BY: Richard j.Kosciejew
Freud’s awareness of the actuality of transference phenomena - that is, of the development in the patient of powerful feelings and wishes toward the therapist learned from Joseph Breuer of the events that occurred in the treatment of Anna O. It was not, however, until the debacle with Dora that the full force of this phenomenon was brought home to him - if not of his own counter-transference feelings as well. Transferences are, Freud said, ‘new editions or facsimiles of the impulses and fantasies aroused and made consciously during the process of the analysis, but they have this peculiarity . . . that they replace some earlier person by the person of the physician’ (Freud, 1905) in ‘Psychoanalytic treatment does not create transference, it merely brings them to light like so many other hidden psychical factors’.
Freud did not again deal in detail with the subject of transference until 1912, in ‘The Dynamics of Transference’. In fact, the first paper devoted specifically to the subject was Ferenczi’s ‘Introjection and Transference’ published in 1909. Fereneci offered an exposition of the topic, drawing its stimulus from Freud’s reference to ‘transference’, in The Interpretation of Dreams about the Dora case. Transference, he stares, is a special case of the mechanism of displacement, is ubiquitous in life but especially pronounced in neurotics, and makes its most explicit appearance in the relationship of patient to the analyst - in or outside the psychoanalysis. He relates the transference to other psychic mechanisms, most particularly projection and introjection, and defends the psychoanalysis against accusations of improperly generating transference reactions in its patients. ‘The critics who look on these transferences as dangerous should’, he says, ‘condemn the non-analytic modes of treatment more severely than the psychoanalytic method, since the former really intensifies the transference, while the latter strive to uncover and to resolve them when possible.
It was not until 1912, in The Dynamics of Transference; that Freud returned to the subject, in explaining, about libido economy and, while the topographic model of the mind the inevitable emergence of the transference in the analytic situation and its role as a primary mode of resistence. ;The transference idea has penetrated into consciousness in front of any other possible association because it satisfies the resistance’ - but only if it is a negative, or erotic transference. The analyst’s role is to ‘control’ or ‘remove’ the transference resistance. ‘It is’ Freud says, ‘on th at field that the victory must be won’.
None of Freud’s epochal discoveries - the power of the dynamic unconscious, the meaningfulness of the dream, the universality of intrapsychic conflict, the critical role of repression, the phenomena of infantile sexuality - has been more heuristically productive or more clinically valuable than his demonstration that humans regularly and inevitably repeat with the analyst and with other important figures in their current live pasterns of relationship, of fantasy, and of conflict with the crucial figures in their childhood - primarily their parents.
The transference has become a sort of projectve device, a vessel into which each commentators pour the essence of his or her approach to the clinical situation and to the understanding of that unique immuration process that makes up the analytic situation. The initial combinality (1909-36) that of the pioneers, marches the efforts of Freud and his early followers to grasp and to deal with the powerful phenomenon they were only beginning to recognize and to attempt to understand. The middle period (1936-60) reflects the consolidation of therapeutic technique and the attempt of both European and American analysts to bring the idea of transference into consonance with the increasingly important constructs of ego psychology. In the latest of periods (1960-87), we find a balance between reassertion of traditional views and various revisionist statements and reconsiderations of some classical position.
The productivity of the neurosis (during a course of psychoanalytic treatment) is far from being extinguished, but exercises itself in the creation of a peculiar sort of thought-formation, mostly unconscious, to which the name ‘transference’ may be given.
Despite radical implications for which theory has presented of psychoanalytic techniques and others of the dialectically discoursing involvement, is often without awareness. Where these psychoanalysts disagree in their conceptual reprehended frame of reference, creating the recognitions that the analyst and the patient cannot simply avoid having an impact upon one-another. Even so, that it cannot be removed, by that obstructions form whether we have related this to our deliberate technological interventions or intentional aspects as drawn on or upon the conceptual interactions. As for reasons that are useful and necessary to distinguish between theory of technological analysis, with which interconnectivity can be established through the conjunctive relationships having in relations of what seems allowable for us to expand our knowledge of the complex and subtle factors that account for therapeutic action. This, however, can ultimately become the most effective fight for regaining and developing our understanding of how best to serve ourselves to advance the analytic situation and too aculeate more profound and very acute satisfactions, as depictions in the psychoanalytic encounter, no matter whatever our accountable resultants may be of our therapeutical orientations.
An appreciation of its power of interactive forces addressed in the analytic fields of thought, not only challenges many traditionally held beliefs about the hidden natures of therapeutic actions. However, these take upon the requirement for us to recognize and acknowledge the untenability of the traditional view that analysts can be an object source in the works. They have better to understand it, for example, where patients’ and the analysts may express as a quality that which the analyst is in a possibility of a position to an objective interpreter of the patient’s experiential process. That in this may reflect a form of ‘collusive enactment’ and a convergence of need of both the analyst and the patient so see that the analyst as the authoritarian. If the patient and analyst submit to needs to believe that the analyst is the omniscient other or the benevolent authority, to which one can entrust one’s self-sufficiency, that in having to antecedent cause, is that of existing of itself that is itself self-existent.
As the foundational structure of the relationship might serve to obscure the acknowledging fact that it is involved to encourage the belief that, as one may say, that wherever a coordinate system is complicating and hardness to its plexuities, that its complexity has of recognizing of the mind, such that the immediate ‘indeterminacy’ arises, not necessarily because of some conditional unobtainability, but holds accountably to subjective matters that grow stronger in gathering the right prediction, least of mention, that of many things that are yet to be known. Such that th e stray consequences of studying them will disturb the status quo, and of not-knowing to what influential persuasions do really occur between the protective anatomy, therefore, that our manifesting of awareness cannot accord with the inclinations tat are beheld to what is meant in how. History, is not and cannot be determinate. Thus, the supposed causes may only produce the consequences we expect, this has rarely been more true of those whose thoughts and interactions in psychoanalytic interpretations but the interrelatedness is a way that no dramatist would dare to conceive.
In Winnicott (1969) has noted that there are times when ‘analyers’ can serve as holding operations and become interminable without any real growth occurring.
An attractive perspective helps to clarify ‘why’ sometimes the analyers ‘abstinence’ carries as much risk of negative iatrogenic consequences as carrying out active intervention. Although silence at times obviously can be respectful and facilitating, and yet, at times it can be cruel and sadistic, or it can be based on a fear of engagement, among a host of possible other meanings and equally attributive to distributional dynamic functions.
A strong appreciation of interacted factors also allow us to consider that whatever degree the patient’s perceptions of the analyst are plausible and even valid (Ferenczi 1933, Little 1951, Levenson 1973, Searles 1975, Gill 1982, and Hoffman 1983). This may be due to the patient’s expertise upon the stimulating precessions to this kind of responsiveness in the analyst. The reverse is true as well, although the patient and the analyst each will have some unique vulnerabilities, sensitivities, strengths, and needs, such that we must consider ‘why’ such peculiarities have elated the particular qualities or sensibilities of either patient or the analyst at a given moment and not at others. At any moment the patient that of the analyst might be involved in some kind of collusive enactment (Racker 1957, 1959, Grotstein 1981, and McDougall 1979), they have held that their considerations explain of reasons that posit themselves of why clinicians often seem to practice in ways that contradict their own shared beliefs and therapeutic positions, least of mention, principles by way of enacting to some unfiltered dialectic discourse.
Yet, these differences, which occur within and between the diverse analytic traditions, are that an interactive view of the analytic field has some theoretical and technological implications that bridge all psychoanalytic perceptivity, which each among us cannot ignore. Its premise lies in the fact that we recognize and do acknowledge that the analyst and patient cannot simply avoid having an impact on each other, even if both analyst and the patient are totally silent, requiring that we realize that even if a treatment is productive or successful, we cannot be clear of whether they have related this to our deliberated technological interventions or to aspects of the interaction that has eluded our awareness.
Psychoanalysts’ of diverse orientations increasingly have come to recognize is that the patient and the analysts are continually persuasive and being influenced by each other in a dialectic way, and often without awareness. This has radical implication for abstractive views as drawn on or upon psychoanalytic technique. Where their psychoanalytic philosophes disagree are comprised in the conception of what the specific implications of an interactive view of the analytic fields of thought that it might characterize.
It is, therefore, that distinguishing between its theoretical technique, which is useful and necessary, that relates to what we do with awareness and intention, as a theory of a theoretical action that deals in the accompaniment of our manifesting health and wholeness, that the psychoanalytic interaction has itself, that whether or not is to evolve from our technical and mechanistic forms of technique. The recognition as such, can allow us to expand our knowledge of the complications as set in the complex subtler factors that account for the therapeutic action. This, nonetheless, can ultimately become the most effective basis as a reason or justification for an action or option. That for refining and developing our understanding of how best to use ourselves to advance the analytic work and to simplify more profound and incisive kinds of psychoanalytic engagement, no matter what our therapeutic orientation.
An appreciation for which the power of interactive forces in the analytic subject field, not only challenges many traditionally held beliefs about the hidden dimensions through which times have hidden the nature of therapeutic action, but also requiring us to acknowledge and to recognize the untenability assembling on or upon the relational view that the analyst can be an objective participant in the work? It also helps us to grasp the extent upon which they are presupposed therapeutic interpretations, for example, can be ways of harassing, demeaning, patronizing, impinging on, penetrating or violating the patient, or the particular ways of gratifying, supporting, complying, among several other possibilities. Where the patient and analysts assume that the analyst can be an objective interpreter of the patient’s experience, this may factually reflect a form of collusive enactment and a convergence of the needs, whereof both analyst and the patient can see the analyst as an authoritarian. If the patient and the analyst have needs to believe that the analyst is the omniscient other or the benevolent authority to which one can entrust in one’s favour. The foundational structure of the relationship might serve to obscure recognition of the fact that they are enacting such a drama. In this regard, Winnicott (1969) has marked and noted that, at that point are times when the analyses can serve as holding operations and become interminable, without any real growth occurring.
The contentual meaning of the patient’s free association also has to be reconsidered from an interactive perceptive. Usually viewed as the medium of analytic work, as for free association that may, at times be a profound frame of resistance, and to avoid, rather than engage in the analytic process. Alternative measures can reflect with a form of compliance or collusion, for being aware and affected by conscious or insensible of emotion or passion the unconsciousness, from which is held within the analyst’s needs, fears, and resistance.
