THE AMERICAN PSYCHIATRIC PUBLISHING

Textbook of Psychoanalysis
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 THE AMERICAN PSYCHIATRIC PUBLISHING

Textbook of Psychoanalysis
E D I T E D B Y

ETHEL S. PERSON, M.D.

Professor of Clinical Psychiatry
College of Physicians and Surgeons, Columbia University
Training and Supervising Analyst, Columbia University Center for
Psychoanalytic Training and Research, New York, New York

ARNOLD M. COOPER, M.D.

Stephen P. Tobin and Dr. Arnold M. Cooper Professor Emeritus
in Consultation-Liaison Psychiatry, Weill Cornell Medical College
Training and Supervising Analyst, Columbia University Center for
Psychoanalytic Training and Research, New York, New York

GLEN O. GABBARD, M.D.

Brown Foundation Chair of Psychoanalysis and Professor
Department of Psychiatry and Behavioral Sciences
Director of the Baylor Psychiatry Clinic, Baylor College of Medicine
Training and Supervising Analyst
Houston/Galveston Psychoanalytic Institute, Houston, Texas

Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and
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Library of Congress Cataloging-in-Publication Data
The American Psychiatric Publishing textbook of psychoanalysis / edited by Ethel S. Person, Arnold M. Cooper,
Glen O. Gabbard.—1st ed.
p. cm.
Includes bibliographical references and index.
ISBN 1-58562-152-8 (hardcover; alk. paper)
1. Psychoanalysis. I. Title: Textbook of psychoanalysis. II. Title: Psychoanalysis. III. Person, Ethel Spector.
IV. Cooper, Arnold M. V. Gabbard, Glen O.
[DNLM: 1. Psychoanalysis. 2. Psychoanalytic Theory. 3. Psychoanalytic Therapy. WM 460 A5129 2005]
RC504.A48 2005
616.89′17—dc22
2004021206
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
 C H A P T E R
24
THE EARLY DEVELOPMENT OF psychoanalysis rests
primarily on the thought and work of Sigmund Freud. His
detailed and unprecedented clinical observations about
psychological life and the theories generated from these
observations form the central core of psychoanalysis.
Freud once described himself as “one of those who have
‘disturbed the sleep of the world’” (Freud 1914/1957, p. 21).
(The phrase was borrowed from Hebbel’s play Gyges und
sein Ring [V, i].) Freud predicted astutely that his ideas
were unlikely to be evaluated by his contemporaries with
objectivity and tolerance. His insistence on the impor-
tance of childhood sexuality in psychological development
and in contributing to adult neurotic syndromes proved to
be indeed disturbing and largely unacceptable to most of
his scientific and lay contemporaries.
If Freud’s focus on childhood sexuality was perhaps his
most controversial contribution, it can be argued that his
emphasis on the importance of unconscious mental pro-
cesses was equally difficult for his contemporaries to ac-
cept. While the notion of the unconscious mind had sur-
faced in the work of the Romantic poets, as well as in that
of philosophers such as Schopenhauer and Nietzsche, Freud
developed the first systematic, thorough, and explicit pic-
ture of how the unconscious dimension of the mind exerts
its influence on the full spectrum of mental life and behav-
375
Psychoanalysis:
The Early Years
DARIA COLOMBO, M.D.
SANDER M. ABEND, M.D.
ior. His theory of the mind, first set forth in his 1899 Inter-
pretation of Dreams and continuously modified in his later
work, contained links to ideas that had been circulating in
philosophy, medicine, and literature. Freud’s genius lay in
his ability to glean brilliantly from his intellectual environ-
ment and integrate this knowledge with his clinical obser-
vations to arrive at startling and revolutionary conclusions.
The considerable controversy stimulated by Freud’s
ideas almost immediately led to the proposal of compet-
ing views of the nature and etiology of emotional illness
and of the principles of clinical practice. Freud’s theories
have been modified, clarified, and contested by genera-
tions of followers, so that the term classical psychoanalysis has
come to mean what some believe to have been the core of
technique and theory set forth by Freud.
To understand Freud’s singular contribution, and to ap-
preciate what psychoanalysis in his time came to include
and exclude, it is necessary to recognize both the extent to
which Freud’s work reflected the evolution of his own think-
ing and the context in which these changes occurred. Freud
gathered around him a group of students and disciples
who, both in their allegiance and in their dissent, helped
to determine the setting in which psychoanalysis—as sci-
ence, technique, and movement—developed. Freud’s the-
ories indeed proved to be disturbing to the sleep of the
376 THE AMERICAN PSYCHIATRIC PUBLISHING TEXTBOOK OF PSYCHOANALYSIS
world; the sleep he was disturbing was that of his own his-
torical period, of which he was as much a product as any
of his objectors and followers.
Our review of the early history of psychoanalysis, and
of the milieu in which Freud developed his revolutionary
theories about human behavior, will focus on the intellec-
tual background from which Freud emerged, on the core
features of his discoveries, and on the effect on his devel-
oping theory of the revisions, splits, and controversies
that ensued during his lifetime.
Early History
Sigmund Freud was born on May 6, 1856, in Freiberg, a
small town in Moravia, then a part of the Austro-Hungarian
Empire. His father was an impoverished Jewish wool mer-
chant, and Sigmund was the first child of his third marriage
to the much younger Amalia Nathansohn. Freud had two
half brothers from his father’s earlier marriages, the elder
half brother being older than Freud’s mother. At the age
of 4, Freud moved with his family to Leopoldstadt, the tra-
ditional Jewish district in Vienna, in the wake of growing
financial difficulties. While the family continued to live in
very straitened circumstances, Freud, cherished as the tal-
ented and brilliant eldest son, was favored with his own
room, even as six younger siblings arrived. He was an out-
standing student, driven by ambition and enraptured in
particular by the natural sciences, although his broad edu-
cation in the arts would serve him well and later inform his
scientific writing with culture and richness.
