " cathartic method," constituted a tremendous advance upon the mere suggestive technique under which commands were given to the patient and which precluded the possibility of any scientific inquiry.

Breuer did not seem to realize the importance of his discovery, and only resumed his " talking treatments " when Freud, after studying under Charcot, returned to Vienna and prevailed upon him to do so. He and Freud practiced that method for a while, guiding the patient's attention to the scene during which morbid symptoms had made their first appearance, and causing the patient to live It over and get rid, in the process, of the excitement he once repressed.

They noticed that if the patient remained unmoved while reproducing the crucial scene, the process had no curative effect. Their conclusion was that the patient fell ill because the emotion developed in the crucial situation had been prevented from escaping normally and had been " converted " Into some abnormal physical or mental symptom.

They discovered then one of the characteristics of neurotic processes, which Freud later called the *' regression." The patient's memory generally carried him back to a period antedating the crucial scene which ushered in the neurosis. This forced the analyst to occupy himself, not with the present but with the past. The regression sometimes led him back to the period of puberty. Sometimes it even led him back to the years of childhood and infancy, which until then had not been accessible to any sort of investigation. Freud and Breuer were compelled to admit that every pathological experience presupposed an earlier one which, while not necessarily pathological in itself, lent a psychological character to the later occurrence.

Freud and Breuer soon parted company, as they disagreed upon the role which sexuality plays in the formation of neuroses. But Freud has always expressed the most respectful gratitude to his old teacher and given him full credit for many things he himself originated.

In 1893 Freud published the results of his first experiments, and in that year he gave up entirely the practice of hypnotism.

The fanciful and mystical character of hynotism repelled him, as it repelled Jung, and when he discovered that some of his patients could not be hypnotized he decided to make his method of treatment independent of hypnotic suggestion.

While studying with Bernheim in Nancy he had learned that, contrary to the current opinion, patients who have been hypnotized do not actually lose the memory of their somnambulic experiences. The memory of those experiences can be brought back in normal waking states, by persistent urging and by giving the patient the assurance that he can remember all that took place during his somnambulic " trance/'

Freud adopted that procedure with his patients. When he reached a point at which the patient declared that he knew nothing more, Freud assured him that his memory would return when he laid his hand on the patient's forehead. He abandoned that " laying of hands " later and simply let the patient speak on any subject that came to his mind, convinced that nothing could occur to the patient which did not bear directly or indirectly upon the " sore spot " in his unconscious.

He decided to communicate his discoveries to the public by means of lectures. His first lectures, delivered in 1895, attracted an audience of only three, Sadger, Adler and Stekel. Sadger remained his faithful follower; Adler and Stekel struck out paths of their own.

After studying a number of striking dreams his patients related to him, Freud came to the conclusion that the patient's dreams stand in a close connection with his mental conflict. He began to collect an enormous amount of material which was all assembled by 1896 and reduced to book form in 1899.

In 1900 a group of Swiss physicians, led by C. G. Jung, began to treat patients according to the analytic method in Burgholzli, the clinic of psychiatry in Zurich. One after another, they went to confer with Freud, and in 1908 the first analytical congress took place in Salzburg by invitation of Jung. The first result of that congress was the founding of a review, Jahrhuch fiir Psychoanalytische und Psychopathologische Forschungen, published by Bleuler and Freud and edited by Jung.

Freud, who had been violently attacked by every medical publication, and treated with scant courtesy at meetings where he read reports of his cases, found in the Zurich men faithful supporters. Most of his followers came to him by way of Zurich.

The Zurich school developed cleverly the association experiments initiated by the Wundt School, and thus bridged the chasm between experimental psychology and psychoanalysis.

Jung propounded also the important theory of " complexes " or groups of emotional ideas in a repressed state.

The second psychoanalytic congress took place in Nuremberg in March, 19 lo. A certain disharmony was noticeable among those present. The International Psychoanalytic Association was organised, with Jung as chairman and Ricklin as secretary. It was also decided to publish a journal " to foster and further the science of psychoanalysis as founded by Freud, both as pure psychology and in its application to medicine and the mental sciences, and to assist the members in their efforts to acquire and to spread psychoanalytic knowledge."

The Viennese group opposed the project and Adler expressed publicly his fear of a possible censorship and limitation of scientific freedom by Freud.

The new journal Zentralhlatt fur Psychoanalyse, was to be edited by Freud and the first issue appeared in September, 19 10.