Yet, the ongoing dialectic discourse of transference and its place in analytic theory and technique, was during the periods of the middle 1936 and 1960, where this period was to relate its phenomenology to the growing understanding of the ‘ego’, both on its defensive and in Hartmann’s terms, ‘autonomous aspects’, to new theories of early development and a growing concern in some quarters with ‘interpersonal’ as opposed too purely ‘intrapsychic’ aspects of personality function. A further stimulus was Alexander’s (1946) advocacy of active role playing by the analyst to send the patient a ‘corrective emotional experience’, at least, in psychoanalytic psychotherapy if not in analysis proper.
In her very practically orientated paper, Greenacre emphasizes the distinction, first shared by Freud, between the analytic transference and that which characterizes other modes of therapy. All manipulation, exploitation, all use of transference for ‘corrective emotional experience’, is excluded from the psychoanalytic situation, which relies exclusively on interpretation to achieve its therapeutic goal. Greenacre‘s view of the analyst’s role in analysis and in the world outside in a relatively austere one: She would preclude the analyst from publically participating in social or political activities that might tend to reveal aspects of the analyst’s person that would contaminate the transference. Like Freud, Stone, and others she distinguishes between ‘basic’, essentially nonconflictual transference derived from the early mother-child relationship and the analytic transference proper, which involves projection (for example, Brenner) challenge this distinction.
It is, however, echoed in Elizabeth Zetzel’s masterful review of what were, at the time of writing, the dominant trends in the field. She proposed, following the usage of Edward Bibring, the idea of the ‘therapeutic alliance’, derived, as was Greenacre’s basic transference, from the positive aspects of the mother-child relationship. Like nearly all other commentators she asserted the centrality of transference interpretation in the analytic process, but she outlines in sharp detail some differences in form and content of such interpretations between Freudian and Klemian analysis - that is, between those who are concerned with the role of the ego and the analysis of defence and those who emphasize the importance of early object relations and primitive instinctual fantasy.
Like Greenacre and Zetzel, Greenson distinguishes between what he calls the ‘working alliance’ and the ‘transference neurosis’. He contends that without the development of the working alliance the transference cannot be analyzed effectively. The ‘working alliance’ depends not only on the patient’s capacity to establish adequate object ties and to assess reality. Nevertheless, is that, also on the analyst’s assumption of an attitude that permits such an alliance to emerge. Thus, Greenson advocates an analytic stance that, which of the adhering to the rule of abstinence, allows for more ‘realistic’ gratification and a less austere stance than Greenacre would encourage. Greenson’s definition of transference - that in any case or without exception it always represents a repetition of experience and that it is always ‘inappropriate to the present’ - will later be challenged by Gill, who contends that transference reactions may be appropriate responses to aspects of the psychoanalytic situation of which both patient and analyst is not necessarily aware.
It is, only to mention, that, at the outset, that resistance is, in certain foundational reference, an operational equivalence of defence, its scope is really far larger and more complicated. The thought of its nature and motivation on grounds that resistance in the psychoanalytic process, in using a variety of mechanisms that defy classification in the ways that genetically determine defences derived from important and common developmental progressions, as having a particular direction and character for having a growing tendency to underestimate the potential or strength of that notion, then it may be classified. From falling asleep to a brilliant argument there is a limitless mobility of developmental devices with which the patient may protect the current integration of his personality, including his system of permanent defences. In fact, resistance of a surface, for which a consciously related individual character and educationally cultural background, when presented of itself, are the patient’s first confrontations with a unique and as often puzzling treatment of methodological analysis. While some of these phenomena are continuous with deeper resistance, a closer and perhaps, a balanced equilibrium held in bondage to some forming mutuality within the continuity that we must meet, for which of others, are at their own level. All the same, it now leaves to a greater extent, the much neglected faculty of informed and reflective common sense, such that to a lesser extent as readily accessible and explicable dynamism that inevitably supervenes in the analytic work, evens though the surface resistance have been largely or wholly mastered. Its submissive providence lay order to a perfect commonality. This, premising with which is the specific type in influence to the immediacy in cultural climatically stressed of the general attitude of many young people (Anna Freud 1968) toward the psychoanalytic process and its goals.
However, an important factor responsible for the neglect of the theory of transference was the early preoccupation of analysis with showing the various mechanisms involved in transference. Interest in the genesis of transference was sidetracked by focussing research on the manifestations of resistance and the mechanisms of defence. These mechanisms are often explained the phenomenon of transference, and their operation was taken to explain its nature and occurrence.
What is more, is that, the neglect of this subject may in part be the result of the personal anxieties of analysts. Edward Glover comments on the absence of open discussion about psychoanalytic technique, and considers the possibility of subjective anxieties: . . .’this seems more likely in that so much technical discussion centres round th e phenomena of transference and counter-transference, both positive and negative. There may in addition enter it an unconscious endeavour to avoid any active ‘interference’ or, more exactly, to remove any suspicion of methods reminiscent of the hypnotist.
That is saying, that there is no consensus about the use of the term ‘transference’ which is called variously ‘the transference’, ‘a transference’, ‘transferences’, ‘transference state’ and sometimes as ‘analytical rapport’.
Does transference embrace the whole affective relationship between an analyst and the patient, or the more restricted ‘neurotic transference’ manifestation? Freud used the term in both senses. To this fact, Silversberg recently drew attention to, and argued that transference should be limited to ‘irrational’ manifestations, maintaining that if the patient says ‘good morning’ to his analyst including such behaviour under the term transference is unreasonable. The contrary view is also expressed: That transference, after the opening stage, is every where, and the patient’s every action can be given a transference interpretation.
Can transference be adjusted to reality, or are transference and reality mutually exclusive, so that some action can only be either the one or the other, or can they coexist so that behaviour in accord with reality can be given a transference meaning as in forced transference interpretations? Alexander comes to the conclusion that they are, . . . truly mutually exclusive, just as the more general concept ‘neurosis’ is quite incompatible with that of reality adjusted behaviour.
Our next query arises from one special aspect of transference, that of ‘acting out‘ in analysis. Freud introduced the term ‘repetition compulsion’ and he says, ‘during a patient in analysis . . . it is plain that the compulsion too repeated in analysis the occurrence of his infantile life disregards in every way the pleasure principle’. In a comprehensive critical survey of the subject, Kubie comes to the conclusion that the whole conception of a compulsion to repeat for the sake of repetition is of questionable value as a scientific idea, and were better eliminated. He believes the conception if a ‘repetition compulsion’ involves the disputed death instinct, and that the term is used in psychoanalytic literature with such widely differing connotations that it has lost most, if not all, of its original meaning. Freud introduced the term for the one variety of transference reaction called ‘acting out’, but it is, in fact, applied to all transference manifestations. Anna Freud, defines transference as,‘ . . . all those impulses experienced by the patient in his relation with the analyst that are not newly created by the objective analytic situation but have their sources in early . . . relations and are now merely revived under the influence of the repetition compulsion. Ought, then, the term ‘repetition compulsion’ be rejected or retained and, if retained, is it applicable to all transference reactions, or to acting out only?
This leads to the question of whether transference manifestations are essentially neurotic, as Freud most often maintains: ‘The striking peculiarity of neurotic to develop affectionately and hostile feelings toward their analyst are called ‘transference’. Other authors, however, treat transference as an example of the mechanism of displacement, and hold it to be a ‘normal’ mechanism. Abraham considers a capacity for transference identicals with a capacity for adaptation that is ‘sublimated sexual; transference’, and he believes that the sexual impulse in the neurotic is distinguishable from the normal only by as excessive strength. Glover states: ‘Accessibility to human influence depends on the patient’s capacity to establish transference, i.e., to repeat in current situations . . . altitudes develop in early family life’. Is transference, then, a consequent to trauma, conflict and repression, and so exclusively neurotic, or is it normal?
In answer to the question, is transference rational or irrational, Silverberg maintains that transference should be defined as something having the two essential qualities that it be ‘irrational and disagreeable to the patient’. Fenichel agrees that transference is bound up with the fact that a person does not react rationally to the influence of the outer world’. Evidently, no advantage or clarification of the term ‘transference’ has followed its assessment as ‘rational’ or otherwise. Unfortunately, the antithesis, ‘rational’ versus ‘irrational’, was introduced, as it was precisely the psychoanalysis that explained that rational behaviour can be traced to ‘irrational’ roots. What is transferred? : Affects, emotions, ideas, conflicts, attitudes, experiences? Freud says only effect of love and hate is included; but Glover finds that ‘Up to date (1937) discussion of transference was influenced for the most part by the understanding of one unconscious mechanism only, that of displacement, and he concludes that an adequate conception of transference must reflect all the individuals’ development . . . ,. He displaces onto the analyst, not merely affects and ideas but all he has ever learned or forgotten throughout his mental development. Are these transferred to the person of the analyst, or also to the analytic situation, is extra-analytic behaviour to be classed as transference?
Our positive and negative transference felt by the analyst to be an intrusive foreign body, as Anna Freud states in discussing the transference of libidinal impulses, or are they agreeable to the patient’s, a gratification as great that they serve as resistance: Alexander concludes that transference gratifications are the greatest source of unduly prolonging analysis, he reminds us that whereas Freud initially had the greatest difficulty in persuading his patients to continue analysis, he soon had equally greater difficulty in persuading them to give up.
Freud divides positive transference into sympathetic and positive transferences, as the relation between the two is not clearly defined, and sympathetic, or remain distinct, is sympathetic transference resolved with positive and negative transference? Debates concerning the importance of positive transference at the beginning of analysis and carrier of the whole analysis have largely been revived among child analyses. As this has extended to the question of whether or not a transference neurosis in children is desirable or even possible. While this dispute touches on the fundament of psychoanalytic theory, the definitions offered as a basis for the discussion are not very precise.