Freud entered university in 1873, during a time when
anti-Semitism was rampant—Jews were being scape-goated
for the stock market crash of that same year—and Freud
dated his self-awareness as a Jew to this period. Peter Gay
has written about the particular tension, during those
years, between anti-Semitism and a new openness in
which Jewish males were entering the professions at an
increasingly high rate and beginning to dream of success
in a—if only briefly—more liberal society (Gay 1998, p. 27).
Freud chose to study medicine at the university but took
a somewhat circuitous route, entering early, at age 17, and
finishing late, at age 25, largely as a result of his wide-
ranging intellectual curiosity and interest in research (see
Gay 1998, p. 28). He studied with Ludwig Feuerbach and
with Franz Brentano, influenced by the former’s Hege-
lian approach and by the latter’s philosophy of intention-
ality. Freud actively engaged with the scientific and philo-
sophic ideas of his time: he came of age in an era shaped
both by the Helmholz school of physiology, which
searched for the physical and chemical basis of natural
phenomena, and by Romanticism, with its emphasis on
subjectivity. Eventually, “in a synthesis of these two trends
in his education, Freud took subjectivity itself as the object
of scientific investigation” (Auchincloss and Glick 1996,
p. 3).
After a preparatory education in medicine and physi-
ology, Freud worked as a researcher in the laboratory of the
physiologist Ernest Brucke, studying the invertebrate ner-
vous system and imbibing the positivistic, empirical ap-
proach that he would later make the foundation of his
psychological work. His training was in neuropathology,
and his early work on the smallest building blocks of neu-
rological function could be considered the first steps in
building a comprehensive theory of mental life.
While Freud’s early monographs on this subject began
to earn him a small reputation, practical considerations,
most prominently the need to earn enough to marry and
support a family, led to his taking up clinical neurological
practice. Freud had little training in academic psychiatry,
which at the time was not interested in the study of the sub-
jective experience of patients. Instead, by entering clinical
practice Freud joined a general medical culture in which
listening to the patient was indeed central, and it has been
argued that Freud’s development could not have occurred
within the framework of the era’s academic psychiatry. It
was Freud’s decision to open a neurological practice that
placed him in frequent contact with a type of patient com-
monly seen in such settings at that time, the hysteric.
Shift to Psychological Investigations
and the Problem of Hysteria
Freud joined the General Hospital in Vienna, working
briefly in various departments, including internal medi-
cine, psychiatry (with the brain anatomist Theodor Mey-
nert), and neurology. He narrowly missed making his name
for his observation on the anesthetic properties of cocaine.
He applied for and obtained the rank of Privat Dozent in
1885 and became the recipient of a travel grant.
Interested in disorders of the nervous system, he de-
cided to travel to Paris, to study at the Salpêtrière with the
celebrated neurologist Charcot. Freud initially worked on
a microscopic study of children’s brains and gathered data
later used for publications on infantile cerebral paralysis
and aphasia. Most significant for Freud was Charcot’s un-
derstanding of mental illness, in particular his use of hyp-
nosis in the treatment of hysteria. Hysteria was a wide-
spread malady of the time, either believed to be caused by
organic brain disturbances in its mostly female sufferers or
condemned as a malingerer’s ruse; treatment in the former
Psychoanalysis: The Early Years
cases involved a variety of ineffective physical manipula-
tions. Charcot, however,
diagnosed hysteria as a genuine ailment...he had recog-
nized that it afflicts men....Even more daring Charcot
had rescued hypnosis from mountebanks and charlatans
for the serious purposes of mental healing. Freud was
amazed and impressed to see Charcot inducing and cur-
ing hysterical paralyses by means of direct hypnotic sug-
gestion. (Gay 1998, p. 49)
Freud also witnessed the strong emotional attachment
developed by the hypnotized patients, an observation that
he would much later elaborate and conceptualize as trans-
ference (see section “Theoretical Revisions and the Begin-
ning of a Movement” later in this chapter). Furthermore,
he admired Charcot’s devotion to acute observation; Freud’s
own emphasis on clinical observation would later serve him
well and lend him the confidence to overturn received
wisdom.
Freud returned to Vienna enthusiastic about Char-
cot’s work and interested in the application of hypnosis to
his clinical practice. At the time, susceptibility to hypnosis
was thought of as either an artificially induced nervous dis-
order in already disturbed minds or as purely a product of
suggestion, to which anybody could be susceptible. Char-
cot believed the former, but Freud also traveled in 1889 to
Nancy to study with Hippolyte Bernheim, who subscribed
to the latter view. Freud also probably came into contact
in France with the work of Pierre Janet, who had been ex-
perimenting with cathartic treatment. Freud later wrote
that as a result of these various studies, he had “received
the profoundest impression of the possibility that there
could be powerful mental processes which nevertheless
remained hidden from the consciousness of men” (Freud
1925/1959, p. 17).
During this period, Freud was employing in his prac-
tice the then-current technique of attempting to remove
hysterical symptoms using hypnotic suggestion. He noted
in 1925, however, that he had also considered hypnosis a
tool for inquiring into the origin of patient’s symptoms,
thus combining from the beginning both the clinical and
scientific aspects of his work. But Freud had difficulty hyp-
notizing many patients and soon became disappointed by
the limitations of the technique. He searched for an alter-
native therapy, and the next step in this search was to be
found in his work with Josef Breuer; the results of their
collaboration were presented in writings considered to be
the immediate antecedent of psychoanalysis.
Freud was in the process of shifting his primary focus
from neuroanatomy to detailed observations of mental func-
tioning. In his first book, On Aphasia: A Critical Study,
published in 1891, he had considered psychological con-
377
tributions to these disorders (Freud 1891/1953). Freud
had dedicated this work to Breuer, an older, established
physician who was one of his mentors and a close friend
during a time in which Freud was struggling in relative
isolation to establish his practice and academic repu-
tation. It was in Studies in Hysteria (Breuer and Freud
1893–1895/1955), published a few years later in 1895, and
coauthored with Breuer, that a new approach to treating
hysterical patients was described. Already in 1893, the two
men had written “A Preliminary Communication,” in
which they proposed the fruitful hypothesis that “hysterics
suffer mainly from reminiscences” (Breuer and Freud 1893/
1955, p. 7).