The third congress took place at Weimar in September, 191 1, the fourth one in Munich in September, 1913, both of them with Jung as chairman. Jung was reelected chairman of the International Psychoanalytic Association, although two-fifths of the members refused him their support. " We took leave from one another," Freud wrote on that occasion, " without feeling the need to meet again."

The dissensions which had been breeding for some time brought about two secessions in the psychoanalytic group.

Adler left the Vienna group shortly before the Weimar congress and the Swiss school seceded soon afterward. Adler founded a new group called the Society for Free Psychoanalysis, then abandoned altogether the word " psychoanalysis " and designated his teaching an " Individual Psychology." While psychoanalysis under Freud's guidance endeavored to show that all ego strivings were tinged with sexuality, Adler insisted that all sexual feelings contained an admixture of egotism. He traced the origin of the neurosis to a real or imaginary feeling of inferiority due to some organ deficiency.

The Swiss school, many members of which were clergymen, modified Freud's sexual theories so as to bring about a reconciliation between psychoanalysis on the one hand, and traditional ethics and religion on the other. This they did by assuming that certain elements considered by Freud as sexual are purely symbolical and hence conventionally unobjectionable.

In a letter dated September 5, 19 19, Jung, asked to define his attitude to the various schools of psychoanalysis, wrote me that he was trying to reconcile the contradictory views through a theory of attitude and a different appreciation of symbolism. He was working on a book on the Problem of Attitude and Types of Attitude. His present views concerning Freud and Adler are presented, he added, in his '' Collected Papers on Analytical Psychology," pp. 299, 336, 367, sqq.

The Zurich method, especially as applied by pastors, pays little attention to tracing the neurosis to its actual source in childhood but prescribes inner concentration, religious meditation, etc.

Whether one sides with one of the three schools or, as the author does, finds in every one of the three points of view suggestions of value in the study of every case, (for in certain patients the sex element is more accentuated, in others parental influences in a symbolic or desexualized form are clearly paramount, in others a feeling of inferiority dominates the situation, the three elements being always present), only a thorough study of Freud's writings can enable the student to acquire a clear understanding of psychoanalysis.

His " Papers on Hysteria," his *' Contributions to the Sexual Theory " and his " Interpretation of Dreams," constitute the foundation of modern psychoanalysis.

His book on " Wit and the Unconscious " and on the " Psychopathology of Everyday Life " furnished the first examples of application of the analytical theory to aesthetic themes and to normal actions. In " Totem and Taboo " he has discussed the problems of race psychology in the light of analytical psychology.

Practical applications of the analytical method to the study of art and letters have been published by Karl Abraham, Otto Rank, Ricklin and others who have shown that myths, fairy tales and hero legends are akin to the infantile scenes of many of our dreams and constitute, so to speak, the day-dreams of the human race in its infancy.

Psychoanalysis found ready acceptance in Austria, Germany, England and the British colonics.

THE HISTORY OF PSYCHOANALYTIC RESEARCH II

France showed herself rather unreceptlve. Moricheau-Beauchant of Poitiers was the first Frenchman to accept it openly. Regis and Henard of Bordeaux accepted it in part, rejecting only the Freudian symbolism.

Italy has taken very little interest in the new science.

Psychoanalysis was introduced in Holland by Jelgersma, rector of the University of Leyden, in 1904, and has been studied by Van Emden, Van Ophuijsen and Van Renterghem particularly from the theoretical side.

In Sweden, Poul Bjerre, Wetterstrand's successor, gave up his practice of hypnosis to join the Freudian school.

In Norway, A. Vogt of Christiania mentioned psychoanalysis in a book on psychiatry published in 1907.

In Russia psychoanalysis is generally known. Wulff of Odessa, Ossipof and Bernstein of Moscow, and Povnitzki of Petrograd, have published numerous articles on the subject.

In Poland the practice and literature of psychoanalysis have been introduced by L. Jekels.

In the autumn of 1909 psychoanalysis was officially introduced to the scientists of America when Freud and Jung were invited by Stanley Hall of Clark University to come and lecture on Psychoanalysis. S. Ferenczi accompanied them. Canada was represented by Ernest Jones of Toronto University, the United States by A. A. Brill of New York. Professor James J. Putnam of Harvard, who, until then, had been rather sceptical in his attitude toward psychoanalysis, befriended the new movement on which he delivered many lectures. A. A. Brill began to translate Freud's work into English, an undertaking which required infinite effort and a great deal of ingenuity, for Freud's technical terms were very novel at the time and equivalents had to be coined for them in English.

