Psychoanalysis was described as the ‘talking cure’ by its first patient, Bertha Pappenheim. Viennese neurologist Sigmund Freud introduced it at the beginning of the 1900s to treat mental problems. Psychoanalysis developed in different directions and has been called the most influential psychiatric technique of the 20th century.
Freud was convinced hysteria, neurosis, strange dreams and other difficult-to-explain aspects of mental life were rooted in conflicting and usually unconscious desires. Freud’s psychoanalytic practice involved frequent, often daily, private sessions, usually lasting about an hour. A patient reclined on a couch in Freud’s office, and would talk about fears, fantasies, worries, memories and anything that came to mind. Freud listened, took notes and occasionally commented to prompt the patient to identify patterns or inconsistencies. The patient’s feelings and frustrations about the therapy and the therapist were an important source of insight.
This technique inspired avid followers, often outside medicine. Freud attempted to control the medical definition of psychoanalysis and publicly rejected disciples when their ideas diverged from his. But psychoanalysis grew in so many directions its founder could not maintain control for long. Many practitioners of psychoanalysis were exiled from Nazi Germany in the 1930s, ending up in the US. These men and women called themselves ‘neo-Freudians’. They adapted Freud’s ideas and methods in various ways to make them more appropriate in this new context. Their efforts helped psychoanalysis become central to American psychiatry during and after the Second World War.
The use of psychoanalysis within psychiatry has now dramatically declined, largely because of psychiatric drugs. These are more widely available, cheaper and less labour-intensive. Psychoanalysis remains widely used outside psychiatry to interpret art, history and cultural difference.
J Forrester, Dispatches from the Freud Wars (Massachusetts: Harvard University Press, 1997)
S Freud, On the History of the Psycho-analytic Movement (published in the Standard Edition of the Works of Sigmund Freud, edited by James Strachey)
The study of the functions, anatomy and organic disorders of the nervous system.