In the face of such divergent opinions on the hidden nature and manifestations of transference, one might expect several hypotheses and opinions about how these manifestations come about. Nevertheless, this is not so. On the contrary, there is the earliest approach to full unanimity and accord throughout the psychoanalytic literature on this point. Transference manifestations are held to arise within the patient’s spontaneously. ‘This peculiarity of the transference is not, therefore, says Freud, ‘to be placed to the account of psychoanalysis treatment, but is to be ascribed to the patient’s neurosis itself’. Elsewhere he states, ‘In every analytic treatment the patient develops, without any activity by the analyst, an intense affective relation to him . . . It must not be assumed the analysis produces the transference . . . ,. The psychoanalytic treatment does not produce the transference, it only unmasks it’. Ferenczi, in discussing the positive and negative transference says: ‘ . . . and it has particularly to be stressed that this process is the patient’s own work and is hardly ever produced by the analyst’. Analytical transference appears spontaneously; the analysts need only take care not to disturb this process. Rado states, ‘The analysis did not deliberately set out to affect this new artificial formation [the transference neurosis]: He merely observed that such a process took place and forthwith made use of it for his own purpose’. Freud further states, ‘The fact of the transference appearing, although neither wanted nor induced by either the analyst or the patient, in every neurotic who comes under treatment . . . has always seemed to me . . . proof that the source of the propelling forces of neurosis lies in the sexual life.
There is, however, a reference by Freud from which one has to infer that he had in mind another factor in the genesis of transference apart from spontaneity - in fact, some outside influence: The analyst ‘must recognize that the patient’s falling in love is induced by the analytic situation . . .’ He [the analyst] has evoked this love by undertaking analytic treatment to cure the neurosis, for him, it is an unavoidable consequence of a medical situation . . . Freud did not amplify or specify what importance he attached to this causal remark.
Anna Freud states that the children’s analysis has to woe the little patient to gain its love and affection before analysis can go on, and she says, parenthetically, that something similar takes place in the analysis of adults.
Another reference to the effect those transference phenomenons are not completely spontaneous is found in as statement by Glover, summarizing the effects of inexact interpretation. He says that the artificial phobic and hysterical formation resulting from incomplete or inexact interpretations is not an entirely new conception. Hypnotic manifestations had long been considered as induced hysteria and Abraham considered that states of autosuggestions were induced obsessional systems. He continues, ‘ . . . and, of course, the induction or development of a transference neurosis during analysis is regarded as an integral part of the process’. One is entitled from the context to assume that Glover commits himself to the view that some outside factors are operative which induce the transference neurosis. Still, it is hardly a coincidence that it is no more than a hint.
A few remarks about clinical considerations are the transference nauseosus, and the problem of transference interpretation, may be offered at this point. The whole situational structure of analysis (in contrast with other personal relationships), its dialogue of free association and interpretation, and its deprivations too most ordinary cognitive and emotions’ interpersonal striving tends toward the separation of discrete transferences from their synthesis with one another and with defences, in character or symptoms, and with deepening regression, toward the re-enactment of the essentials of the infantile neurosis, in the transference neurosis. In other relationships, the ‘exchange of ideas’ expression - gratifying, aggressive, punitive or otherwise is actively responsive, and the open mobility of search for alternative or greater satisfaction - exert a profound dynamic and economic influence, so that only extraordinary situations, or transference of pathological character, or both, occasion comparable regression.
If we, in considering the function of the transference in the analytical process, one is confronted by the apparent naïve, but nonetheless important question of the role of the actual (current) objects as compared with that of the object representation of the original personage in the past. We recall Freud’s paradoxical, somewhat gloomy, but portentous concluding passage in ‘The Dynamics of Transference’. This struggle between the doctor and the patient, between intellect and instinctual life, between understanding and seeking to act, is played out almost exclusively in the phenomenon of transference. It is on that field that the victory must be won - the victory whose expression is the permanent cure of the neurosis. It cannot be disputed that controlling the phenomena of transference presents the psycho-analysis with the greatest difficulties. However, it should be forgotten that they do us the inestimable service of making the patient’s hidden and forgotten erotic impulses immediate and manifest. For when all is said and done, destroying anyone in the absentia is impossible or in effigy.
Both object and representations are made necessary by the basic phenomenon of original separation. Even so, the existence of an image of the object, which persists without that object, is one important beginning of psychic life overall, certainly an indispensable prerequisite for object relationship, as generally considered. Whether this is viewed as (or at times demonstrable is) an unstable introjects, which is always subject to alternative projection, or an intrapsychic object representation clearly distinguished from the self representation, or a firm identification in the superego, or in the ego itself, these phenomena are in various ways components of the system of mastery of the fact of separation, or separateness, from the originally absolutely necessary anaclitic or (in the earliest period) symbiotic ‘object’. In the light of clinical observation, it may be the relative stable (parental) object representation, at times drawing to varying degree on the more archaic phenomena, at moments, even in nonpsychotic patients, overwhelmed by them, sometimes a restoration from oedipal identification, which provides the preponderant basis for most demonstrable analytic transference, in neurotic patients. The transference is effectively established when this representation invests the analyst to a degree - depending on intensity of drive and mode of ego participation - which ranges from wishing and striving to remake the analyst, to biassed judgments and misinterpretations of data, finally in actual perceptual distortion.
However, richly and vividly the old object representation as such may be invested, however rigidly established the libidinal or aggressive cathexis if the image may be, his as such can become the actual and exclusive focus of full instinctual discharge, or of complicated and intense instinct-defence solution, only in states of extreme pathological severity. This is consistent with the usual and general energy-sparing quality of strictly intrapsychic processes. For the vast majority of persons, viable to a degree, including those with severe neurosis, character distortions, addictions, and certain psychoses, the striving is toward the living and actual object, even at the expense of intense suffering. In a sense, this returns us to the beginning, to the state in which th e psychological ‘object-to-be’ (if you prefer) has a critical importance never to be duplicated but in certain acute life emergence, even if the object is not firmly perceived as such, in the sense of later object relations. It does seem those trace impressions from the realistic contacts in the service of life preserving, and the associated instinctual gratifications, and innumerable secondarily associated sensory impressions, are vaster by the specific inborn urges of sexual maturation. There propels the individual to renew many earliest modes of actual bodily contact, about seeking specific instinctual gratification, or, to look away from clear-out instinctual matters to the more remote elaborations of human contact: Few regard loneliness as other than a source of suffering, even self-imposed, as an apparent matter of choice, and the forcible position of ‘solitary confinements’ is surely one of the most cruel of punishment.
Interpretation, recollection or reconstruction, and, of course, working through, is essential for the establishment of effective insight, but they cannot operate mutatively, if applied only to memories of the strict sense, whether of highly cathected events or persons. For it is the thrust of wish or impulse or the elaboration of germane dynamic fantasies, and the corresponding defensive structure and their inadequacies, associated with such memories, which produce neurosis. It is a parallel thrust that creates the transference neurosis. Where memories are clear and vivid, through recall, or accepted as much through reconstruction, and associated with variable, optional, and adaptive, rather than rigidly ‘structuralized’ response patterns, the analytic work has been done.
This view does place somewhat heavy than usual emphasis on the horizontal coordinate of operations, the conscious and unconscious relation to the analyst as a living and actual object, who becomes invested with the imagery, traits, and functions of critical objects of the past. The relationship is to be understood in its dynamic, economic, and adaptive meanings, in its current ‘structuralized’ tenacity, the real and unreal carefully separated from one another. The process of subjective memory or of reconstruction, the indispensable genetic dimension, is, in this sense, invoked toward the decisive and specific autobiographic understanding of the living version of old conflict, rather than with the assumption that the interpretative reduction of the transference neurosis to gross mnmemic elements is, in itself and automatically, mutative. At least, this of the problem seems appropriate to most chronic neurosis embedded in germane character structure of some Plexuity. That neurotic symptoms connected with isolated traumatic events, covering indisputably true, although the details of process, including the role of transference, are probably not yet adequately understood. Psychoanalysis was born in the observation of this type of process. Nonetheless, for some time, the role of the transference, in the early writings of both Freud and Ferenczi, seemed weighted somewhat in the direction of its resistance function (i.e., as directed against recall), although its affirmative functions were soon adequately appreciated, and placed in the dialectical position, which has obtained with time.
However, even if it is insufficient for exclusive reliance, in relation to the complicated neurotic problems faced, assigning it to the recall and reconstruction of the past an exclusively explanatory value would be fallacious (in the intellectual sense), important though that functions be, and difficult as its full-blown emotional correlate may be to come by. There is no doubt that, even in complicated neuroses, with equivalently complicated transference neuroses, the genuinely experienced linking of the past and present can have, at times, a certain uniquely specific dynamic effect of its own, a type of telescoping or merging of common elements in experience, which must be connected with the meaninglessness of time in unconscious life, compared with its stern authority in the life of consciousness and adaptation to everyday reality. Contributing decisively to such experience, to whatever degree it occurs, is of course, the vivid currency of thee transference neurosis, and central in this, the reincarnation of old objects in an actual person, the analyst.