Dr. Smith Ely JeHiffe of New York City has made valuable contributions not only to the technique of the psychoanalytic treatment but to the apphcations of the psychoanalytic point of view in other fields.

He has suggested a new method for handling the more dynamic transference situations (see Chapter XIX) which arise in dementia praecox and the manic-depressive psychoses. In collaboration with Louise Brink he has published a study on " The Role of Animals in the Unconscious," outlining a new method for the understanding of cultural fossils in the individual unconscious arid their recognition when used as symbols.

He has developed the Freudian conceptions of displacement and conversion which he considers as the origin not only of neuroses but of certain so-called organic diseases. The technique likely to deal adequately with such conditions must follow, he thinks, the Freudian formulas, although he considers that those formulas can be improved upon.

His studies along this line are comprised in his contributions on " Psoriasis as an Hysterical Conversion Syndrome " and " Hypertension Nephritis and its Unconscious Psychogenic Foundations."

Finally, Dr. Jelliffe has occupied himself with the question of mass psychotherapy and the part played by the artist in freeing the unconscious of the population and thus helping to keep the masses mentally healthy. He has analyzed from that point of view many plays and novels, such as " Eyes of Youth," " Peter Ibbetson," " Dear Brutus," " The Willow Tree," '' The Yellow Jacket,"

" The Jest," " I, Mary MacLane." He has in preparation a volume on Ibsen's plays treated in the same manner.

William H. White, superintendent of Saint Elizabeth Hospital, Washington, D. C, has amplified the Adlerian doctrine of organ inferiority but should not be described as an Adlerian in the narrow sense of the word. His feeling about the psychoanalytic movement is that it has come to be so inclusive that there is plenty of room for all the points of view that are emphasized by the different movements. Each one of the movements has contributed something valuable, and he thinks it is more important to see the value of each contribution than to become immersed in disputes as to their priority or relative importance.

White's personal contribution to the psychoanalytic movement is largely along the lines of correlating it with fundamental scientific principles as exhibited in other branches of knowledge. He has done this in his " Mechanisms of Character Formation." He has pointed out, there and in various other works, that the principles involved in psychoanalysis are the same principles which obtain throughout the biological sciences. In making this correlation he has examined some of the current antithetical concepts, such as mind and body, individual and environment, functional and organic, germ plasm and soma, and has shown that those concepts have become static and need revaluation in order to be useful in the present stage of development. He has shown that the distinctions between these pairs of opposites are by no means as rigid as has heretofore been supposed, and that a revaluation of these concepts which tends to do away with the clear-cut distinctions between them, makes them more useful, more fluid, more dynamic. In " The Diseases of the Nervous System," written in collaboration with Dr. Smith Ely Jelliffe, he has built up a concept of the individual as a biological unit with reactions at the various levels and shown the interrelations of these several reacting levels. This is a distinctly new note in neurology.

Dr. Edward J. Kempf, of Washington, D. C, subscribes to Freud's view of the influence exerted upon the personality by repressed wishes, and to Freud's inference that the wishes which cause, directly or indirectly, most, if not all, pathological adaptations, are essentially sexual. But he rejects Freud's theory of the " conversion " of libido, or what is being termed " psychic energy," into physiological or physical derangements. He follows the James-Lange theory of the peripheral origin of the emotions in the sense organs of the visceral and circulatory systems. We are compelled to think with our muscles by our cravings as they seek for appropriate stimuli. Wishes and cravings continue active until they are neutralized through acquiring appropriate counterstimulation. The repressed wish flows from the heightened postural tension of the segment in which it had its origin. The segment becomes conditioned through years of experiences to seek relatively well-defined types of stimuli which alone have the capacity to neutralize (satisfy) the craving. When these conditioned needs happen to be tabooed by society as unjust, asocial or perverse, or are unobtainable, the foundation of the neurotic or psychotic personality is established.

Kempf's book, " The Autonomic Functions of the Personality," opens a new chapter in the psychology of the emotions and the part they play in the personality make-up of the individual. It strikes a note distinctly in advance of Adler's theory of organ inferiority, but like that theory founds character traits in definitely located neuro-physiological processes. Recent advances in the anatomical and physiological knowledge of the autonomic nervous system and its relations to the glands and the visceral and somatic musculature have made his work possible.