The case of Anna O., treated between 1880 and 1881,
was Breuer’s, who confided its remarkable course to his pro-
tégé. Salient features of the case included the link of neu-
rotic symptoms to traumatic memories, and the idea,
coined by the patient herself, of the “talking cure”—that is,
of a cathartic effect consequent to the retelling of neuro-
sis-inducing memories. Breuer apparently had been re-
luctant to publish the case himself, however, because of
what had turned out to be the sexual origin of the neurotic
symptoms. Freud “was the explorer who had had the cour-
age of Breuer’s discoveries; in pushing them as far as they
would go, with all their erotic undertones, he had inevita-
bly alienated the munificent mentor who had presided
over his early career” (Gay 1998, p. 67).
Freud found that the memories at the source of his pa-
tients’ neurotic symptoms were invariably revealed to be
sexual in nature. He wrote, “I was not prepared for this con-
clusion and my expectations played no part in it, for I had
begun my investigation of neurotics quite unsuspectingly”
(Freud 1925/1959, p. 24). Despite general skepticism,
Freud became convinced that the symptoms of neuras-
thenia, as well as of hysteria, were caused by sexual distur-
bances, setting aside the previously held view that such ill-
nesses were a consequence of unspecified weaknesses in
the nervous system. He rejected Janet’s idea that a split-
ting of consciousness occurred in hysteria. He also held
that the patient’s verbal productions had meaning and that
psychic as well as physical life followed the principle of
determinism. Having arrived at the central concept of
psychic determinism, Freud was committed to studying the
productions of the mind as causally linked to earlier events,
rather than dismissing them as meaningless epiphenom-
ena (Auchincloss and Glick 1996, p. 4).
Freud’s First Model of the Mind
In his practice, Freud gradually abandoned hypnosis for
the cathartic method. Of the case of Elisabeth Von R.,
378 THE AMERICAN PSYCHIATRIC PUBLISHING TEXTBOOK OF PSYCHOANALYSIS
whom he treated in 1892 (the case was published in 1895),
in what he called “the first full-length analysis of a hyste-
ria undertaken by me” (Breuer and Freud 1893–1895/
1955, p. 139), Freud wrote, “I arrived at a procedure which
I later developed into a regular method and employed
deliberately. This procedure was one of clearing away the
pathogenic psychical material layer by layer, and we liked
to compare it with the technique of excavating a buried
city” (p. 139.) Many important principles of psychoanaly-
sis appeared in fledgling form in this early case, as Freud
not only presented his clinical information but, even more
importantly—and a key reason for the richness of his writ-
ings—described the process by which his thinking devel-
oped. Freud would “carefully note the points at which
some train of thought remained obscure or some link in
the causal chain seemed to be missing” (p. 139). As Freud
listened, he noted the substitution of “physical feelings as
a symbol of her mental ones” (p. 144). At one point Freud
tried and failed (to the patient’s “triumphant” pleasure)
to hypnotize her, and shifted to “the pressure technique”
instead. “In view of the difficulty he had in hypnotizing
his own patients and remembering that Bernheim was
able, in the state of post-hypnotic amnesia, to have the sub-
ject recall what had happened under hypnosis, Freud told
his patients to close their eyes and concentrate” (Ellen-
berger 1970, p. 518). Pressing his hands on the patient’s
head, he “instruct(ed) the patient to report to me faithfully
whatever appeared before her inner eye or passed through
her memory at the moment of the pressure” (Breuer and
Freud 1893–1895/1955, p. 145). This was the introduction
of free association.
Freud noted that at times the pressure technique would
yield extensive material, while at others it appeared to fail.
Freud’s careful clinical scrutiny, combined with a stub-
born confidence, led to fascinating results; he “resolved...
to adopt the hypothesis that the procedure never failed”
(Breuer and Freud 1893–1895/1955, p. 153) and found
indeed that material had been present but had been held
back. He writes, “In the course of this difficult work I be-
gan to attach a deeper significance to the resistance of-
fered by the patient in the reproduction of her memories
and to make a careful collection of the occasions in which
it was particularly marked” (p. 154). This is the first use of
the term resistance, which was to become an important
feature of his evolving theory of clinical psychoanalysis.
The Freud in this early case was an uneasy blend of a
confident scientist using empirical observations to de-
velop a new theory and an isolated and occasionally defen-
sive figure. He noted at one point of his investigations,
“These, incidentally, were not the kind of questions that
physicians were in the habit of raising.” In his discussion,
he wrote,
it still strikes me myself as strange that the case histories
I write should read like short stories and that, as one might
say, they lack the serious stamp of science....The fact is
that local diagnosis and electrical reactions lead nowhere
in the study of hysteria, whereas a detailed description of
mental processes such as we are accustomed to find in
the works of imaginative writers enables me, with the
use of a few psychological formulas, to obtain at least
some kind of insight into the course of that affection.
(Breuer and Freud 1893–1895/1955, pp. 160–161)
At this point, this insight consisted of several critical
principles: the importance of close clinical listening; the
belief that behavior was meaningful rather than acciden-
tal; and the premise that infantile sexuality was the core of
unconscious meaning that needed to be uncovered. Freud
had received a couch as a gift from a patient in 1890, and
he retained from hypnosis the practice of having his pa-
tients recline on a sofa while he sat behind them, out of
their field of vision.
While his clinical practice afforded him more financial
security, he continued to be scientifically isolated, mainly at-
tached to Wilhelm Fliess, a Berlin ear and nose specialist
who was his confidant at that time. Freud struggled am-
bitiously to outline his aims in his posthumously pub-
lished “Project for a Scientific Psychology,” in which he
envisioned the biological/neurological substratum for the
psychological phenomena he was delineating. His theo-
ries were in a process of flux. The concept of defense
(Abwehr) appeared in 1894. In 1895, he began to refer to
his work as “psychoanalysis.” By 1896, he was setting forth a
theory of neuroses, distinguishing between “actual neuro-
ses,” caused by current disturbances in sexual functioning,
and “psychoneuroses.” The latter, divided between hysteria
and obsessions, were thought by Freud to be caused by sex-
ual abuse in childhood, a theory he described in a poorly
received 1896 lecture to the Society for Psychiatry and
Neurology entitled “The Etiology of Hysteria.”
