Suggestion x Free Association
Hysteria, Charcot, Breuer, Anna O.
Hysteria, now commonly referred to as a conversion disorder, displays physical symptoms (numbness/paralysis of a limb, loss of voice or blindness) that occur in a healthy body.
The French neurologist, Jean Martin Charcot, who was concerned with the treatment of hysteria, believed it to be a genuine ailment that afflicted men and women, and tried to free his patient's from their symptoms through hypnotic suggestion.
Joseph Breuer, a Vienese physician who also chose hypnosis as a clinical procedure, didn't intend just to suppress his patient's symptoms but rather searched for the deep causes of their suffering. He realized, during the treatment of his young patient "Anna O." (1880-82), that the results were far reaching if he let her talk about her feelings and thoughts. He named "spontaneous hypnosis" her trance-like states. Anna named 'talking cure' or 'chimney sweeping' the process that lead to the disappearance of her symptoms whenever she was able to recollect their root events.
Freud studied with Charcot in 1885-86. He collaborated with Joseph Breuer, while progressively formulating his theory on the mind, and considered hypnosis far more satisfactory than the electrotherapy he had tried until 1890.
Beginnings of Psychoanalysis
Breuer and Freud published their findings and theories inStudies in Hysteria , in 1895. They assumed that hysterical symptoms occurred when a mental process highly charged with affect found its normal path blocked to consciousness and movement. This 'strangulated' affect diverted along wrong paths and flowed off into the somatic innervation (conversion).
Through hypnosis, the thoughts and memories connected with the symptoms would eventually reach consciousness. 'Catharsis' (cleansing in Greek) would come about bringing a normal discharge of affect; despite these facts, symptoms tended to reappear if the relation with the physician was disturbed in any way, signaling that an intense emotional tie with him played an important role in the cure.
The authors stated that these symptoms had sense and meaning, being substitutes for normal mental acts and were caused by unconscious wishes and forgotten memories (psychic traumas).Thus, hysterics suffered mainly from 'reminiscences' that had not been worked-through.
The cornerstone of this theory was the assumption of the existence of unconscious mental processes that follow laws that do not apply to conscious thinking. Later, these processes were better understood and the mechanisms of psychological productions such as dreams could be grasped.
The Fundamental Technical Rule
Finding hypnosis inadequate, Freud refined Breuer's methods, based on his increasing clinical understanding of neuroses. He realized that success of the treatment depended upon the patient's relation to his physician whose task was to make the unconscious become conscious.
An entirely new relation between patient and physician developed out of a change in the technique and the surprising results thus obtained extended themselves to many other forms of neurotic disorders. Freud named this procedure Psychoanalysis - an art of interpretation, in 1896.
Freud thought that disturbing thoughts and conflicting urges were kept unconscious(repression) but, even so, they caused strong guilty feelings and great anxiety, interfering with conscious mental activity, as they consumed vital psychic energy in their struggle for release. As they were incompatible with the individual's normal standards, he would feel compelled to raise defenses against the intrusive ideas and the release of such urges, in order to maintain his inner equilibrium (defense mechanisms).
As Freud believed in the strict determination of mental events and assumed that all memories were interconnected, so that one recollection would lead to the next, he insisted that the patient should tell him everything that came to his mind, regardless of how irrelevant, senseless or disagreeable the idea might seem to him(free association). He found it possible for the patient to recover crucial memories while conscious.
By surrendering to his own unconscious mental activity(a state of evenly-suspended attention), Freud would follow the unconscious flow of his patient's mental productions, in order to trace the connections between the chain of allusive associations and the forgotten memories.
Occasionally, the patient might omit some material and this very gap in the communication would reveal that the association was avoided(resistance) due to its potential evocative power to bring the underlying forgotten memories to the surface of consciousness, along with the emergence of its previously inaccessible meaning.
Freud noticed that in the majority of the patients seen during his early practice the events most frequently repressed were concerned with disturbing sexual ideas. In 1897, he concluded that, rather than being memories of actual events, they were the residues of infantile impulses and desires(fantasies). Thus he assumed that anxiety was a consequence of the repressed libido, which found expression in various symptoms.
By being in touch with his inner experiences in a state of regression, in which long-forgotten 'events' would be remembered, the analysand would relate to the analyst as if the latter were a figure from his past(transference).
Freud would communicate the connection between the patient's fantasies and feelings about the analyst and the origin of these thoughts and emotions in childhood experiences(interpretation).
This powerful re-experience of original conflicts caused great distress to the patient, but the working-through of the emotional pain(insight) rendered the treatment efficient, due to a new balance and distribution of psychic energy, promoting a reorganization of the psychological structures into healthier mental configurations.