Thus, an allied problem in the general sphere of transference is the fascinating and often enigmatic interplay of past and present. If one wishes to view this interplay as to a stereotyped formulation, the matter can remain relatively uncomplicated - as a formulation. Unfortunately, this is too often the case. The phenomenon, however, retains some important obscurities, which cannot thoroughly be to dispel, but to which would be to call of its attention. To concentrate on the dimension of time, only to omit reference to the many complicated and intermediate aspects of technique, is, however essential. For example, we can assume that the transference neurosis re-enacts the essential conflicts of the infantile neurosis in a current setting. If a reasonable degree of awareness of transference is established, the next problem is the genetic reduction of the necrosis to its elements in the past, through analysis of the transference resistance and allied intrapsychic remittances, ultimately genetic interpretations, recollection and reconstruction, and working through. As the transference is related to its genetic origins, the analyst by that emerges in his true, i.e., real, identity to the patient, the transference is putatively ‘resolved’. To the extent that one follows the traditional view that all remittances, including the transference itself, is ultimately directed against the restoration of early memories as such, this is a convincing formulation. Yet, in its own right, it has a certain tightly logical quality. However, we know that all this is not so readily accomplished, apart from the special intrapsychic considerations described by Freud in ‘Analysis Terminable and Interminable’. Although in some favourable cases, much of the cognitive interpretative work can be accomplished, there remains the fact that cognition alone, in its bare sense, does not necessarily lead to the subsidence of powerful dynamics, to the withdrawal of ‘cathexes’ from important real objects. For, a short while ago, the analyst is a real and living object, apart from the representations with which the transference invests him, which agree interpretably as such. There is, not seldom, as for a confusing interrelation and commingling of the emergent responses due to an old seeking, and those directed toward a new individual in his own right. Both are important, furthermore, there are large and important zones of overlapping. Apart from such considerations, even the explicitly incestuous transference is currently experienced (at least in good part) by a full-grown adult (like the original Oedipus), instead of a totally and actually a helpless child. To be sure, the latter state is reflected subjectively in the emergent transference elements of instinctual striving: But it is subject to analysis, and the residue is something significantly, if not totally, different. It is these as such, which, must be displaced to others. If, as generally agreed, the revival of infantile fantasies and striving in the biologically mature adolescent. This presents a new and special problem, one must assume distinctiveness of experience for the adult, although it is true that in the majority of instances, adequate solution is favoured by the effected state. There is, in any case, a residual real relationship between persons who have worked together in a prolonged, arduous, and intimate relationship, which, strictly speaking, is not a transference, but there may be mutual colouration, blending, and some confusion between the two spheres of feeling. The general tendency is, such as to ignore this dual aspect, in continuing relationships, probably both components are gratified to some degree. Above all, there is the ubiquitous power of the residual primordial transference, the urge to cling to an omnipotent parent, to resist the displacement of its ‘sublimated’ analytic aspects, even if the various representations of the wishes for bodily intimacy have been thoroughly analysed and successfully displaced. The outcome is largely the ‘transference of the transference’. For example, reality can provide no actual answer to the man of faith finds this gratification in revealed religion, others in a wide range of secular beliefs and ‘leaders’, the modern rational and sceptical intellectual is less fortunate in this respect. Presumably free, he is prone to invest even intellectual disciplines or their proponents with inappropriate expectations and partisan passions. Elsewhere, in that of our own field does not provide exception to this tendency.
Of unequivocal importance, is the sheer fact of current continued physical proximity, as a dynamic and economic factor of great importance in itself, in the prolongation of transference effects. The flood of neurophysiological stimuli occasioned by the analyst’s presence causes an entirely different intrapsychic situation from the prevailing in is absence, regardless of how one conceptualizes the difference. Thus, the gradual ‘weaning’ to independence, through the reduction of hours, is very useful in many instances: In some, it may be that the dissolution of the transference (in a practical sense), if well analysed, occurs, as Macalpine suggests, only after regular vistas cease. There are a certain number of patients who will never show a terminal phase (or incipient adaptation to the idea of termination as a reality), without relatively arbitrary setting of a termination date. Even though it has been tendentiously misunderstood in one or two instances. That is to say, that a predismissed period of varying duration, following what would ordinarily be regarded as termination, be devoted to vis-à-vis interviews, at reduced frequency, dealing in integrated fashion with whatever preoccupations the patient is impelled to bring to such valedictory. The vis-à-vis element adds the further advantage of testing tenacious transference images against the actuality.
The urge toward actual instinctual gratifications and allied satisfactions, the need to be rid of burdens of time and expense, the sheer urges toward independent functioning, often participate importantly in the dynamic of ultimately successful separation. Certainly, the analyst’s own nonarrogant but firm inaccessibility to residual transference wishes of the patient (however expressed), coupled with the conscious and unconscious wish to set him free for developments in his individual potentialities, also contributes to his important development.
The conflicts occurring in the earlier developmental stages are no less significant as a formative influence, because these problems represent the earliest prototypes of such basic human situations as dependency on others and relationship to authority. Also basic in molding the personality of the individual is the behaviour of the parents toward the child during these stages of development. The fact that the child reacts, not only to objective reality, but also to fantasy distortions of reality, however, greatly complicates even the best-intentioned educational efforts.
The effort to clarify the bewildering number of interrelated observations uncovered by psychoanalytic exploration led to the development of a model of the structure of the psychic system. Three functional systems are distinguished that are conveniently designated as the id, ego, and superego.
The first system refers to the sexual and aggressive tendencies that arise from the body, as distinguished from the mind. Freud called these tendencies Triebe, which literally means ‘drives,’ but which is often inaccurately translated as ‘instincts’ to indicate their innate character. These inherent drives claim immediate satisfaction, which is experienced as pleasurable; the id thus is dominated by the pleasure principle. In his later writings, Freud tended more toward psychological rather than biological conceptualization of the drives.
How the conditions for satisfaction are to be brought about is the task of the second system, the ego, which is the domain of such functions as perception, thinking, and motor control that can accurately assess environmental conditions. In order to fulfill its function of adaptation, or reality testing, the ego must be capable of enforcing the postponement of satisfaction of the instinctual impulses originating in the id. To defend itself against unacceptable impulses, the ego develops specific psychic means, known as defence mechanisms. These include repression, the exclusion of impulses from conscious awareness; projection, the process of ascribing to others one's own unacknowledged desires; and reaction formation, the establishment of a pattern of behaviour directly opposed to a strong unconscious needs. Such defence mechanisms are put into operation whenever anxiety signals a danger that the original unacceptable impulses may reemerge.
An id impulse becomes unacceptable, not only as a result of a temporary need for postponing its satisfaction until suitable reality conditions can be found, but more often because of a prohibition imposed on the individual by others, originally the parents. The totality of these demands and prohibitions constitutes the major content of the third system, the superego, the function of which is to control the ego in accordance with the internalized standards of parental figures. If the demands of the superego are not fulfilled, the person may feel shame or guilt. Because the superego, in Freudian theory, originates in the struggle to overcome the Oedipal conflict, it has a power akin to an instinctual drive, is in part unconscious, and can give rise to feelings of guilt not justified by any conscious transgression. The ego, having to mediate among the demands of the id, the superego, and the outside world, may not be strong enough to reconcile these conflicting forces. The more the ego is impeded in its development because of being enmeshed in its earlier conflicts, called fixations or complexes, or the more it reverts to earlier satisfactions and archaic modes of functioning, known as regression, the greater is the likelihood of succumbing to these pressures. Unable to function normally, it can maintain its limited control and integrity only at the price of symptom formation, in which the tensions are expressed in neurotic symptoms.
A cornerstone of modern psychoanalytic theory and practice is the concept of anxiety, which institutes appropriate mechanisms of defence against certain danger situations. These danger situations, as described by Freud, are the fear of abandonment by or the loss of the loved one (the object), the risk of losing the object's love, the danger of retaliation and punishment, and, finally, the hazard of reproach by the superego. Thus, symptom formation, character and impulse disorders, and perversions, as well as sublimations, represent compromise formations—different forms of an adaptive integration that the ego tries to achieve through more or less successfully reconciling the different conflicting forces in the mind.
Various psychoanalytic schools have adopted other names for their doctrines to indicate deviations from Freudian theory.
Swiss psychiatrist Carl Jung began his studies of human motivation in the early 1900s and created the school of psychoanalysis known as analytical psychology. A contemporary of Austrian psychoanalyst Sigmund Freud, Jung at first collaborated closely with Freud but eventually moved on to pursue his own theories, including the exploration of personality types. According to Jung, there are two basic personality types, extroverted and introverted, which alternate equally in the completely normal individual. Jung also believed that the unconscious mind is formed by the personal unconscious (the repressed feelings and thoughts developed during an individual’s life) and the collective unconscious (those feelings, thoughts, and memories shared by all humanity).
Carl Gustav Jung, one of the earliest pupils of Freud, eventually created a school that he preferred to call analytical psychology. Like Freud, Jung used the concept of the libido; however, to him it meant not only sexual drives, but a composite of all creative instincts and impulses and the entire motivating force of human conduct. According to his theories, the unconscious is composed of two parts; the personal unconscious, which contains the results of the individual's entire experience, and the collective unconscious, the reservoir of the experience of the human race. In the collective unconscious exist a number of primordial images, or archetypes, common to all individuals of a given country or historical era. Archetypes take the form of bits of intuitive knowledge or apprehension and normally exist only in the collective unconscious of the individual. When the conscious mind contains no images, however, as in sleep, or when the consciousness is caught off guard, the archetypes commence to function. Archetypes are primitive modes of thought and tend to personify natural processes in terms of such mythological concepts as good and evil spirits, fairies, and dragons. The mother and the father also serve as prominent archetypes.
An important concept in Jung's theory is the existence of two basically different types of personality, mental attitude, and function. When the libido and the individual's general interest are turned outward toward people and objects of the external world, he or she is said to be extroverted. When the reverse is true, and libido and interest are centreed on the individual, he or she is said to be introverted. In a completely normal individual these two tendencies alternate, neither dominating, but usually the libido is directed mainly in one direction nor the other; as a result, two personality types are recognizable.
Jung rejected Freud's distinction between the ego and superego and recognized a portion of the personality, somewhat similar to the superego, that he called the persona. The persona consists of what a person appears to be to others, in contrast to what he or she actually is. The persona is the role the individual chooses to play in life, the total impression he or she wishes to make on the outside world.
Austrian psychologist and psychiatrist Alfred Adler studied under Sigmund Freud, the founder of psychoanalysis, before developing his own theories about human behaviour. Adler’s best-known theories stress that individuals are mainly motivated by feelings of inferiority, which he called an inferiority complex.
Alfred Adler, another of Freud's pupils, differed from both Freud and Jung in stressing that the motivating force in human life is the sense of inferiority, which begins as soon as an infant is able to comprehend the existence of other people who are better able to care for themselves and cope with their environment. From the moment the feeling of inferiority is established, the child strives to overcome it. Because inferiority is intolerable, the compensatory mechanisms set up by the mind may get out of hand, resulting in self-centreed neurotic attitudes, overcompensations, and a retreat from the real world and its problems.
Adler laid particular stress on inferiority feelings arising from what he regarded as the three most important relationships: those between the individual and work, friends, and loved ones. The avoidance of inferiority feelings in these relationships leads the individual to adopt a life goal that is often not realistic and frequently is expressed as an unreasoning will to power and dominance, leading to every type of antisocial behaviour from bullying and boasting to political tyranny. Adler believed that analysis can foster a sane and rational ‘community feeling’ that is constructive rather than destructive.
