The Story of Psychology (33 page)

But all too soon he found to his sorrow that the relief was usually partial and temporary, so he took a different tack, using hypnosis as Breuer had with Bertha Pappenheim. For several years Freud hypnotized hysterics and asked them to recall and talk about the “traumatic event” that first brought about a particular symptom. He had fairly good results with some, but, disappointingly, either the improvement was temporary or the banished symptom was replaced by a different one. Moreover, the technique was inapplicable to the many patients who could not be hypnotized.

Despite these limitations, in the course of half a dozen years Breuer and he discussed a series of cases—Bertha Pappenheim and Freud’s more recent patients—and gradually worked out a theory of hysteria that, unlike Charcot’s, was wholly psychological. They concluded that “hysterics suffer from reminiscences”—memories of emotionally painful experiences—that have somehow been excluded from consciousness. As long as such memories remain forgotten, the emotion associated with them is “strangulated” or bottled up and converted into physical energy, taking the form of a physical symptom. When the memory is recovered through hypnosis, the emotion can be felt and expressed, and the symptom disappears.

This was the gist of a brief paper that Breuer and Freud published in 1893
¹⁴
and of a lengthy, detailed work published in 1895,
Studies on Hysteria
, which reported on Breuer’s one case and four of Freud’s, presented their theory of hysteria, and discussed the relief of symptoms by hypnotic catharsis—and by a better method Freud had discovered that abandoned hypnosis altogether and brought about not temporary relief but actual cure.

No historical or sociological account of scientific progress can adequately explain the sudden appearance of psychoanalysis and its discoveries of unconscious psychological processes. In the latter part of the nineteenth century many men reared in Vienna or other leading European cities were trained in medicine and steeped in the tradition of physiological psychology, but Freud alone went on to practice neurology,
then to use hypnotherapy with hysterics, and finally to invent psychoanalysis. The evolution of his thinking was nurtured in part by the social conditions and state of scientific knowledge in his era, but in part by his genius and the personal problems that made him sensitive to similar problems in others.

Freud took his first small step toward the invention of psychoanalysis not by design but in response to a demand made by one of his patients. She was Baroness Fanny Moser, a forty-year-old widow whom he called Frau Emmy von N. in
Studies on Hysteria.
She sent for Freud in 1889 when she was suffering from facial tics, hallucinations of writhing snakes and dead rats, fearful dreams of vultures and fierce wild animals, frequent interruptions of her speech by a spastic clacking or popping noise that she made with her mouth, a fear of socializing, and a hatred of strangers.

Over a period of time Freud rid her of many of her symptoms by the cathartic Breuer method—she was the first patient with whom he used it—and also by the Nancy method of post-hypnotic suggestion. As he later reported in
Studies:

From Frau Emmy, however, he learned something of great importance. When he asked her to recall the traumatic episode that had initiated some symptom, she would often ramble on tediously and repetitiously without relating anything pertinent. One day Freud asked her why she had gastric pains and what they came from:

To his credit, Freud sensed that this was an important request and let her proceed as she wished. She began talking of her husband’s death and wandered on from there, eventually speaking of the slander circulated
by his relatives and by a “shady journalist” to the effect that she had poisoned him. Although this had nothing to do with her gastric pains, it revealed to Freud why she was so isolated and unsociable, and why she hated strangers; previous urging had not elicited the significant thoughts, but allowing her to ramble freely had. He realized that, wearisome as it might be, allowing the patient to say whatever came into her mind was a more effective route to hidden memories than prodding and probing; this eventually led him to the use of the technique, critically important to both therapy and research, of “free association.”

Freud recognized, too, that the technique might spare him the attempt at hypnosis with patients who could not be hypnotized. He asked them—and, after a while, all his patients—to lie down on a couch in his office, close their eyes, concentrate on remembering, and say whatever came to mind. Often they would go blank; nothing would come to mind, or what came was irrelevant, and for good reason: Freud had already noticed that forgotten memories that were retrieved only with great difficulty were those one would prefer to forget—memories involving shame, self-reproach, “psychical pain,” or actual harm. Patients who could not remember traumatic episodes were unconsciously defending themselves from pain.

Freud called this inability to retrieve painful memories “resistance” and invented a way to break through it. He first used the technique in 1892 with a young woman who could not be hypnotized and who was unable to produce useful memories. He pressed her forehead with his hand, assuring her that this would infallibly produce such memories. And it did. What came to her mind that first time was the recollection of a night when she returned home from a party and stood beside her father’s sickbed. From that she went on, slowly and meanderingly, to related thoughts, and after a while to the recognition that she had felt guilty for enjoying herself while her father lay critically ill. At last, and with much effort, Freud got her to recognize that one of her symptoms, severe pain in her legs, was her way of fending off guilt-producing pleasures. She later made a complete recovery and married.
¹⁷

The essential aspect of the process, however, was not what Freud did with his hand but what the patient agreed to do. As he later explained:

What came forth was very rarely a forgotten painful memory but usually a link in a chain of associations that, if pursued, slowly led to the pathogenic idea and to its hidden meaning. In
Studies
Freud called this process “analysis,” and the next year, 1896, began using the term “psychoanalysis.”