By the fall of 1897, in a letter to Fliess dated Septem-
ber 21, Freud, while still identifying sexuality as the origin
of hysteria and while never denying the occurrence of
childhood sexual abuse, abandoned the seduction theory
as a universal etiological factor. (Freud corresponded with
Wilhelm Fliess between 1887 and 1904, in a series of let-
ters in which Freud described the evolution of his ideas.
Through his self-analysis, Freud had gradually come to
recognize his own intense childhood love for his mother
and his corresponding jealousy of his father, a situation he
termed “the Oedipus complex,” after Sophocles’ Oedipus
Rex. “This was to be a decisive turning point in psycho-
analysis: Freud found that in the unconscious it is impos-
sible to distinguish fantasies from memories, and from
that time on he was not so much concerned with the re-
construction of events from the past through the uncov-
Psychoanalysis: The Early Years
ering of suppressed memories, as with the exploration of
fantasies” (Ellenberger 1970, p. 488).
This shift, critical for psychoanalysis, has become in
recent times a nodal point of controversy, as Freud was at-
tacked by J. M.Masson in 1984 (Masson 1985) as denying
the importance of childhood sexual trauma. While this
argument hinged on an inaccurate understanding of what
Freud’s revision of the seduction theory actually entailed,
it needs to be understood as the continuation of an ongo-
ing, more significant theoretical divide between the impor-
tance of unconscious fantasy and that of “real” trauma, a split
that emerged early in the psychoanalytic movement and
that had some significant consequences. But it is inargu-
able that the rejection of the seduction theory was critical
for the development of Freud’s thinking. Cooper (1985)
noted that “[t]he subsequent abandonment of the seduction
hypothesis, which I believe was an essential step for the
development of psychoanalysis rather than social theory,
led to a focus on fantasy and on the sources of fantasy in
instinct or drive” (pp. 9–10).
Freud’s realization that the childhood sexual seduc-
tions described by his patients were largely fantasies, com-
bined with his intense interest in what these fantasies re-
vealed about the complexity and intensity of childhood
sexuality, offered a new way to understand what had long
been familiar to medical and legal authorities—that is, the
complex array of perverse sexual activities enacted by dis-
turbed adults. It also helped to clarify anthropological ob-
servations, very well known at the time, about the range of
sexual practices encountered in other cultures. But when
Freud addressed commonplace events such as such as slips,
forgetting names, and childhood memories in The Psycho-
pathology of Everyday Life (Freud 1901/1960), he was ad-
vancing a claim for the applicability of his discoveries to
normal as well as pathological psychology. This work fol-
lowed The Interpretation of Dreams (Freud 1900/1953),
first published in 1899, in which Freud used the universal
phenomena of dreams to demonstrate the fruitfulness of
investigating infantile sexuality through exploring adult
fantasy, rather than by direct developmental observation
(which would be a later shift made by his daughter Anna
Freud). He set forth a technique with which this investi-
gation could be carried out, presented his first model of the
mind, and promulgated the concept of an inherent sexual
energy, later to be named “libido,” thus claiming a biolog-
ical basis for his new psychological theory.
In The Interpretation of Dreams, Freud made the oft-
quoted comment that “[t]he interpretation of dreams is the
royal road to the knowledge of the unconscious in mental
life” (1900/1953, p. 608). Freud attempted to construct a
diagram of the mental apparatus with which he could ex-
plain the formation of dreams in terms of perception, mem-
379
ory, symbol formation, and the fate of images. This effort
can be viewed as a transitional conceptual bridge between
his neurophysiological foundations and his increasing
tendency to deal with purely psychological data. Since
dreams were universal, Freud, using sample dreams from
his own life, as well as those of patients, claimed to eluci-
date normal as well as abnormal mental life, even as he
was introducing a technique, dream interpretation, that
could be utilized in the treatment of neuroses. He described
dreams as wish fulfillments and identified the method of
free association as the key to their interpretation. He de-
scribed how meanings in dreams are obfuscated by mental
operations such as the principles of condensation, displace-
ment, “consideration for representation,” and secondary
revision. He distinguished between the manifest and la-
tent content of the dream and introduced the censor, a pre-
cursor of the superego. Dreams that appeared to be unpleas-
ant merely confirmed his theory of wish fulfillment; the
wishes were disguised because of conflict they engendered in
the dreamer. Infantile wishes often appeared, disguised,
in dreams, and their uncovering was for Freud the key
part of the interpretation. The oedipal myth that he had
first discussed in letters to Fliess here appeared in a sec-
tion on typical dreams, to help explain why aggressive
dreams about parents or siblings were also wish fulfillments.
In The Interpretation of Dreams Freud also proposed a
hypothetical model of the mind based on his study of
dreams, and made an imaginative leap by claiming that this
model served as well to explain the mental operations that
underlay the formation of neurotic symptoms. Freud intro-
duced the topographic model of the mind in which mental
contents were distributed among three systems, the Un-
conscious, the Conscious, and the Pre-Conscious. While
this model seemed to be describing different loci or areas of
the mind, Freud never intended that these divisions should
be thought of in a concrete, anatomical fashion.
He employed the term systems because he meant to con-
vey that each of the three dimensions of mental life was
organized in a distinctive way. The system Unconscious
contains wishes from infancy and operates via primary pro-
cess, a primitive way of thinking based entirely on the
pleasure principle. This system is separated by repression
from the other systems. The system Conscious, on the
other hand, functions according to familiar reason and logic
and interfaces with the external world. The system Pre-
Conscious refers to mental contents not at the moment in
conscious awareness but possibly accessible. Secondary
process thinking, in which the reality principle dominates,
is characteristic of both the systems Conscious and Pre-
Conscious.