During the period from 1895 to 1900 Freud developed many of the concepts that were later incorporated into psychoanalytic practice and doctrine. Soon after publishing the studies on hysteria he abandoned the use of hypnosis as a cathartic procedure and substituted the investigation of the patient’s spontaneous flow of thoughts, called free association, to reveal the unconscious mental processes at the root of the neurotic disturbance.
In his clinical observations Freud found evidence for the mental mechanisms of repression and resistance. He described repression as a device operating unconsciously to make the memory of painful or threatening events inaccessible to the conscious mind. Resistance is defined as the unconscious defense against awareness of repressed experiences in order to avoid the resulting anxiety. He traced the operation of unconscious processes, using the free associations of the patient to guide him in the interpretation of dreams and slips of speech. Dream analysis led to his discoveries of infantile sexuality and of the so-called Oedipus complex, which constitutes the erotic attachment of the child for the parent of the opposite sex, together with hostile feelings toward the other parent. In these years he also developed the theory of transference, the process by which emotional attitudes, established originally toward parental figures in childhood, is transferred in later life to others. The end of this period was marked by the appearance of Freud’s most important work, The Interpretation of Dreams (1899). Here Freud analyzed many of his own dreams recorded in the 3-year period of his self-analysis, begun in 1897. This work expounds all the fundamental concepts underlying psychoanalytic technique and doctrine.
The plexuity of anxiety, acclimate their anxiety, of such that an emotional state in which people feel uneasy, apprehensive, or fearful. People usually experience anxiety about events they cannot control or predict, or about events that seem threatening or dangerous. For example, students taking an important test may feel anxious because they cannot predict the test questions or feel certain of a good grade. People often use the word’s fear and anxiety to describe the same thing. Fear also describes a reaction to immediate danger characterized by a strong desire to escape the situation.
The physical symptoms of anxiety reflect a chronic ‘readiness’ to deal with some future threat. These symptoms may include fidgeting, muscle tension, sleeping problems, and headaches. Higher levels of anxiety may produce such symptoms as rapid heartbeat, sweating, increased blood pressure, nausea, and dizziness.
All people experience anxiety to some degree. Most people feel anxious when faced with a new situation, such as a first date, or when trying to do something well, such as give a public speech. A mild to moderate amount of anxiety in these situations is normal and even beneficial. Anxiety can motivate people to prepare for an upcoming event and can help keep them focused on the task at hand.
However, too little anxiety or too much anxiety can cause problems. Individuals who feel no anxiety when faced with an important situation may lack alertness and focus. On the other hand, individuals who experience an abnormally high amount of anxiety often feel overwhelmed, immobilized, and unable to accomplish the task at hand. People with too much anxiety often suffer from one of the anxiety disorders, a group of mental illnesses. In fact, more people experience anxiety disorders than any other type of mental illness. A survey of people aged 15 to 54 in the United States found that about 17 percent of this population suffers from an anxiety disorder during any given year.
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, a handbook for mental health professionals, describes a variety of anxiety disorders. These include generalized anxiety disorder, phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.
People with generalized anxiety disorder feel anxious most of the time. They worry excessively about routine events or circumstances in their lives. Their worries often relate to finances, family, personal health, and relationships with others. Although they recognize their anxiety as irrational or out of proportion to actual events, they feel unable to control their worrying. For example, they may worry uncontrollably and intensely about money despite evidence that their financial situation is stable. Children with this disorder typically worry about their performance at school or about catastrophic events, such as tornadoes, earthquakes, and nuclear war.
People with generalized anxiety disorder often find that their worries interfere with their ability to function at work or concentrate on tasks. Physical symptoms, such as disturbed sleep, irritability, muscle aches, and tension, may accompany the anxiety. To receive a diagnosis of this disorder, individuals must have experienced its symptoms for at least six months.
Generalized anxiety disorder affects about 3 percent of people in the general population in any given year. From 55 to 66 percent of people with this disorder are female.
Participants in a program to overcome a phobia (fear) of flying on airplanes get ready to ‘graduate’ by taking a short flight. The program uses a type of behavioural therapy called systematic desensitization, which teaches people to relax in a situation that would normally produce anxiety.
A phobia is an excessive, enduring fear of clearly defined objects or situations that interferes with a person’s normal functioning. Although they know their fear is irrational, people with phobias always try to avoid the source of their fear. Common phobias include fear of heights (acrophobia), fear of enclosed places (claustrophobia), fear of insects, snakes, or other animals, and fear of air travel. Social phobias involve a fear of performing, of critical evaluation, or of being embarrassed in front of other people.
Panic is an intense, overpowering surge of fear. People with panic disorder experience panic attacks—periods of quickly escalating, intense fear and discomfort accompanied by such physical symptoms as rapid heartbeat, trembling, shortness of breath, dizziness, and nausea. Because people with this disorder cannot predict when these attacks will strike, they develop anxiety about having additional panic attacks and may limit their activities outside the home.
In obsessive-compulsive disorder, people persistently experience certain intrusive thoughts or images (obsessions) or feel compelled to perform certain behaviours (compulsions). Obsessions may include unwanted thoughts about inadvertently poisoning others or injuring a pedestrian while driving. Common compulsions include repetitive hand washing or such mental acts as repeated counting. People with this disorder often perform compulsions to reduce the anxiety produced by their obsessions. The obsessions and compulsions significantly interfere with their ability to function and may consume a great deal of time.
Post-traumatic stress disorder sometimes occurs after people experience traumatic or catastrophic events, such as physical or sexual assaults, natural disasters, accidents, and wars. People with this disorder relive the traumatic event through recurrent dreams or intrusive memories called flashbacks. They avoid things or places associated with the trauma and may feel emotionally detached or estranged from others. Other symptoms may include difficulty sleeping, irritability, and trouble concentrating.
Most anxiety disorders do not have an obvious cause. They result from a combination of biological, psychological, and social factors.
Studies suggest that anxiety disorders run in families. That is, children and close relatives of people with disorders are more likely than most to develop anxiety disorders. Some people may inherit genes that make them particularly vulnerable to anxiety. These genes do not necessarily cause people to be anxious, but the genes may increase the risk of anxiety disorders when certain psychological and social factors are also present.
Anxiety also appears to be related to certain brain functions. Chemicals in the brain called neurotransmitters enable neurons, or brain cells, to communicate with each other. One neurotransmitter, gamma-amino butyric acid (GABA), appears to play a role in regulating one’s level of anxiety. Lower levels of GABA are associated with higher levels of anxiety. Some studies suggest that the neurotransmitter’s norepinephrine and serotonin play a role in panic disorder.
Psychologists have proposed a variety of models to explain anxiety. Austrian psychoanalyst Sigmund Freud suggested that anxiety results from internal, unconscious conflicts. He believed that a person’s mind represses wishes and fantasies about which the person feels uncomfortable. This repression, Freud believed, results in anxiety disorders, which he called neuroses.
More recently, behavioural researchers have challenged Freud’s model of anxiety. They believe one’s anxiety level relates to how much a person believes events can be predicted or controlled. Children who have little control over events, perhaps because of overprotective parents, may have little confidence in their ability to handle problems as adults. This lack of confidence can lead to increased anxiety.
Behavioural theorists also believe that children may learn anxiety from a role model, such as a parent. By observing their parent’s anxious response to difficult situations, the child may learn a similar anxious response. A child may also learn anxiety as a conditioned response. For example, an infant often startled by a loud noise while playing with a toy may become anxious just at the sight of the toy. Some experts suggest that people with a high level of anxiety misinterpret normal events as threatening. For instance, they may believe their rapid heartbeat indicates they are experiencing a panic attack when in reality it may be the result of exercise.
While some people may be biologically and psychologically predisposed to feel anxious, most anxiety is triggered by social factors. Many people feel anxious in response to stress, such as a divorce, starting a new job, or moving. Also, how a person expresses anxiety appears to be shaped by social factors. For example, many cultures accept the expression of anxiety and emotion in women, but expect more reserved emotional displays from men.
Mental health professionals use a variety of methods to help people overcome anxiety disorders. These include psychoactive drugs and psychotherapy, particularly behaviour therapy. Other techniques, such as exercise, hypnosis, meditation, and biofeedback, may also prove helpful.
Psychiatrists often prescribe benzodiazepines, a group of tranquilizing drugs, to reduce anxiety in people with high levels of anxiety. Benzodiazepines help to reduce anxiety by stimulating the GABA neurotransmitter system. Common benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium). Two classes of antidepressant drugs—tricyclics and selective serotonin reuptake inhibitors (SSRIs)—also have proven effective in treating certain anxiety disorders.
Benzodiazepines can work quickly with few unpleasant side effects, but they can also be addictive. In addition, benzodiazepines can slow down or impair motor behaviour or thinking and must be used with caution, particularly in elderly persons. SSRIs take longer to work than the benzodiazepines but are not addictive. Some people experience anxiety symptoms again when they stop taking the medications.
Therapists who attribute the cause of anxiety to unconscious, internal conflicts may use psychoanalysis to help people understand and resolve their conflicts. Other types of psychotherapy, such as cognitive-behavioural therapy, have proven effective in treating anxiety disorders. In cognitive-behavioural therapy, the therapist often educates the person about the nature of his or her particular anxiety disorder. Then, the therapist may help the person challenge, and irrational thoughts that lead to anxiety. For example, to treat a person with a snake phobia, a therapist might gradually expose the person to snakes, beginning with pictures of snakes and progressing to rubber snakes and real snakes. The patient can use relaxation techniques acquired in therapy to overcome the fear of snakes.
Research has shown psychotherapy to be as effective or more effective than medications in treating many anxiety disorders. Psychotherapy may also provide more lasting benefits than medications when patients discontinue treatment.
A cornerstone of modern psychoanalytic theory and practice is the concept of anxiety, which institutes appropriate mechanisms of defence against certain danger situations. These danger situations, as described by Freud, are the fear of abandonment by or the loss of the loved one (the object), the risk of losing the object's love, the danger of retaliation and punishment, and, finally, the hazard of reproach by the superego. Thus, symptom formation, character and impulse disorders, and perversions, as well as sublimations, represent compromise formations—different forms of an adaptive integration that the ego tries to achieve through more or less successfully reconciling the different conflicting forces in the mind.
