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Psychoanalysis was developed in Vienna in the 1890s by Sigmund Freud, a neurologist interested in finding an effective treatment for patients with neurotic or hysterical symptoms. Freud had become aware of the existence of mental processes that were not conscious as a result of his neurological consulting job at the Children's Hospital, where he noticed that many aphasic children had no organic cause for their symptoms. He wrote a monograph about this subject. In the late 1880s, Freud obtained a grant to study with Jean-Martin Charcot, the famed neurologist and syphilologist, at the Salpêtrière in Paris. Charcot had become interested in patients who had symptoms that mimicked general paresis, the psychotic illness that occurs due to tertiary syphilis. Charcot had found that many patients experienced paralyses, pains, coughs, and a variety of other symptoms with no demonstrable physical cause. Prior to Charcot's work, women with these symptoms were thought to have a wandering uterus (hysteria means "uterus" in Greek), but Freud learned that men could have psychosomatic symptoms as well. He also became aware of an experimental treatment for hysteria utilized by his mentor and colleague, Dr. Josef Breuer. The treatment was a combination of hypnotism and catharsis which utilized abreaction (ventilation of emotion). This treatment was used to treat the hysterical symptoms of Dr. Breuer's now famous patient, Anna O.
Freud's first theory to explain hysterical symptoms was the so-called "seduction theory". Since his patients under treatment with this new method "remembered" incidents of having been sexually seduced in childhood, Freud believed that they had actually been abused only to later repress those memories. This led to his publication with Dr. Breuer in 1893 of case reports of the treatment of hysteria. This first theory became untenable as an explanation of all incidents of hysteria. As a result of his work with his patients, Freud learned that the majority complained of sexual problems, especially coitus interruptus as birth control. He suspected their problems stemmed from cultural restrictions on sexual expression and that their sexual wishes and fantasies had been repressed. Between this discovery of the unexpressed sexual desires and the relief of the symptoms by abreaction, Freud began to theorize that the unconscious mind had determining effects on hysterical symptoms.
His first comprehensive attempt at an explanatory theory was the then unpublished Project for a Scientific Psychology in 1895. In this work Freud attempted to develop a neurophysiologic theory based on transfer of energy by the neurons in the brain in order to explain unconscious mechanisms. He abandoned the project when he came to realize that there was a complicated psychological process involved over and above neuronal activity. By 1900, Freud had discovered that dreams had symbolic significance, and generally were specific to the dreamer. Freud formulated his second psychological theory – that of there being an unconscious "primary process" consisting of symbolic and condensed thoughts, and a "secondary process" of logical, conscious thoughts. This theory was published in his 1900 opus magnum, The Interpretation of Dreams. Chapter VII was a re-working of the earlier "Project" and Freud outlined his "Topographic Theory". In this theory, which was mostly later supplanted by the Structural Theory, unacceptable sexual wishes were repressed into the "System Unconscious", unconscious due to society's condemnation of premarital sexual activity, and this repression created anxiety. Freud also discovered what most of us take for granted today: that dreams were symbolic and specific to the dreamer. Often, dreams give clues to unconscious conflicts, and for this reason, Freud referred to dreams as the "royal road to the Unconscious."
This "topographic theory" is still popular in much of Europe, although it has been superseded in much of North America. In 1905, Freud published Three Essays on the Theory of Sexuality in which he laid out his discovery of so-called psychosexual phases: oral (ages 0-2), anal (2-4), phallic-oedipal (today called 1st genital) (3-6), latency (6-puberty), and mature genital (puberty-onward). His early formulation included the idea that because of societal restrictions, sexual wishes were repressed into an unconscious state, and that the energy of these unconscious wishes could be turned into anxiety or physical symptoms. Therefore the early treatment techniques, including hypnotism and abreaction, were designed to make the unconscious conscious in order to relieve the pressure and the apparently resulting symptoms.
In On Narcissism (1915) Freud turned his attention to the subject of narcissism. Still utilizing an energic system, Freud conceptualized the question of energy directed at the self versus energy directed at others, called cathexis. By 1917, In "Mourning and Melancholia",he suggested that certain depressions were caused by turning guilt-ridden anger on the self. In 1919 in "A Child is Being Beaten" he began to address the problems of self-destructive behavior (moral masochism) and frank sexual masochism. Based on his experience with depressed and self-destructive patients, and pondering the carnage of WW I, Freud became dissatisfied with considering only oral and sexual motivations for behavior. By 1920, Freud addressed the power of identification (with the leader and with other members) in groups as a motivation for behavior (Group Psychology and Analysis of the Ego). In that same year (1920) Freud suggested his "dual drive" theory of sexuality and aggression in, Beyond the Pleasure Principle, to try to begin to explain human destructiveness.
In 1923, he presented his new "structural theory" of an id, ego, and superego in a book entitled, The Ego and the Id. Therein, he revised the whole theory of mental functioning, now considering that repression was only one of many defense mechanisms, and that it occurred to reduce anxiety. Note the 180 degree shift - earlier he had thought that repression caused anxiety. Moreover, in 1926, in Inhibitions, Symptoms and Anxiety, Freud laid out how intrapsychic conflict among drive and superego (wishes and guilt) caused anxiety, and how that anxiety could lead to an inhibition of mental functions, such as intellect and speech. By 1936, the "Principle of Multiple Function" was clarified by Robert Waelder. He widened the formulation that psychological symptoms were caused by and relieved conflict simultaneously. Moreover, symptoms (such as phobias and compulsions) each represented elements of some drive wish (sexual and/or aggressive), superego (guilt), anxiety, reality, and defenses. Also in 1936, Anna Freud, Sigmund's famous daughter, published her seminal book, The Ego and the Mechanisms of Defense, outlining numerous ways the mind could shut upsetting things out of consciousness.
Although criticized since its inception, psychoanalysis has been used a research tool into childhood development, and has developed into a flexible, effective treatment for certain mental disturbances. In the 1960s, Freud's early thoughts on the childhood development of female sexuality were challenged; this challenge led to the development of a variety of understandings of female sexual development, many of which modified the timing and normality of several of Freud's theories (which had been gleaned from the treatment of women with mental disturbances). Several researchers, followed Karen Horney's studies of societal pressures that influence the development of women. Most contemporary North American psychoanalysts employ theories that, while based on those of Sigmund Freud, include many modifications of theory and practice developed since his death in 1939.
In the 2000s there are approximately 35 training institutes for psychoanalysis in the United States accredited by the American Psychoanalytic Association which is a component organization of the International Psychoanalytical Association, and there are over 3,000 graduated psychoanalysts practicing in the United States. The International Psychoanalytical Association accredits psychoanalytic training centers throughout the rest of the world, including countries such as Serbia, France, Germany, Austria, Italy, Switzerland, and many others, as well as about six institutes directly in the U.S. Freud published a paper entitled The History of the Psychoanalytic Movement in 1914, German original being first published in the Jahrbuch der Psychoanalyse.
History of psychoanalysis in different countries
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