In the topographical model, the main emphasis was
placed on the censorship barrier between conscious and
380 THE AMERICAN PSYCHIATRIC PUBLISHING TEXTBOOK OF PSYCHOANALYSIS
unconscious material. This emphasis was in accordance with
Freud’s views on the pivotal role of repression in neuroso-
genesis and with the then-prevalent focus in psychoana-
lytic treatment on the lifting of repression and the identi-
fication of the unconscious instinctual wishes against which
the repressions were arrayed. At this stage, Freud also pos-
tulated that the energy attached to repressed sexual wishes,
later defined as “libido” in 1905, somehow became con-
verted, as a consequence of repression, into a toxic prod-
uct, anxiety. Successful psychoanalytic treatment was thus
supposed to relieve anxiety.
In Three Essays on the Theory of Sexuality, published in
1905, Freud (1905/1953) made the point, as he had in his
work on dreams, that neurotic patients merely demonstrated
excesses or distortions of normal human psychology. “For
Freud... a neurosis is not some outlandish and exotic dis-
ease, but rather the all-too-common consequence of in-
complete development, which is to say, of unmastered
childhood conflicts” (Gay 1998, p. 146). Freud introduced
the forerunner of libido—described in economic terms re-
vealing Fechner’s influence, as well as in evolutionary terms
revealing Darwin’s—as he outlined his theories about the
infantile origins of biologically rooted sexual drives. He
also discussed the reasons for the amnesia of this early pe-
riod and for the psychological tasks necessary in latency
and adolescence for the establishment of normal adult
genital sexuality. It is important to recognize that in writ-
ing about sexuality, Freud was not unique: Ellenberger
points out that “Freud’s Three Essays appeared in the midst
of a flood of contemporary literature on sexology and were
favorably received” (Ellenberger 1970, p. 508).
A detailed analysis of what Freud described in these
essays is contained elsewhere in this volume (see Chapter 6,
“Gender and Sexuality”). For the purpose of understand-
ing the early history of psychoanalysis, several points
need to be emphasized. First is the biological underpin-
nings of Freud’s thinking: “Implicit in the concept of psy-
chic determinism is a system of motivation. Freud’s moti-
vational system is based on the pleasure-unpleasure
principle. ...the origins of behavior lie, at least in part, in
the biological nature of the organism itself....the organism
is driven” (Cooper 1985, pp. 8–9). This biological basis in-
cluded the primacy and universality of the sexual instinct,
with which Jung most prominently would later disagree.
Later hermeneutic critiques of the field would turn away
from this biological foundation for different reasons.
The second point that needs to be emphasized is the
inherent conceptualization of conflict in Freud’s model, in
which childish fantasy combined with immature cognitive
development inevitably led to fears and fantasies about
the nature of sexual activity and the dangers believed to be
associated with it. Later theoretical revisions would make
this conflict and the ego’s handling of it more central than
the mere identification of the underlying conflict-laden
wishes.
The last point to be made is, as previously mentioned,
the premise that childhood development can be studied
through the prism of adult fantasy rather than simply by
direct observation of children. In addition, it is within the
context of this discussion that Freud first introduced his
ideas about female sexuality, the centrality of penis envy,
and the fear of castration, all of which would later occa-
sion significant controversy. (Freud believed that children
of both sexes mistakenly believe that every individual ei-
ther has a penis or has somehow been damaged by losing
it. An unconscious belief in the reality of castration, or in
the fear of its occurrence, persists long after children learn
anatomical differences, and such fantasies may persist in
adulthood and cause significant distress. Perhaps of all the
propositions Freud offered about sexuality, this has be-
come the most controversial, and the most frequently chal-
lenged element of his entire theoretical edifice.) Indeed,
each of these issues was a fault line that would soon lead
to schisms and dissent; at this point, however, with a model
of the mind and an instinct theory based on libido, Freud
had a theoretical foundation rooted in a biological, deter-
ministic conception of humankind, along with a clinical
armamentarium consisting of free association, interpreta-
tion, and the analysis of transference and resistance.
This last principle was at this time the key focus of an-
alytic technique, with the analysis of resistance linked to
the idea that unconscious meaning related to infantile sexu-
ality needed to be uncovered. Early psychoanalysis at this
point was thus defined by a search for a core meaning—
the “excavating (of) a buried city” in Freud’s words (Breuer
and Freud 1893–1895/1955, p. 139)—rather than by a core
methodology; the subsequent shift to the latter approach
would eventually enable very different thinkers to claim
to be psychoanalytic. The ground for this potentially di-
visive plurality was established as Freud gradually began
to have a wider audience, and it is in this less isolated set-
ting that psychoanalysis further developed.
Theoretical Revisions and the
Beginning of a Movement
In 1902, Freud finally obtained a promotion to Professor
Extraordinarius at the University of Vienna. He had been
a Privat Dozent for 17 years, an unusually long time to be
fixed at this rank, and was likely hindered by a combination
of anti-Semitism and the unpopular nature of his views.
Edoardo Weiss, the first Italian psychoanalyst, wrote of
Psychoanalysis: The Early Years
Freud, “While his studies of the central nervous system
had been well received by his colleagues, his psychoana-
lytical writings reduced his scientific reputation sharply.
.. .In this situation a feeling of personal loyalty towards
Freud developed in the small group of his adherents—not
all of them physicians” (Weiss 1970, p. 4). Freud had indeed
begun to find a sympathetic audience, and in the year of
his appointment as professor, his Wednesday meetings,
soon known as the Wednesday Psychological Society, began.
Initiated at the suggestion of physician Wilhelm Stekel,
this small group, consisting along with Stekel and Freud
of Alfred Adler, Hugo Heller, Max Graf, and Paul Federn,
initially met informally in Freud’s study and formed the
nucleus of what became in 1908 the Vienna Psychoana-
lytic Society. Otto Rank, introduced by Adler, became the
group’s secretary in 1906. Members or frequent visitors
eventually included Sandor Ferenczi from Budapest, the
Viennese Victor Tausk, Karl Abraham and Max Eitingon
from Berlin, C.G. Jung and Ludwig Binswanger from Swit-
zerland, Ernest Jones from England, Edoardo Weiss from
Italy and A. A. Brill from America.