Panic Disorder, is a graduated form of mental illness in which a person experiences repeated, unexpected panic attacks and persistent anxiety about the possibility that the panic attacks will recur. A panic attack is a period of intense fear, apprehension, or discomfort. In panic disorder, the attacks usually occur without warning. Symptoms include a racing heart, shortness of breath, trembling, choking or smothering sensations, and fears of ‘going crazy,’ losing control, or dying from a heart attack. Panic attacks may last from a few seconds to several hours. Most peak within 10 minutes and end within 20 or 30 minutes.
About 2 percent of people in the United States suffer from panic disorder during any given year, and the condition affects more than twice as many women as men. People with panic disorder may experience panic attacks frequently, such as daily or weekly, or more sporadically. Additionally, panic attacks may occur as part of other anxiety disorders, such as phobias—in which a specific object or situation triggers the attack—and, more rarely, post-traumatic stress disorder.
People with panic disorder frequently develop agoraphobia, a fear of being in places or situations from which escape might be difficult if a panic attack occurs. People with agoraphobia typically fear situations such as traveling in a bus, train, car, or airplane, shopping at malls, going to theaters, crossing over bridges or through tunnels, and being alone in unfamiliar places. Therefore, they avoid these situations and may eventually become reluctant to leave their home. In addition, people with panic disorder appear to have an increased risk of alcoholism and drug dependence. Some studies indicate they also have a higher risk of depression and suicide.
Panic disorder, and both with and without agoraphobia, result from a combination of biological and psychological factors. Some individuals may inherit a vulnerability to stress and anxiety and increase risk of experiencing panic attacks. In addition, certain physiological cues may trigger a panic attack. For example, if a person experiences a racing heart during a panic attack, he or she may begin to associate this sensation with panic attacks. A rapid heartbeat, even if caused by exercise, may then trigger future panic attacks.
Not everyone who experiences a panic attack develops panic disorder. For example, most people experience a rapid heartbeat after running but do not perceive the sensation as dangerous. Those who develop panic disorder tend to interpret their physical sensations as more terrible than they really are. Some psychologists believe that early childhood, and experiences of separation from important people, such as parents, increase the risk of developing panic disorder.
Mental health professionals usually treat panic disorder with medications, specialized psychotherapy, or a combination of both. Benzodiazepines, a group of tranquilizing drugs that includes alprazolam (Xanax) and diazepam (Valium), often reduces anxiety with few physical side effects. However, these medications can be addictive and may impair movement and concentration in some people. Some antidepressant drugs, such as imipramine (Tofranil), also reduce panic symptoms in some people but can produce side effects such as dizziness or dry mouth. Another classes of drugs, selective serotonin reuptake inhibitors (SSRIs), appear to reduce panic symptoms with fewer side effects. SSRIs used to treat panic disorder include paroxetine (Paxil) and fluvoxamine (Luvox). Medication eliminates panic symptoms in 50 to 60 percent of patients. For many patients, however, panic attacks return when they stop taking the medication.
Research has shown that cognitive-behavioural therapy, a type of psychotherapy, eliminates panic attacks in 80 to 100 percent of patients. In this method, therapists help patients re-create the physical symptoms of a panic attack, teach them coping skills, and help them to alter their beliefs about the danger of these sensations. Patients with agoraphobia face their feared situations under the therapist’s supervision, using coping skills to overcome their strong anxiety. These coping skills may include physical relaxation techniques, such as deep breathing and muscle relaxation, as well as cognitive techniques that help people think rationally about anxiety-provoking situations. About 70 percent of panic disorders patients who also have moderate to severe agoraphobia benefit from this type of treatment.
Stress (psychology), has in knowing of an unpleasant state of emotional and physiological arousal that people experience in situations that they perceive as dangerous or threatening to their well-being. The word stress means different things to different people. Some people define stress as events or situations that cause them to feel tension, pressure, or negative emotions such as anxiety and anger. Others view stress as the response to these situations. This response includes physiological changes—such as increased heart rate and muscle tension—as well as emotional and behavioural changes. However, most psychologists regard stress as a process involving a person’s interpretation and response to a threatening event.
Stress is a common experience. We may feel stress when we are very busy, have important deadlines to meet, or have too little time to finish all of our tasks. Often people experiences stress because of problems at work or in social relationships, such as a poor evaluation by a supervisor or an argument with a friend. Some people may be particularly vulnerable to stress in situations involving the threat of failure or personal humiliation. Others have extreme fears of objects or things associated with physical threats—such as snakes, illness, storms, or flying in an aeroplane—and become stressed when they encounter or think about these perceived threats. Major life events, such as the death of a loved one, can cause severe stress.
Stress can have both positive and negative effects. Stress is a normal, adaptive reaction to threat. It signals danger and prepares us to take defensive action. Fear of things that pose realistic threat motivates us to deal with them or avoid them. Stress also motivates us to achieve and fuels creativity. Although stress may hinder performance on difficult tasks, moderate stress seems to improve motivation and performance on less complex tasks. In personal relationships, stress often leads to less cooperation and more aggression.
If not managed appropriately, stress can lead to serious problems. Exposure to chronic stress can contribute to both physical illnesses, such as heart disease, and mental illnesses, such as anxiety disorders. The field of health psychology focuses in part on how stress affects bodily functioning and on how people can use stress management techniques to prevent or minimize disease.
The circumstances that cause stress are called stressors. Stressors vary in severity and duration. For example, the responsibility of caring for a sick parent may be an ongoing source of major stress, whereas getting stuck in a traffic jam may cause mild, short-term stress. Some events, such as the death of a loved one, are stressful for everyone. But in other situations, individuals may respond differently to the same event—what is a stressor for one person may not be stressful for another. For example, a student who is unprepared for a chemistry test and anticipates a bad grade may feel stress, whereas a classmate who studies in advance may feel confident of a good grade. For an event or situation to be a stressor for a particular individual, the person must appraise the situation as threatening and lack the coping resources to deal with it effectively.
Stressors can be classified into three general categories: catastrophic events, major life changes, and daily hassles. In addition, simply thinking about unpleasant past events or anticipating unpleasant future events can cause stress for many people.
Life-threatening disasters, such as earthquakes, cause severe stress and can take a heavy psychological toll on their victims. Pictured here are buildings in Mexico City destroyed by a September 1985 earthquake. The quake left almost 30,000 people homeless and 7000 dead.
A catastrophe is a sudden, often life-threatening calamity or disaster that pushes people to the outer limits of their coping capability. Catastrophes include natural disasters—such as earthquakes, tornadoes, fires, floods, and hurricanes—as well as wars, torture, automobile accidents, violent physical attacks, and sexual assaults. Catastrophes often continue to affect their victims’ mental health long after the event has ended. For example, in 1972 a dam burst and flooded the West Virginia mining town of Buffalo Creek, destroying the town. Two years after the disaster, most of the adult survivors continued to show emotional disturbances. Similarly, most of the survivors of concentration camps in World War II (1939-1945) continued to experience nightmares and other symptoms of severe emotional problems long after their release from the camps.
The most stressful events for adults involve major life changes, such as death of a spouse or family member, divorce, imprisonment, losing one’s job, and major personal disability or illness. For adolescents, the most stressful events are the death of a parent or a close family member, divorce of their parents, imprisonment of their mother or father, and major personal disability or illness. Sometimes, apparently positive events can have stressful components. For example, a woman who gets a job promotion may receive a higher salary and greater prestige, but she may also feel stress from supervising coworkers who were once peers. Getting married is usually considered a positive experience, but planning the wedding, deciding whom to invite, and dealing with family members may cause couples to feel stressed.
Much of the stress in our lives results from having to deal with daily hassles pertaining to our jobs, personal relationships, and everyday living circumstances. Many people experience the same hassles every day. Examples of daily hassles include living in a noisy neighbourhood, commuting to work in heavy traffic, disliking one’s fellow workers, worrying about owing money, waiting in a long line, and misplacing or losing things. When taken individually, these hassles may feel like only minor irritants, but cumulatively, over time, they can cause significant stress. The amount of exposure people has to daily hassles is strongly related to their daily mood. Generally, the greater their exposure is to hassles, the worse is their mood. Studies have found that one’s exposure to daily hassles is actually more predictive of illness than is exposure to major life events.
Studies conducted in countries around the world demonstrate that people can actually work themselves to death. Factors such as workplace stress and long hours contribute to the risk of death from overwork. In this article from Scientific American Presents, Harvey B. Simon, a professor at Harvard Medical School, explores recent findings about the dangers of working too hard and suggests ways of developing healthier work habits.
A person who is stressed typically has anxious thoughts and difficulty concentrating or remembering. Stress can also change outward behaviours. Teeth clenching, hand wringing, pacing, nail biting, and heavy breathing are common signs of stress. People also feel physically different when they are stressed. Butterflies in the stomach, cold hands and feet, dry mouth, and increased heart rate are all physiological effects of stress that we associate with the emotion of anxiety.
When a person appraises an event as stressful, the body undergoes a number of changes that heighten physiological and emotional arousal. First, the sympathetic division of the autonomic nervous system is activated. The sympathetic division prepares the body for action by directing the adrenal glands to secrete the hormones epinephrine (adrenaline) and norepinephrine (noradrenaline). In response, the heart begins to beat more rapidly, muscle tension increases, blood pressure rises, and blood flow is diverted from the internal organs and skin to the brain and muscles. Breathing speeds up, the pupils dilate, and perspiration increases. This reaction is sometimes called the fight-or-flight response because it energizes the body to either confront or flee from a threat.
Another part of the stress response involves the hypothalamus and the pituitary gland, parts of the brain that are important in regulating hormones and many other bodily functions. In times of stress, the hypothalamus directs the pituitary gland to secrete adrenocorticotropic hormone. This hormone, in turn, stimulates the outer layer, or cortex, of the adrenal glands to release glucocorticoids, primarily the stress hormone cortisol. Cortisol helps the body excess fats and carbohydrates to fuel the fight-or-flight response.
