Defence mechanisms

  Early psychoanalysis was about enabling the patient to discover repressed conflicts. Initially Freud and his growing band of colleagues thought that this was sufficient. However, as analyses got longer and more complex, analysts encountered ‘resistance’ where patients appeared to block change using various psychological defence mechanisms. One of the most troublesome ‘resistances’ for Freud was that patients kept falling in love with him (or at the least seeing him as a father figure). At one level this helps – if the patient likes you they are more likely to do what you ask. However, these strong feelings (he called them ‘transference’ because he thought they were transferred from important figures in the patient’s past life) made the exploration of free association almost impossible. Having initially seen transference as exclusively a problem Freud began to exploit it in the analysis. This ‘analysis of defence mechanisms’ became an essential part of the treatment.

  There were certainly many blind alleys in Freud’s work – no surprise in a man who wrote so much. He made us aware of the power of unacknowledged thoughts and how the past can continue to haunt lives. Perhaps more importantly he showed that a brave attempt to confront and understand the origins of the misery (not simply to offer support and comfort) can lead to real liberation and relief. He also (against his own wishes, no doubt) showed how an honestly entered reflective human relationship can itself be the tool for recovery from quite severe mental illnesses.

  Freud was a pessimist (particularly after the carnage of the First World War) and never promised happiness. The aim of psychoanalysis, he wrote, was to help a patient ‘to work and to love’. No more, no less. The rigidity and grandiosity of many of his successors has tarnished his reputation. His claims to have been a scientist are questionable and his treatment, psychoanalysis, is under siege for its failure to prove effectiveness. However, he has probably contributed as much to understanding and tolerance in the care of the mentally ill as any other individual. His insistence on taking the patient’s past seriously and his vivid metaphors for mental processes appeal to therapists and patients alike. They have formed the basis for a humane working relationship for which he deserves more credit than is currently his lot.

  Jung

  Freud collected about him a glittering band of followers. As often with such creative groups there were tensions, conflicts, and schisms. Several took the approach in differing directions and their individual fames have waxed and waned. Probably Carl-Gustav Jung (1875–1961) has had the most lasting influence. While Freud called himself a ‘Godless Jew’ with little sense of the spiritual or transcendent, Jung’s theories were more mystical. They included such constructions as a racial unconscious with ‘archetypes’ (symbolic figures which we all share). Jung also emphasized the importance of opposites in the human personality and how a ‘shadow self’ develops from aspects of our personality that we fail to acknowledge. Jung probably suffered a psychotic breakdown himself and drew on some of these deeply irrational experiences. Unlike Freud he believed that therapy could promote deep personal fulfilment and his approach is attractive to those who work with very ill patients and in artistic circles. Jung’s most persisting contribution, however, is probably his elaboration of the introvert and extrovert personality types. These have entered common language and are in daily usage by millions unfamiliar with even his name.