As Freud continued to develop his model of the mind,
he did so in the context of what was becoming a burgeon-
ing movement, with increasing tension between the tasks
necessary to sustain the field’s survival and expansion and
those concerned with the developments and refinements
of psychoanalytic theory. As Cooper (1985) noted,
Freud’s protectiveness of his ideas and his belief that the
development of psychoanalysis would best be served by
founding a movement rather than a forum for open sci-
entific discussion of competing ideas, while probably es-
sential for the rapid triumph of psychoanalysis within
western culture, also contributed to the sectarianism of
early psychoanalytic thought and the tendency for each
new system to attempt completion and closure. (p. 12)
Jung and Binswanger, after visiting Freud in 1907,
founded a psychoanalytic society in Zurich in 1908. The
First International Congress of Psychoanalysis met in
Salzburg in 1908, and in 1909 the first psychoanalytic
journal, Jahrbuch für Psychoanalytische und Psychopatholo-
gische Forschungen, was founded. Freud was also invited to
lecture at Clark University, in Massachusetts, traveling
with Ferenzci and Jung to America. In 1910 the Interna-
tional Psychoanalytical Association was founded, at the
Second International Congress of Psychoanalysis. “But the
very fact that psychoanalysis was proclaimed a ‘movement’
(and not just a new branch of science) inevitably provoked
opposition in psychiatric circles, and crises within the ini-
tial group, and an antipsychoanalytic feeling rapidly arose
in psychiatric circles” (Ellenberger 1970, pp. 455–456).
Edoardo Weiss (1970), in his memories of Freud, wrote,
381
“Freud himself knew that the concepts of psychoanalysis
would be developed and revised. At the same time, he felt
quite understandably very protective of the great field of
his scientific investigation and theory he had christened
psychoanalysis, and he resented any distortion or misin-
terpretations of his concepts” (p. 5).
While Freud took care to distance himself from some
of his followers’ work, the first truly significant break was
with Alfred Adler, who developed what he called “individ-
ual psychology” with a decreased emphasis on the uncon-
scious. Adler believed that the drive for superiority or
mastery and the inferiority complexes that could result were
more important than the unconscious dynamics that
Freud put forth. Adler left the Vienna Psychoanalytic Soci-
ety with some adherents in 1911, forming a dissident group.
The next significant break, in 1913, was with Jung,
who was at the time president of the International Psy-
choanalytic Association and publisher of its journal. Trained
in Switzerland under Eugen Bleuler, Jung early became
acquainted with Freud’s work and was his passionate advo-
cate. Freud singled him out among his followers as his heir,
but the two men increasingly disagreed on the impor-
tance of libido theory. Jung began to term his own theory
“analytical psychology” as he extended the concept of li-
bido to encompass general, nonsexual forces, and rejected
what he saw as Freud’s mechanistic view. Another impor-
tant break was with Otto Rank, who proposed a theory of
neurosogenesis based on the birth trauma and discounted
the importance of childhood sexual wishes and fantasies.
Brenner has noted of these various theoretical dissents
that there was a striking “uniformity with which all the
otherwise diverse formulations reject the idea of the im-
portance to mental functioning and development of con-
flicts over sexual and aggressive wishes originating at ages
three to six” (Brenner 2000, p. 608).
Freud, in his 1914 On the History of the Psychoanalytic
Movement, clarified the central tenets of psychoanalysis
and declared that “I consider myself justified in maintain-
ing that even to-day no one can know better than I do what
psycho-analysis is, how it differs from other ways of inves-
tigating the life of the mind, and precisely what should be
called psycho-analysis and what would better be described
by some other name” (Freud 1914/1957, p. 7). He described
the secession of Adler and Jung and “reportedly wrote this
essay in order to save psychoanalysis from dilution. . . . He
made an organizational decision to enforce his theoretical
position about the centrality of the unconscious. From
then on, followers would defend his doctrine not only
against Jung and Adler’s deviance but against all those who
would water it down” (Kurzweil 1998, p. 89).
With the departure of Jung and Adler, Freud relied in-
creasingly on Abraham, Ferenczi, and Jones. Ernest Jones,
382 THE AMERICAN PSYCHIATRIC PUBLISHING TEXTBOOK OF PSYCHOANALYSIS
who had met Freud at the First International Congress in
1908, was analyzed by Ferenzci. In 1913 Jones formed the
London Psycho-Analytical Society, and later, demon-
strating his loyalty to Freud, dissolved the London society
because of Jungian dissent, immediately reconstituting it
as the British Psycho-Analytical Society in 1919. He be-
came the key advocate for Freud in Britain and North Amer-
ica and was a powerful polemicist and disseminator. He did
have his disagreements with Freud, most notably about
his theories on female sexuality. He also played a critical
role in later attempting to mediate between Anna Freud
and Melanie Klein (see Chapter 26, “Psychoanalysis in
Great Britain and Continental Europe,” in this volume).
Freud also supported Abraham’s prominence in the move-
ment and was influenced by his papers on the development
of libido.
