Harold Blum, MD
First of all regarding Freud in the 21st Century, of all things, the hardest to predict is the future. I think that given Freud’s contributions to the understanding of human nature, it’s quite likely, based on probabilities that Freud’s theories, his ideas, his discoveries about human nature will persist, until the human genome changes. The reason I bring that up is the following: It’s not only the way we understand it in the 20th Century or in the first few years of this century, it is that Freud used the Oedipus complex in references to Greek myths, to Shakespeare, to Goethe in a particular way. He wanted to demonstrate that the ideas that he had found listening to his patients and in his own self analysis, could be found in the art and literature of the past and across different cultures. The most important aspect of the Oedipus complex from that point of view is that Freud discovered in Sophocles, who had written the Oedipus myth in a play, the same conflicts that he found in his patients. When he realized that Hamlet represented in a core form some of the same conflicts to be found in Sophocles across the centuries, he was able to unify past and present, normal and pathological phenomena. He could verify and validate his concepts and show that they didn’t just apply to people in Vienna, not just to Jewish or Christian people, but to all peoples and through all times. Sometimes excoriated as Jewish pervert, Freud asserted that his discovery about the unconscious applied to people of all races. Now we have actually seen across the 20th Century, Freud-flogging and today perhaps even more Freud-bashing, sometimes of a lunatic nature. The fact is that we have had periods of appreciation of psychoanalysis, of idealization of psychoanalysis, and then periods of devaluation and derision. These attitudes have fluctuated. Freud was accused of being a phrenologist, a palmist, a charlatan and so on, at the same time that he was gathering students, disciples, adherents. This ambivalent reaction went on and on and we have to ask ourselves why now the challenges are greater. Eli Zaretsky certainly brought up, I think, some of the most telling points – I want to add another point: We live in an age at the present time where there is a plethora of psychoanalytic theories. We live in an age of psychoanalytic pluralism. Freud probably, in his own reflective thinking today might infer “Well that’s the way science goes”. There are always new pathways, new developments, and it’s not to be expected that people would see the things the same way as he did; and had he lived, certainly things would have changed in his own views as he kept changing. Some of his ideas remain unchanged and are at the core of the way we understand patients today. Let me start here with Anna O in the early 1880s. She was actually Breuer’s patient, and you may recall that in 1895 Breuer and Freud published the book “Studies on Hysteria”. Freud was not listening to that patient, Breuer was. Breuer, who was actually a doctor of internal medicine, was like a fish out of water in developing the hypnotherapy on his own, with the help of a very extraordinary patient who discovered the “talking cure”. It was her name for the cure. Anna O gave the name in English because she had lost the capacity to speak in German. That’s a sidelight of what I’m talking about. Freud was in the role of a supervisor at some distance from the case. He discovered what he was beginning to see in himself and other patients – the phenomenon of transference between doctor and patient. Here I would disagree slightly with Sheila but also elaborate the discourse in a different way. One of the most important legacies of psychoanalysis, even if it were to be abrogated or relatively eliminated as a therapy as we know it today, is its popular form for vast members of the population. Psychoanalysis gave rise to dynamic psychotherapy or psychoanalytic psychotherapy and what’s also called insight psychotherapy. There Freud’s discoveries – the importance of transference, the doctor patient relationship, the importance of defences, how we understand patients, insight into crisis intervention, and the way in which we understand the nature of the therapeutic process itself, explanations of what happens in psychotherapy, all are really based on psychoanalytic findings and psychoanalytic principles. Freud became part of our language – e.g. the Oedipus complex, libido, defences, projection, denial, and repression. Another aspect about Freud receding is that today Freud is so much a part of a culture, of the intellectual climate of our time and of the past century, that these terms and formulations are taken for granted without usually being acknowledged to derive from Freud. Terms like denial and repression are used without reference to Freud. Plays are analyzed. People go to plays which are analyzed by themselves and the drama critics. They analyze conflicts, characters and so forth without really bringing up the fact that drama criticism was completely different before Freud and after Freud. Human conflict, the analysis of character and motive was very different before Freud. You only have to read Samuel Taylor Coleridge’s descriptions and criticisms of Shakespeare compared to contemporary critics of Shakespeare. Freud found also in the great poets further inspiration and acknowledgement of his ideas. Recently we had the case of a person who confessed supposedly to having killed a girl, apparently his fantasy. We know that Freud wrote a paper on unconscious guilt that presists from childhood.
