As the 19th century came to an end, a new kind of philosopher was dawning for the 20th century. He would come up with strange and ground breaking theories of the human unconscious. Bridging the 19th century’s experience with Darwin and hard science, with softer sciences of hypnotism and free association. This was the rise of Sigmund Freud and Psychoanalysis.
Studies in Hysteria
Family
Sigmund Freud was born in Freiberg in 1856. Son of Jacob Freud, a wool merchant, and Amalia Nathansohn. Amalia was the 3rd wife to Jacob, and was half his age. This left Freud in the strange position of having 2 brothers near the same age as his mother. They later would become objects of self-analysis for Freud. His future work often involved not just the unconscious, but experiences of childhood.
School
Freud did well in school and was a voracious reader, and would teach his siblings about the subjects he read. When the family moved to Vienna, and Sigmund grew up, he wasn’t able to find a specialty to put these passions to work. His interests went in many different directions. Between Law and Medicine, Freud chose medicine because of his desire to gain knowledge, and its practical ability to gain an income. Freud graduated in medicine in Vienna in 1881. He did anatomical research before working in Meynert’s laboratory where neurological causes of psychiatric disturbances were being sought.
Cause and effect lens
With his various mentors throughout his training he was taught objectivity, and emotional distance to facts. His influences came from empiricism, and from Darwin’s work on evolution. Yet Freud found that he was actually drawn to human affairs more than natural objects, but he would keep is empirical cause and effect attitude in these humanistic studies.
Martha Bernays
As Freud struggled to gain expertise in medicine he decided to focus on a private medical practice to win over his lover’s mother. She didn’t see Freud as a good catch for her daughter, due to his lack of prospects. His lover was Martha Bernays. They were often apart when Freud pursued his career interests, but they wrote to each other almost daily.
Charcot
In 1885 Freud received a travelling scholarship, and he took 6 months off to visit a hero of his in Paris, Jean-Martin Charcot. He wanted to learn about hypnotism and how it was used in dealing with mental disorders. The hypnotist Pierre Janet was learning there as well.
Charcot was a psychiatrist and medical hypnotist. He showed that hypnosis and suggestion could help people with their hysteria. Hysteria was a very common diagnosis at the end of the 19th century. It often involved strange paralyses, anesthesias, and fits. Many doctors couldn’t find any physical neurological damage and couldn’t explain the symptoms. They often treated it as if the patient was faking the symptoms, which is called malingering. To Charcot these symptoms were from a conversion from psychological stress into physical symptoms. He also felt that sexual problems were the culprit.
Freud heard Charcot say “in this sort of case it’s always a question of the genitals – always, always, always.”
Freud was indebted to Charcot for the clinical methods and hints that hysteria was related to trauma and sexual elements. He was also inspired by how the mind has layers of unconscious material not available when the patient is completely conscious. This is where Freud decided to focus.
Extending on Charcot’s methods of hypnotism and suggestion, Freud was able to theorize at what gave patients relief. This was the beginning of a catharsis method that is still a part of counselling today. When Freud returned to Vienna, he used his neurology practice as a place to try hypnosis. He was also impressed with physiologist Josef Breuer, and worked with him on the foundational Studies in Hysteria.
Studies in Hysteria
Studies in Hysteria involves 5 case studies and theories on the origin of Hysteria. As Freud and Breuer continued on their studies, Freud theorized that what they were learning included unconscious phenomenon in normal people. For example, as patients got better they would often respond to Freud with love responses, as if he were a lover or a family member. This he called Transference.
Topography
The early theory of Freud at the time was that emotions that were not allowed to be expressed, got “dammed up” and appeared in physical symptoms instead. These memories were either out of conscious awareness or an abridged story missing pertinent details.
Trauma
The cause of hysteria wasn’t always a single strong trauma, it could also be a series of smaller traumas. These traumas were psychic traumas or frights. The mind finds something objectionable about thoughts or traumas, and then doesn’t react emotionally in the correct way but instead represses these events in memory. Often these repressions were to avoid some social stigma. Here are some examples:
- Anxiety – over consequences to an action.
- Hypochondria – fear of the bodily effects of the anxiety, and then superstitious treatments, medicines, and rituals to rid the bodily effects.
- Delusions of persecution – fear of the social effects of releasing what is repressed.
- Shame – fear of others knowing about you.
Catharsis
As Freud worked with these patients he was able to come up with 2 general procedures to apply.
- Bringing up repressed memories related to the trauma. This meant using hypnotism and suggestions with Freud’s hand pressed on the head.
- Free association, where patients were allowed to release their unconscious thoughts without censorship.
The main part of the practice was to bring out more and more detail from the traumatic memories, to expand on those abridged memories. The patient would be in a chair facing away from the listening Freud, and letting the patient release the repressed emotions associated with the memories. This release, catharsis or abreaction, relieved the patients of their hysterical symptoms as well. By bringing out the cause and effect of the trauma details, that were redacted from conscious awareness, it gave the patient the opportunity to bring out the repressed emotion.
Obstacles
Freud’s methods moved from hypnotism into a form of “talking cure.” As this opened the doors to new avenues for Freud, many unexpected problems emerged.
Over time Freud and Breuer’s patients found their cure did not last. Hysteria ended up being an amalgamation of many psychological and neurological disorders. Modern psychology still recognizes this disorder, but it is now called Conversion Disorder. Elements of Multiple Sclerosis, and anxiety disorders are separated into their own sections as science advanced through the decades. Hysteria as a disorder became obsolete.
Another difficulty was related to the type of trauma. The understanding of external traumas is still important as Freud’s method advanced, but he still had to see what people were doing internally to cause their own stress.
Sex abuse
One of the problems of focusing on what was external, was sex abuse. As much as sexual assault is a real problem, Freud was becoming aware that providing suggestions of sexual abuse could be leading the patient to conclusions that are untrue.
As ground breaking as Studies in Hysteria was, Freud was challenged to develop his understanding of the unconscious much further. In the next installment on Psych Reviews, we will be looking at those further developments in understanding dreams. After that, the series will continue on Freud’s later updates of his topography, and then his massive influence on later psychologists which continues to this day.
Studies in Hysteria by Sigmund Freud and Joseph Breuer: https://www.isbns.net/isbn/9781420948608/
Freud’s Models of the Mind: An Introduction by Joseph Sandler: https://www.isbns.net/isbn/9781855751675/
Reading Freud: A Chronological Exploration of Freud’s Writings by Jean-Michel Quinodoz: https://www.isbns.net/isbn/9781583917473/
Freud: A Life for Our Time by Peter Gay: https://www.isbns.net/isbn/9780393318265/
Psychology: https://psychreviews.org/category/psychology01/