Kempf sees in the autonomic nervous system the primitive means for recording the inherent cravings — organic needs — of the individual and in the cerebro-spinal or projicient nervous system the means for so relating the organism to its environment as to secure a neutralization of these needs — a satisfaction of its cravings. From this point of view the familiar psychoanalytic problems of the conflict, repression, and the unconscious receive a new interpretation in anatomo-physiological terms. The energy of the repression is seen as bound up in visceral tonicities and postural tensions and a distinctly new viewpoint is opened up for a consideration of many obscure visceral and neuro-psychiatric problems.

Kempf has suggested a new classification of mental disturbances which will be presented in detail in Chapter XV.

There are several periodicals, most of them in the German language, devoted to psychoanalysis.

To the '^ Jahrbuch fiir Psychoanalytische und Psychopathologische Forschungen " and the " Zentralblatt fiir Psychoanalyse " which I mentioned above, I shall add " Imago," a bi-monthly founded by Freud in 19 12, edited l6 PSYCHOANALYSIS

by O. Rank and H. Sachs, and containing among other things extensive bibliographies of studies on the application of psychoanalysis to the mental sciences.

In January, 1913, the "Internationale Zeitschrift fiir Aerztliche Psychoanalyse " was founded by Freud and edited by S. Ferenczi and O. Rank. It covers the same field as the Zentralblatt which later it replaced. Besides this, Freud publishes at varying intervals monographs entitled " Freud's Schriften zur angewandten Seelenkunde."

Adler and Fortmiiller founded in 19 13 the "Zeitschrift fiir Individuale Psychologic " which presents the views of the Adlerian school. Adler is the editor of a monograph series entitled " Schriften des Vereins fiir freie Psychoanalytische Forschung."

The only Journal published in English is the " Psychoanalytic Review," which aims to be catholic in its tendencies, a faithful mirror of the psychoanalytic movement and to represent no schisms or schools but a free forum for all.

It contains besides original articles, a very extensive digest of all the periodical literature. It is edited by Dr. William A. White and Dr. Smith Ely Jelliffe, and is now in its sixth year.

The " Journal of Nervous and Mental Disease " and the " Nervous and Mental Disease Monographs " have also supplied the English reading public with many special psychoanalytic studies.

Chapter II The Unconscious And The Urges

Psychoanalysis Is not a panacea for all mental ills. It is much less and much more than that. It attempts to rectify but few mental abnormalities. At the same time, psychoanalytic information, if widely disseminated would probably prevent every mental disturbance which is not the result of temporary or permanent organic deterioration, but which is psychogenic, that is, due to purely unconscious causes.

For psychoanalysis is not merely a new theory of the unconscious; it is a practical method of studying the unconscious. Matter-of-fact minds manifest a justified impatience when encountering the countless hypotheses and definitions offered by academic psychologists. Defining the unconscious, the foreconscious and the subconscious, dilating on the relative merits of the terms consciousness and awareness, is a most barren form of mental gymnastics.

Bergson's vital urge is an interesting conceit, as long as we do not care to know its origin or its goal; his theory of dreams is plausible but we should not seek in It a solution for the riddle of our sleeping fantasies. His distinction between thoughts that float on the surface of our consciousness like dead leaves on a pool and those that, like unto rain drops, merge immediately with the rest of our mental acquisitions, supplies the reader with pretty images; and so do his statements about ideas knocking at the portals of consciousness. Those pleasantly worded assertions, however, are unilluminating to the student of real life. They have no practical application in the life of the average human being.

Psychoanalysis will supersede entirely the guesswork of academic psychologists, bent on generalizing about character, tendencies, instincts. Psychoanalysis is not interested in mental states as such; it aims at tracing their origin and at bringing about their removal when they prove harmful to the individual.

It seeks to direct into useful channels mental activities which are a dangerous or a wasteful display of energy. It searches the unconscious, not for literary illustrations and similes, but for positive, scientific, practical information concerning the operations of the mind.

Before Freud began his experiments, the unconscious had been regarded as the province of the theoretical psychologists who simply filled it with their own personal fancies, then took those fancies out, one by one, and described them to us. Practical men sneered at the word " unconscious " and ignored the possibilities which its study held out for many sciences.

Our unconscious is a tremendous storage-plant full of potential energy which can be expended for beneficial or harmful ends. Like every apparatus for storing up power, it can be man's most precious ally, if man is familiar with it and, hence, not afraid of it. Ignorance and fear, on the other hand, can transform a live electric wire into an engine of destruction and death.

Many indeed are the mental disturbances which are due to some fear, induced in its turn by lack of under-