For even as schisms appeared within his group of fol-
lowers, Freud was himself revising many key aspects of his
theory in work he did beginning in the second half of the
1910s and through the 1920s:
So during the period when Adler increasingly was bas-
ing his theory on observations of personality and Jung
was stressing archetypal influences—both culturally and
more or less “consciously” determined—Freud became
ever more involved in elaborations of the unconscious
sources of both personality and culture. (Kurzweil 1998,
p. 73)
In Freud’s 1915 Papers on Metapsychology, a series of es-
says, he approached the superstructure of psychoanalysis
with an attempt to describe mental life from the dynamic,
economic, and topographical points of view and revised
his understanding of various clinical conditions (Freud
1915/1957). In his 1920 Beyond the Pleasure Principle,
Freud (1920/1955) proposed a new, dual classification of
the instincts, adding to Eros (the libidinal instincts) a
place for aggression in the form of the controversial and
never fully accepted concept of the death instinct. With
these modifications, Freud soon found his topographical
model inadequate. Introduced in The Interpretation of Dreams
(1900/1953), this old model
was challenged by the observation that defenses against
unconscious wishes are themselves unconscious and
cannot be brought to consciousness by undoing repres-
sion. In addition, the analysis of melancholia and obses-
sional symptoms led to the observation that moral im-
peratives and self-punitive tendencies can also operate
unconsciously. (Auchincloss and Glick 1996, p. 15)
Dropping the idea of a self-preservative drive, Freud
hypothesized instead that there must be two biologically
derived primary driving psychic forces, libido and aggres-
sion. Wishes expressing either or both of these drives
could lead to intrapsychic conflict. To better elucidate this
conflict, Freud abandoned the topographical model in fa-
vor of a new tripartite schema, which has come to be called
the structural theory. In The Ego and the Id (1923/1961),
Freud introduced a new conceptual language in which the
mental apparatus was divided into “Id,” “Ego,” and “Super-
ego,” providing Freud with an improved framework with
which to describe mental conflicts and their clinical man-
ifestations. The id contained instinctual drives, both li-
bidinal and aggressive; the ego represented the executive
functions of the mind and represented the mind’s connec-
tion with external reality; and the superego encompassed
moral prohibitions and ideals. In this new explanatory sys-
tem, there was a critical shift; now certain aspects of ego
and superego functioning were also recognized as located
in the unconscious stratum, along with the contents of the
id. This recognition allowed Freud to develop a more so-
phisticated picture of intrapsychic conflict and thus pro-
vided a better way to account for the clinical data.
The dual-instinct theory gave clinical weight to both
aggression and sexuality. Freud also gradually revised his
theory of anxiety as his growing clinical experience led
him to reconsider his earlier formulations. In his earlier
theories, “Freud held that anxiety appears as a consequence
of accumulated, undischarged libidinal cathexes, a situa-
tion brought about by the repression of the instinctual drive
derivatives” (Arlow and Brenner 1964, p. 59). His new the-
ory of mental conflict held that whenever wishes from the
id threaten to emerge in thought or action, anxiety is gen-
erated. The anxiety acts as a signal, causing the ego to mobi-
lize repression, along with a broad spectrum of other de-
fenses, in order to block or disguise the anxiety-provoking
wish. The invention of the structural model, along with
revised theories about anxiety, led to “an emphasis on the
centrality of the ego’s executive role, both in providing the
signal of anxiety and in constructing the defenses which
organize the characterologic and symptomatic construc-
tions of ongoing individual life” (Cooper 1985, p. 10).
Freud was modifying and refining not only his theory
but also his technique during these years, and disagreements
about such central principles as the nature, role, and pur-
pose of transference led to other schisms. Transference had
replaced resistance as the focus of the analyst’s interpretive
work. The term transference encompassed the wishes, per-
ceptions, and attitudes that are formed by children in re-
lation to parents and other significant figures, that persist
unconsciously in adult life, and that are inevitably trans-
ferred onto the analyst. The phenomenon of transference
provided the analyst with an emotionally rich stage on
which the analysand could be helped to understand the
nature of the important unconscious formative influences
Psychoanalysis: The Early Years
of childhood, still active in the present. The analysis of
the transference took a central position in the technique
of treatment. Freud disagreed with one of his closest fol-
lowers, Ferenczi, who believed in gratifying some aspects
of the transference relationship and in utilizing more sup-
portive techniques. As Ellenberger (1970) noted, “In 1919
Freud warned analysts against taking false routes. He dis-
avowed Ferenczi’s innovation and precept of the active
role of the analyst, and also rose up against the idea of the
analyst giving emotional gratification to the patient; the
analysis should be conducted in an atmosphere of absti-
nence” (p. 520). Freud firmly believed that to do other-
wise would make the analysis of the transference more diffi-
cult, or even impossible.
The codification of clinical practice and of the rules
followed by psychoanalysis’ growing number of practitio-
ners was of concern to Freud, and as the field gained new
adherents, the importance of clarifying it both as theory
and as organization became increasingly important. In spite
of a difficult beginning, Berlin soon became the center of
a flourishing psychoanalytic community, with Karl Abra-
ham, who had left the Burghölzli in Zurich for Berlin, at its
center. Karen Horney, Helene Deutsch, and Melanie Klein
trained there, all analyzed by Abraham, who had devel-
oped some ideas about the female libido that these three
analysands would each, in different ways, challenge and
modify. Sandor Rado and Franz Alexander arrived in 1921.
Some of the basic precepts of analytic training, including the
training analyses, the supervision, and the seminars, had
been established in Berlin by 1930.
The Later Years and the
Major Foci of Dissent
The publication in 1926 of Inhibitions, Symptoms and Anxiety
(1926/1959) “marked a new phase in the transformation
of Freud’s theories, from metapsychology to ego psychol-
ogy” (Ellenberger 1970, p. 517). It was as the significance
of Freud’s theoretical evolution became absorbed that
therapeutic emphasis gradually shifted from the earlier
focus on the lifting of repression and the recovery of patho-
genic memories to the analysis of ego functions. Anna
Freud, presumably with her father’s cooperation, published
in 1936 the seminal work The Ego and the Mechanisms of
Defense, in which the nature of the revised technique was
clearly summarized (A. Freud 1936/1967). Attention was
paid to recognizing, and addressing in interpretations, the
various ways in which the patients’ egos were defending
against forbidden wishes, instead of concentrating on inter-
preting the nature of those wishes directly, as had been
383
prevalent in earlier practice. This clinical approach
became known as ego analysis and the theoretical approach
as ego psychology. The shift from id analysis toward ego
analysis was strongly assisted by Anna Freud and Heinz
Hartmann. “While historically the major ego concepts
developed as an outgrowth of drive-conflict psychology and
remain intimately tied to it via conceptions of defense
against drive, Hartmann’s.. .work introduced a significant
emphasis on adaptation to the average expectable environ-
ment as well” (Pine 1988, p. 572). The followers of Abra-
ham and Eitingon followed this theoretical shift to a focus
on defense, while followers of Ferenzci were drawn to Mel-
anie Klein’s work (Kurzweil 1998, p. 256).