Freud soon concluded that the pressure technique, which was only another form of suggestion, was inadvisable, because it was reminiscent of hypnosis and also made the doctor too vivid a presence at a time when the patient was trying to focus on memories. He abandoned it by 1900, relying thereafter on verbal suggestion.
¹⁹

Thus, by 1900 the basic elements of the method consisted of relaxation on the couch,
*
the therapist’s repeated suggestion that free association would yield useful ideas, the patient’s agreeing to say whatever came to mind without any holding back or self-censorship, and the unconscious associations this process revealed in the patient’s memories and ideas. The method proved applicable not only to hysteria but to other neuroses. Freud tinkered with the technique for decades, but its fundamentals, aimed at achieving curative insight by looking into the psychodynamic unconscious, had all been established within a dozen years of the time he first treated a patient without using hypnosis.

There is, of course, a great deal more to psychoanalytic technique than this, much of it arcane and complex. Since we are concerned primarily with the development of psychological science and only to a limited extent with the treatment of mental disorders, we need not linger here over the details of psychoanalytic therapy or the variants devised by followers of Freud who came to disagree with his theories and therapeutic methods. But we must take note of two other elements of psychoanalytic
therapy that Freud worked out, since they are central not only to his treatment of patients but to his use of psychoanalysis as the investigative method by which he made his major psychological discoveries.

The first is the phenomenon of
transference.
Freud had mentioned this briefly and in a limited sense in
Studies
, but five years later, in 1900, a failed treatment led him to make much more of it. At that time he began treating an eighteen-year-old girl identified in his case report as Dora. He and she traced her hysterical symptoms back to a sexual approach made to her by Herr K., a neighbor, and to her conflicting feelings of repulsion and sexual attraction to him. But Dora broke off treatment after only three months, just as she was making good progress. Freud, stunned, pondered long and deeply about why she might have done so. Re-examining a dream of hers about leaving treatment—an analogue of her fleeing Herr K.’s house at the time of the sexual advance—he concluded that he himself, a heavy smoker whose breath smelled of tobacco smoke, had reminded Dora of Herr K., also a smoker, and that she may have begun to transfer the feelings she had for Herr K. to Freud. Not noticing this, he had failed to deal with it constructively. His conclusion:

This, he said, would have enabled Dora to clear up her feelings about Freud, remain in treatment, and look still deeper into herself for other memories.

Transference, Freud concluded, cannot be avoided; dealing with it is by far the hardest part of the task but is an essential step in breaking through resistance and bringing the unconscious to light:

Seen from the viewpoint of therapy, the analysis of transference is a corrective experience that reveals and repairs the trauma. Had Freud acted in time, Dora would have seen that, unlike Herr K., he (and presumably many other men) could be trusted and that she did not have to fear their feelings about her or hers about them. Seen from the viewpoint of psychology, the analysis of transference is a way of investigating and verifying hypotheses about the unconscious motivations behind inexplicable behavior.

The second element of analytic technique that became a principal method of psychological investigation for Freud is
dream interpretation.
Despite his failure to recognize Dora’s dream as a signal of her transference to him, he had been fruitfully using patients’ dreams for five years to get at unconscious material; he later called dream interpretation “the royal road to the knowledge of the unconscious in mental life.”
²²

Freud was far from the first psychologist to be interested in dreams; in
The Interpretation of Dreams
(1900), he cited 115 references to earlier discussions of the subject. But most psychologists had viewed dreams as degraded, absurd, and meaningless thoughts that originated not in any psychic process but in some bodily process that was disturbing sleep. Freud, conceiving of the unconscious as not merely ideas and memories outside of awareness but as the repository of painful feelings and events that have been forcibly forgotten, saw dreams as significant hidden material breaking into view while the protective conscious self is off duty.

He hypothesized that dreams fulfill wishes that would otherwise wake us and that their basic purpose is to enable us to continue sleeping. Some dreams fulfill simple bodily needs. In
Interpretation
Freud said that whenever he had eaten salty food, he became thirsty during the night and dreamed of drinking in great gulps. He also cited the dream of a young medical colleague who liked to sleep late and whose landlady called through the door one morning, “Wake up, Herr Pepi! It’s time to go to the hospital!” That morning Pepi particularly wanted to stay in
bed, and dreamed that he was a patient in bed in the hospital, at which point he said to himself, “As I’m already
in
the hospital, there’s no need for me to go there,” and went on sleeping.
²³