Canadian scientist Hans Selye was one of the first people to study the stress response. As a medical student, Selye noticed that patients with quite different illnesses shared many of the same symptoms, such as muscle weakness, weight loss, and apathy. Selye believed these symptoms might be part of a general response by the body to stress. In the 1930s Selye studied the reactions of laboratory rats to a variety of physical stressors, such as heat, cold, poisons, strenuous exercise, and electric shock. He found that the different stressors all produced a similar response: enlargement of the adrenal glands, shrinkage of the thymus gland (a gland involved in the immune response), and bleeding stomach ulcers.
Self proposed a three-stage model of the stress response, which he termed the general adaptation syndrome. The three stages in Selye’s model are alarm, resistance, and exhaustion. The alarm stage is a generalized state of arousal during the body’s initial response to the stressor. In the resistance stage, the body adapts to the stressor and continues to resist it with a high level of physiological arousal. When the stress persists for a long time, and the body is chronically overactive, resistance fails and the body moves to the exhaustion stage. In this stage, the body is vulnerable to disease and even death.
The stress test, also called an exercise electrocardiogram, measures the heart rate of a person during exercise and identifies any abnormal changes in heart function. Such changes may indicate the presence of coronary or arterial disease.
Physicians increasingly acknowledge that stress is a contributing factor in a wide variety of health problems. These problems include cardiovascular disorders such as hypertension (high blood pressure); coronary heart disease (coronary atherosclerosis, or narrowing of the heart’s arteries); and gastrointestinal disorders, such as ulcers. Stress also appears to be a risk factor in cancer, chronic pain problems, and many other health disorders.
Researchers have clearly identified stress, and specifically a person's characteristic way of responding to stress, as a risk factor for cardiovascular diseases. The release of stress hormones has a cumulative negative effect on the heart and blood vessels. Cortisol, for example, increases blood pressure, which can damage the inside walls of blood vessels. It also increases the free fatty acids in the bloodstream, which in turn leads to plaque buildup on the lining of the blood vessels. As the blood vessels narrow over time it becomes increasingly difficult for the heart to pump sufficient blood through them.
People with certain personality types seem to be physiologically overresponsive to stress and therefore more vulnerable to heart disease. For example, the so-called Type A personality is characterized by competitiveness, impatience, and hostility. When Type A people experience stress, their heart rate and blood pressure climb higher and recovery takes longer than with more easygoing people. The most ‘toxic’ personality traits of Type A people are frequent reactions of hostility and anger. These traits are correlated with an increased risk of coronary heart disease.
Stress also appears to influence the development of cancer, but the relationship is not as well established as it is for cardiovascular diseases. There is a moderate positive correlation between extent of exposure and life stressors and cancer—the more stressors, the greater the likelihood of cancer. In addition, a tendency to cope with unpleasant events in a rigid, unemotional manner is associated with the development and progression of cancer.
Ordinarily the immune system is a marvel of precision. It protects the body from disease by seeking out and destroying foreign invaders, such as viruses and bacteria. But there is substantial evidence that stress suppresses the activity of the immune system, leaving an organism more susceptible to infectious diseases. An organism with a weakened immune system is also less able to control naturally occurring mutant cells that overproduce and lead to cancer.
Numerous studies have linked stress with decreased immune response. For example, when laboratory animals are physically restrained, exposed to inescapable electric shocks, or subjected to overcrowding, loud noises, or maternal separation, they show decreased immune system activity. Researchers have reported similar findings for humans. One study, for example, found weakened immune response in people whose spouses had just died. Other studies have documented weakened immune responses among students taking final examinations; people who are severely deprived of sleep; recently divorced or separated men and women; people caring for a family member with Alzheimer’s disease; and people who have recently lost their jobs.
Stress appears to depress immune function in two main ways. First, when people experience stress, they more often engage in behaviours that have adverse effects on their health: cigarette smoking, using more alcohol or drugs, sleeping less, exercising less, and eating poorly. In addition, stress may alter the immune system directly through hormonal changes. Research indicates that glucocorticoids—hormones that are secreted by the adrenal glands during the stress response—actively suppress the body’s immune system.
At one time scientists believed the immune system functioned more or less as an independent system of the body. They now know that the immune system does not operate by itself, but interacts closely with other bodily systems. The field of Psychoneuroimmunology focuses on the relationship between psychological influences (such as stress), the nervous system, and the immune system.
Stress influences mental health as well as physical health. People who experience a high level of stress for a long time—and who copes poorly with this stress—may become irritable, socially withdrawn, and emotionally unstable. They may also have difficulty concentrating and solving problems. Some people under intense and prolonged stress may start to suffer from extreme anxiety, depression, or other severe emotional problems. Anxiety disorders caused by stress may include generalized anxiety disorder, phobias, panic disorder, and obsessive-compulsive disorder. People who survive catastrophes sometimes develop an anxiety disorder called post-traumatic stress disorder. They reexperience the traumatic event again and again in dreams and in disturbing memories or flashbacks during the day. They often seem emotionally numb and may be easily startled or angered.
Coping with stress means using thoughts and actions to deal with stressful situations and lower our stress levels. Many people have a characteristic way of coping with stress based on their personality. People who cope well with stress tend to believe they can personally influence what happens to them. They usually make more positive statements about themselves, resist frustration, remain optimistic, and persevere even under extremely adverse circumstances. What is most important, they choose the appropriate strategies to cope with the stressors they confront? Conversely, people who cope poorly with stress tend to have somewhat opposite personality characteristics, such as lower self-esteem and a pessimistic outlook on life.
Psychologists distinguish two broad types of coping strategies: problem-focused coping and emotion-focused coping. The goal of both strategies is to control one’s stress level. In problem-focused coping, people try to short-circuit negative emotions by taking some action to modify, avoid, or minimize the threatening situation. They change their behaviour to deal with the stressful situation. In emotion-focused coping, people try to directly moderate or eliminate unpleasant emotions. Examples of emotion-focused coping include rethinking the situation in a positive way, relaxation, denial, and wishful thinking.
To understand these strategies, consider the example of a premed student in college who faces three difficult final examinations in a single week. She knows she must get top grades in order to have a chance at acceptance to medical school. This situation is a potential source of stress. To cope, she could organize a study group and master the course materials systematically (problem-focused coping). Or she could decide that she needs to relax and collect herself for an hour or so (emotion-focused coping) before proceeding with an action plan (problem-focused coping). She might also decide to watch television for hours on end to prevent having to think about or study for her exams (emotion-focused coping).
In general, problem-focused coping is the most effective coping strategy when people have realistic opportunities to change aspects of their situation and reduce stress. Emotion-focused coping is most useful as a short-term strategy. It can help reduce one’s arousal level before engaging in problem-solving and taking action, and it can help people deal with stressful situations in which there are few problem-focused coping options.
Support from friends, family members, and others who care for us goes a long way in helping us to get by in times of trouble. Social support systems provide us with emotional sustenance, tangible resources and aid, and information when we are in need. People with social support feel cared about and valued by others and feel a sense of belonging to a larger social network.
A large body of research has linked social support to good health and a superior ability to cope with stress. For example, one long-term study of several thousand California residents found that people with extensive social ties lived longer than those with few close social contacts. Another study found that heart-attack victims who lived alone were nearly twice as likely to have another heart attack as those who lived with someone. Even the perception of social support can help people cope with stress. Studies have found that people’s appraisal of the availability of social support is more closely related to how well they deal with stressors than the actual amount of support they receive or the size of their social network.
Research also suggests that the companionship of animals can help lower stress. For example, one study found that in times of stress, people with pet dogs made fewer visits to the doctor than those without pets.
A patient at a biofeedback clinic sits connected to electrodes on his head and finger. Biofeedback is a technique in which patients attempt to become aware of and then alter bodily functions such as muscle tension and blood pressure. It is used in treating pain and stress-related conditions, and may help some paralysed patients regain the use of their limbs.
Biofeedback is a technique in which people learn voluntary control of stress-related physiological responses, such as skin temperature, muscle tension, blood pressure, and heart rate. Normally, people cannot control these responses voluntarily. In biofeedback training, people are connected to an instrument or machine that measures a particular physiological response, such as heart rate, and feeds that measurement back to them in an understandable way. For example, the machine might beep with each heartbeat or display the number of heartbeats per minute on a digital screen. Next, individuals learn to be sensitive to subtle changes inside their body that affect the response system being measured. Gradually, they learn to produce changes in that response system—for example, to voluntarily lower their heart rate. Typically individuals use different techniques and proceed by trial and error until they discover a way to produce the desired changes.
Scientists do not understand the mechanisms by which biofeedback works. Nonetheless, it has become a widely used and generally accepted technique for producing relaxation and lowering physiological arousal in patients with stress-related disorders. One use of biofeedback is in the treatment of tension headaches. By learning to lower muscle tension in the forehead, scalp, and neck, many tension headache sufferers can find long-term relief.
In addition to biofeedback, two other major methods of relaxation are progressive muscular relaxation and meditation. Progressive muscular relaxation involves systematically tensing and then relaxing different groups of skeletal (voluntary) muscles, while directing one’s attention toward the contrasting sensations produced by the two procedures. After practicing progressive muscular relaxation, individuals become increasingly sensitive to rising tension levels and can produce the relaxation response during everyday activities (often by repeating a cue word, such as calm, to themselves).
Meditation, in addition to teaching relaxation, is designed to achieve subjective goals such as contemplation, wisdom, and altered states of consciousness. Some forms have a strong Eastern religious and spiritual heritage based in Zen Buddhism and yoga. Other varieties emphasize a particular lifestyle for practitioners. One of the most common forms of meditation, Transcendental Meditation, involves focusing attention on and repeating a mantra, which is a word, sound, or phrase thought to have particularly calming properties.
Both progressive muscle relaxation and meditation reliably reduce stress-related arousal. They have been used successfully to treat a range of stress-related disorders, including hypertension, migraine and tension headaches, and chronic pain.