Several factors contributed to theoretical shifts during
the last years of Freud’s life, including changes in the intel-
lectual and cultural climate, and new data from growing
clinical experience. During the 1930s, the rise of Fascism in
Europe led much of its analytic community to emigrate,
since many analysts were Jewish, and most were, by nature
and inclination, intellectuals, liberals, and free thinkers.
This social cataclysm promoted the growth of psychoana-
lytic interest in Great Britain and in North and South
America. The inclusion of many talented individuals and
the effect of their dispersal from the first centers in Vienna,
Berlin, and Budapest, together with the normal progressive
accumulation of clinical experience, fostered the emer-
gence of new trends and clinical developments. The earlier
psychoanalytic view had emphasized the genetic viewpoint,
which focuses on the intrapsychic experience of the world,
rather than the maturation of drives as influenced by the
environment. With Anna Freud devoting attention to a de-
velopmental framework and Melanie Klein focused on the
unfolding of childrens’ innate predispositions, conflict
arose surrounding what psychoanalysis could say about,
and gain from, the earliest years of life and about whether
a focus on preoedipal events was either scientifically possi-
ble or useful. Later, with the rise of linguistics, there was
conflict about whether psychoanalysis is a hermeneutic dis-
cipline, “a purely psychological and linguistic effort at un-
derstanding meanings, or whether it is a scientific causal dis-
cipline with biological roots” (Cooper 1985, p.16). Freud’s
weakness in describing female sexuality led to a variety of
feminist critiques of the field. In some ways, this critique
aligned with the controversy over Freud’s abandonment of
the seduction theory, in which the demotion of real trauma
in favor of fantasy was felt to be a denial of sexual abuse; but
more than this, it was clear that Freud’s work had significant
limitations with respect to the understanding of female sex-
ual development.
Consideration of these later trends and critiques is
complicated by the difficult task of tracing the influences
on Freud of his contemporaries and identifying the resi-
384 THE AMERICAN PSYCHIATRIC PUBLISHING TEXTBOOK OF PSYCHOANALYSIS
dues of ideas introduced by earlier dissenters. Ellenberger
has noted that “it is practically impossible to discern the
part that disciples play in the shaping of the master’s ideas.
Not only do disciples bring new advances, but their particu-
lar interests, their questions, and the challenge brought by
their contradiction of the master’s opinions all stand be-
yond the reach of any complete appreciation” (Ellenberger
1970, p. 544). To this day, there is conflict about the leg-
acy of the dissenters. Some thinkers, especially those who
espouse some form of later theory, argue that key disci-
ples and dissenters were introducing vital ideas that Freud
himself was unable to accept, ideas which later found their
way back, in some fashion, into psychoanalysis. (For ex-
ample, it has been argued that the exiled Adler’s influence
was felt in Freud’s eventual introduction of aggression into
his own theoretical framework with a dual instinct theory
[Ellenberger 1970, p. 513]. Cooper has argued that a sim-
ilar thing happened with Rank and Jung. Rank’s “theory
of the birth trauma emphasized issues of loss and merging
as the original sources of anxiety. ...Freud... eventually re-
vised his own theory of anxiety to take into account the very
issues which Rank had raised” [Cooper 1985, p. 10]. Coo-
per has also argued that Jung’s disagreement with libido
theory and focus on self concept influenced Freud’s under-
standing of narcissism and played a role in the rise of ego
psychology.) However, the majority of mainstream psy-
choanalysts have seen Freud’s theoretical shifts quite dif-
ferently, as revisions powered by his growing clinical so-
phistication, and evidence of Freud’s own flexibility,
creativity, and commitment to what his clinical data grad-
ually taught him. This view sees Freud as reasonably reject-
ing followers whose beliefs endangered key aspects of psy-
choanalysis. In a way, definition of the boundaries of the
field became increasingly important as a major shift in
focus from content (of memories of infantile sexuality) to
methodology (analysis of the transference and of ego de-
fenses) occurred, with disagreement among historians and
analysts about the relative significance of each. This shift
later allowed very diverse thinkers to use psychoanalytic
methodology to reach very different conclusions about
psychopathology while considering themselves true heirs
of Freud.
Conclusion
In spite of the many divisions that, as we have noted, made
their appearance early on in the development of psycho-
analysis, the main body of work and thought in the field
remained centered on Freud and his ideas until the onset of
the Second World War. Its central tenets, as conceptual-
ized by Freud, continue to be accepted by various schools
of thought, which Cooper (1985) defined as follows:
The paradigm that Freud constructed, in grossly over-
simplified form, consisted of a claim of psychic de-
terminism; a method of investigation—free association;
a descriptive-explanatory proposition that behavior is
influence or determined by powerful feelings and ideas
occurring out of awareness—the dynamic unconscious;
and a treatment method based on the recognition of the
central role of transference. (p. 6).
Freud came to study neurosis from the vantage point
of an established medical practitioner and physiological
researcher. He thought in biological terms and he at-
tempted to explain his clinical observations in the light of
the then-current understanding of neurophysiology. While
he abandoned his 1895 “Project for a Scientific Psychol-
ogy” and gradually directed his efforts to constructing ex-
planatory models in purely psychological terms, Sulloway
(1979), in an extensive critical review, insists that Freud
remained a biologist at heart and asserts that his followers
overstated the degree of Freud’s shift to a psychological
focus in order to amplify his reputation for originality. A
contemporary reader can easily detect the fundamentally
physiological conceptual framework that Freud adapted
and incorporated into his psychological theorizing, just as
one can see that his confident reliance on his capacity for
accurate scientific observation reflects the prevailing pos-
itivist assumptions of his time. Freud was convinced that
psychological events grow from a biological substrate,
and he was also certain that science would some day be in
a position to integrate physical and psychological phe-
nomena into a coherent theoretical edifice. This integra-
tion, and the question of whether it is necessary, continue
to be a prominent feature of the psychoanalytic schools
that have developed since his time.
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