Eli Zaretsky, I think you are perfectly right that patients come because they want their wishes to be satisfied, but they don’t know that. They come because they are experiencing stress. They come because they are anxious and depressed and distressed, and behind these emotions are forbidden wishes. Behind the defences and what you call the secondary revision, the facade of their presenting complaints, are infantile wishes along with their infantile defences and prohibitions. Now I also want to bring up the fact that even the way we understand symbolism is taken for granted. If someone talks about a banana or a rocket or a sword as a phallic symbol, it’s known today, it’s nothing new. But of course before Freud is was not known – if one looks at the symbol of a sword as a phallus and a cave or cavity as representing the female genitals, we understand that almost without thinking about it. But when Edgar Allen Poe wrote the Pit and the Pendulum, that was not understood in terms of sexual relations. The pit representing the female organ and the pendulum symbolizing the male sexual organ and the swinging back and forth would represent copulation. All of this, which is now part of the way we think was not really understood at all pre Freud. I want to say something further about the way in which Freud was a great unifier. He took the literature – Shakespeare, Sophocles, Goethe and so forth – he looked at art, he analyzed Leonardo, gave us the first psychobiography, all interrelated with the structure of dreams and memories and fantasy. Freud gave us the first interpretations of dreams; before Freud dreams were either considered divine messages from upon high or messages from the devil and divinations. Sorcerers and oracles were the ones to whom people turned for understanding dreams, or they were given symbolic interpretations far removed from the understanding that Freud offered. He showed how dreams have basically the same structure as symptoms, as aspects of character, play, and drama. He linked the child and the adult and showed that the child is very much alive in the adult. This unification of symptoms, dreams, character, transference, the child in the adult, were all things that were not understood before Freud. It’s very important to understand too that the way we think in the century of the child did not occur before Freud and was not really understood in the same way. We know today how important child rearing is, how important child development is for the personality of the adult. This was not something that was understood pre Freud in the same way at all. Nor was the understanding of regression. We know today that people act like infants – adults can act like children in a few moments – you just have to go to a football game to see this. You can even see ordinary people treating each other violently. This kind of mob response where an adult mind becomes child like is in many respects what we call regression. There can also be progression very quickly in the other direction, growing up again very quickly in a reversal of regression. Psychological regression is not paralleled in organic medicine. Our bone structure doesn’t change in adults. This regression-progression flow, the understanding of regression to childhood continues into adult life. I suspect it will continue very much into the future because we’re really old showing them any respects. Now I want to finish with a comment very much appropriate to our day. We live in a time of great violence, and perhaps we always have had great violence. We live in a time of tremendous traumatization. We had hope for rational solutions to international conflicts after World War II, and the formation of the United Nations. We longed for stability without regressions into the most primitive reactions as though going back to cave men times. Freud's important formulations of Psychic Trauma are relevant to the understanding and treatment of victims of terror and violance. There can be psychic trauma with or without physical trauma. People can be severely traumatized, mentally and physically, as they were during World War Two, in concentration camps, in the holocaust, and as they are today in Iraq and in many other parts of the world. What did Freud discover about trauma? He discovered the importance of obligatory repetition, of a tendency, and a need to repeat the trauma, of defences against repeating the trauma. Trauma is relived in the form of nightmares, flashbacks, haunting memories and so forth. Traumatized persons become hyper vigilant and lose basic trust. They are always afraid and are readily alarmed. Someone who has been traumatized may overreact to the sound of a siren or the sound of a fire engine. Psycho physiological reactions occur that we don’t see in a non-severely-traumatized person. Freud was the first one to really describe psychic trauma in depth. Though we have added to trauma theory, the importance of psychic trauma remains and the analytic way of treating it remains. Now neural science has made its own very important contributions to the psychobiology of trauma. It is a competitor of psychoanalysis but it is also a validator, and is synergistic with psychoanalysis. What does neural science demonstrate? Freud began as a Neurologist, and wrote a very important book about aphasia. It is demonstrated that certain changes for example in the hippocampus and amygdala occur with traumatization. Freud has written that certain changes, as he put it, in the energy of the mental processes maybe permanently effected. He was aware of the effect of the mind on the brain, the brain on the mind. Freud knew that in dreaming sleep, people’s voluntary muscular system is paralyzed, otherwise people would act out their dreams. The relationship with neural science is very complicated and there’s reason to hope in the future in the century of the brain, the new 21st century, that there will be not only healthy competition between psychoanalysis in neural science, but also a synergism. Cooperation and mutual stimulation evolve along different but also interlaced and interpenetrating pathways.
Thousands of years ago the Delphic Oracle was regularly consulted. People came with their problems and ills to the Delphic Oracle expecting some kind of divine cure. At least she would have an omniscient way of understanding and offering help to the sufferer. Disturbed persons brought their dreams; they would have a sleep therapy. The oracle would interpret the dream and the healed patient would offer votive tablets on which they would describe their cures. Like people hanging up their crutches in church, the ancients testified to how much they had been helped by this method. It was a forerunner of dream interpretation, much like Joseph’s interpretation of the dreams in the bible. The Delphic Oracle had an adage which I think still is important even though we don’t respect or value it in much of the world. Her adage and her model was “know thyself”, and I think in many ways that maxim still remains very valuable for all of us, down to the present day.