Aerobic exercise—such as running, walking, biking, and skiing—can help keep stress levels down. Because aerobic exercise increases the endurance of the heart and lungs, an aerobically fit individual will have a lower heart rate at rest and lower blood pressure, less reactivity to stressors, and quicker recovery from stressors. In addition, studies show that people who exercise regularly have higher self-esteem and suffer less from anxiety and depression than comparable people who are not aerobically fit. The American College of Sports Medicine recommends exercising three to four times a week for at least 20 minutes to reduce the risk of cardiovascular disease.
In 1886 Freud established a private practice in Vienna specializing in nervous disease. He met with violent opposition from the Viennese medical profession because of his strong support of Charcot’s unorthodox views on hysteria and hypnotherapy. The resentment he incurred was to delay any acceptance of his subsequent findings on the origin of neurosis.
In 1909 pioneers of the growing psychoanalytic movement assembled at Clark University to hear lectures by Sigmund Freud, the founder of psychoanalysis. The group included, top row, left to right, A. A. Brill, Ernest Jones, Sandor Ferenczi, and bottom row, Freud, Clark University President C. Stanley Hall, and Swiss psychiatrist Carl G. Jung. The visit, the only one Freud made to the United States, broadened the influence and popularity of psychoanalysis.
Freud’s first published work, On Aphasia, appeared in 1891; it was a study of the neurological disorder in which the ability to pronounce words or to name common objects is lost as a result of organic brain disease. His final work in neurology, an article, ‘Infantile Cerebral Paralysis,’ was written in 1897 for an Encyclopédie only at the insistence of the editor, since by this time Freud was occupied largely with psychological rather than physiological explanations for mental illnesses. His subsequent writings were devoted entirely to that field, which he had named psychoanalysis in 1896.
Freud’s new orientation was heralded by his collaborative work on hysteria with the Viennese physician Josef Breuer. The work was presented in 1893 in a preliminary paper and two years later in an expanded form under the title Studies on Hysteria. In this work the symptoms of hysteria were ascribed to manifestations of undischarged emotional energy associated with forgotten psychic traumas. The therapeutic procedure involved the use of a hypnotic state in which the patient was led to recall and reenact the traumatic experience, thus discharging by catharsis the emotions causing the symptoms. The publication of this work marked the beginning of psychoanalytic theory formulated on the basis of clinical observations.
During the period from 1895 to 1900 Freud developed many of the concepts that were later incorporated into psychoanalytic practice and doctrine. Soon after publishing the studies on hysteria he abandoned the use of hypnosis as a cathartic procedure and substituted the investigation of the patient’s spontaneous flow of thoughts, called free association, to reveal the unconscious mental processes at the root of the neurotic disturbance.
In his clinical observations Freud found evidence for the mental mechanisms of repression and resistance. He described repression as a device operating unconsciously to make the memory of painful or threatening events inaccessible to the conscious mind. Resistance is defined as the unconscious defence against awareness of repressed experiences in order to avoid the resulting anxiety. He traced the operation of unconscious processes, using the free associations of the patient to guide him in the interpretation of dreams and slips of speech. Dream analysis led to his discoveries of infantile sexuality and of the so-called Oedipus complex, which constitutes the erotic attachment of the child for the parent of the opposite sex, together with hostile feelings toward the other parent. In these years he also developed the theory of transference, the process by which emotional attitudes, established originally toward parental figures in childhood, is transferred in later life to others. The end of this period was marked by the appearance of Freud’s most important work, The Interpretation of Dreams (1899). Here Freud analyzed many of his own dreams recorded in the 3-year period of his self-analysis, begun in 1897. This work expounds all the fundamental concepts underlying psychoanalytic technique and doctrine.
In 1902 Freud was appointed a full professor at Vienna University. This honour was granted not in recognition of his contributions but as a result of the efforts of a highly influential patient. The medical world still regarded his work with hostility, and his next writings, The Psychopathology of Everyday Life (1904) and Three Contributions to the Sexual Theory (1905), only increased this antagonism. As a result Freud continued to work virtually alone in what he termed ‘splendid isolation.’
By 1906, however, a small number of pupils and followers had gathered around Freud, including the Austrian psychiatrists William Stekel and Alfred Adler, the Austrian psychologist Otto Rank, the American psychiatrist Abraham Brill, and the Swiss psychiatrists Eugen Bleuler and Carl Jung. Other notable associates, who joined the circle in 1908, were the Hungarian psychiatrist Sándor Ferenczi and the British psychiatrist Ernest Jones.
Austrian doctor Sigmund Freud spent many hours refining his theories in this study of his home in Vienna, Austria. Freud pioneered the use of clinical observation to treat mental disease. The publication of The Interpretation of Dreams in 1899 detailed his technique of isolating the source of psychological problems by examining a patient’s spontaneous stream of thought.
Increasing recognition of the psychoanalytic movement made possible the formation in 1910 of a worldwide organization called the International Psychoanalytic Association. As the movement spread, gaining new adherents through Europe and the U.S., Freud was troubled by the dissension that arose among members of his original circle. Most disturbing was the defections from the group of Adler and Jung, each of whom developed a different theoretical basis for disagreement with Freud’s emphasis on the sexual origin of neurosis. Freud met these setbacks by developing further his basic concepts and by elaborating his own views in many publications and lectures.
After the onset of World War I Freud devoted little time to clinical observation and concentrated on the application of his theories to the interpretation of religion, mythology, art, and literature. In 1923 he was stricken with cancer of the jaw, which necessitated constant, painful treatment in addition to many surgical operations. Despite his physical suffering he continued his literary activity for the next 16 years, writing mostly on cultural and philosophical problems.
When the Germans occupied Austria in 1938, Freud, a Jew, was persuaded by friends to escape with his family to England. He died in London on September 23, 1939.
Freud created an entirely new approach to the understanding of human personality by his demonstration of the existence and force of the unconscious. In addition, he founded a new medical discipline and formulated basic therapeutic procedures that in modified form are applied widely in the present-day treatment of neuroses and psychoses. Although never accorded full recognition during his lifetime, Freud is generally acknowledged as one of the great creative minds of modern times.
Among his other works are Totem and Taboo (1913), Ego and the Id (1923), New Introductory Lectures on Psychoanalysis (1933), and Moses and Monotheism (1939).
A complex group of repressed ideas that shape an individual’s response to think, feel, and act in a certain habitual pattern. Swiss psychiatrist Carl Jung, who originally coined the term complex, derived it from the Latin word complexus, meaning interweaving or braiding. Jung stated that a complex is a ‘grouping of psychic elements about emotionally toned contents,’ adding that it ‘consists of a nuclear element and a great number of secondarily constellated associations.’ The components of a complex may be present in consciousness or in the unconscious. Conflicts, frustrations, and threats to personal security encountered during infancy are then repressed into the unconscious, where they remain dormant, but not forgotten. These unconscious memories will govern an individual’s response to emotional conflict even into adult life, as the original trauma and its associated effect patterns thinking and behaviour to meet the new conflict.
The Oedipus and Electra complexes as described by Sigmund Freud, and the inferiority complex as described by Alfred Adler, have been influential concepts within the context of psychoanalytic theory.
Freud also placed great value on what could be learned from transference, the patient’s emotional response to the therapist. Freud believed that during therapy, patients transfer repressed feelings toward their family members to their relationship with the therapist. Transference exposes these repressed feelings and allows the patient to work through them. Free association and transference are still central features of Freudian psychoanalysis.
Divination, can be considered as the address in practice of attempting to acquire hidden knowledge and insight into events—past, present, and future—through the direct or indirect contact of human intelligence with the supernatural. The practice was closely allied with religion among pagan, Hebrews, and early Christian peoples.
Contact with the supernatural is usually sought through a psychic medium. A person supposedly endowed with supernormal receptivity. In direct divination, the medium acquires knowledge through direct contact with the unknown. The oracle, a medium or diviner who figured prominently in the beliefs of a number of ancient peoples, including those of Babylonia and Greece, typified the mediumistic method. Oracles employed various techniques in establishing contact with divinity. Some, such as the oracle at Delphi, passed into a trance and, in this condition, uttered divine messages. Others practised oneiromancy, or divination by dreams, and necromancy, the art of conjuring up revelations from the souls of the dead. The direct method of divination is closely approximated in much of modern spiritualism.
The accomplishment of indirect or artificial contact with the supernatural depends on the interpretation by a medium of the behaviour of animals and natural phenomena, which might convey messages from the supernatural. In antiquity, common artificial or inductive means of divination were the casting of lots; haruspication, the inspection of animal entrails; and ornithomancy, the study of the activity of birds. In ancient Rome, augurs or priests performed their divination in elaborate ceremonies, called auguries, by reading auspices or omens. To determine the will of the gods, they utilized such forms of divination as haruspication, ornithomancy, and the interpretation of dreams and visions. These augurs, members of a college that existed in Rome from the founding of the city until late in the 4th century ad, exercised enormous power. No Roman would embark upon a major undertaking unless the augurs decided the auspices were favorable. The forms of inductive divination best known today include astrology; crystallomancy, or crystal gazing; bibliomancy, the interpretation of secret messages from books, especially from the Bible; numerology, the study of numbers; and the reading of palms, tea leaves, and cards.
Divination in China followed a different course. In the Shang dynasty, shoulder blades of oxen and the bottom shells of tortoises were inscribed and heated. A message was derived from the pattern of cracks formed across the inscription after heat was applied. The founder of the Zhou (Chou) dynasty is said to have established the traditional patterns of lines and added the judgments of their significance. His son, the duke of Zhou, is said to have composed the commentaries. The collected judgments are known as T'uan and the commentaries as Yao.
In the time of Confucius, additional texts, the Wings, were appended. The result was the text known as I Ching (Book of Changes). The interpretations found in the Wings are sometimes attributed to scholars of the Han dynasty.
The cosmological principle behind the I Ching is simply that of change. Change is the movement between the cosmic forces of yin and yang, as represented by the divided and undivided lines of the traditional patterns, the 8 trigrams, and the 64 hexagrams formed from them by casting lots. Three divided yin lines signify earth; three undivided yang lines signify heaven. The 64 hexagrams, therefore, represent all possible situations or changes in creation. Examination of the hexagrams will furnish a description of the universe at that particular moment in its endless process of change and will provide hints of its future course of development.
