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Psychiatry_ A Very Short Introd - Burns, Tom.rtf
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The unconscious and free association

  If the laws of energy conservation applied to the mind then new ideas and feeling had to come from somewhere. Freud observed the impact of releasing ‘unconscious’ forces after visiting the French neurologist Charcot who used hypnosis to cure hysterical disorders such as fits or mutism. Freud initially found hypnosis and suggestion successful with many of his patients but the results were only temporary. He encouraged them, under hypnosis, to recall the events leading up to their illness and concluded that traumatic memories were the cause of many of their maladies.

  His conclusion from this was that patients are unaware of much of their ‘thinking’ – that some mental processes were unconscious. The harder one tried to remember the harder it got. Freud responded with the technique of ‘free association’ – encouraging the patient to stop trying to remember and instead say whatever came into their mind. Through these ‘random’ remarks, supplemented by recounting dreams, repressed thoughts leaked out in obscure ways (you can almost see him imagining steam driving pistons). The analyst used his own unconscious to ‘listen’ to these remarks, detecting patterns and so directing the patient to the source of their troubles. Hence a ‘Freudian slip’ is when someone reveals their true thoughts by mistake. Freud became obsessed with the need not to interfere with this free association. The ‘blank screen’ therapist should reveal nothing about themselves, often sitting behind the patient and never answering questions or giving reassurance. It is hard to imagine, looking at the picture of his consulting room, and knowing about the controversy that accompanied him throughout his life, how Freud could ever believe he was a blank screen.

  Nineteenth-century bourgeois Vienna was a very inhibited society. Not surprisingly many of the unconscious conflicts that Freud uncovered were sexual. Initially he believed that his patients had been sexually abused but he changed to a belief that these descriptions were more often fantasies and wish-fulfilments. He went on to propound his theory of infantile sexuality – that even very small children have strong ‘sexual’ feelings about their parents. This, of course, caused uproar, and in many circles still does. The language is clumsy but the ideas do help make some sense of the intense and powerful dynamics children set up in families. The Oedipus Complex is his most famous construct. Freud proposed that at about 3 years old the young boy desires his mother and sees his father as a rival for her affections (based on the Greek myth of Oedipus who killed his father and married his mother). Put like that it is pretty unhelpful, but it is an insightful way to understand how some people never learn to share important relationships. In the process of striving for exclusive intimacy they destroy what they want most. It made sense of many of the patients Freud saw (as it does even today).

 

8. Freud’s consulting room in Vienna c.1910 with his famous couch. The room is packed with evidence of Freud’s preoccupation with ancient Egypt and mythology Ego, id, and superego

  Freud originally believed that the conscious mind was entirely rational and contrasted with the more primitive, less logical, unconscious mental processes. This may explain some of the exaggerated terminology he used when discussing it. However he was struck by the brutal, punitive consciences of some of his patients. How could something as noble as conscience drive a patient to suicide through guilt? His solution was to describe the conscience as derived from both conscious thoughts and also from powerful unconscious remnants of parental and social demands. His map of the mind expanded from two areas (unconscious and conscious) to three. He called the primitive unconscious the id (‘it’), the conscious mind the ego (‘I’) and the conscience the superego (literally ‘over I’). All of these terms are now in common use.

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