Mental Health and the Legacy of Sigmund Freud
Before discussing how Freud continues to influence the practice of mental health today, it is important to place him in some context. That context is the fact that Freud was not a psychologist, social worker or psychiatrist. In point of fact, Freud was a medical doctor whose specialty was neurology. He was fascinated by work in the laboratory where he studied the nervous system and drew incredibly complex diagrams of neurons in the brain. He studied anesthesia and was well on the way to be the scientist to discover the chemicals that would allow for painless surgery. What stopped him was the fact that he was a Jew living in the Austro-Hungarian Empire. At every turn he was confronted with outright and frank anti-Semitism. The fact that he was an avowed atheist made no difference. Constantly discriminated against as a Jew and unable to support his wife and children, he was forced to give up academic medicine at the university and pursue private practice. Keep in mind that private practice at that time did not carry with it the prestige that it does today for physicians. It was in his private practice and at the hospital that Freud began to notice that many female patients were coming for medical help for symptoms that appeared to have no physical basis. Among these were various types of maladies such as paralysis so severe that it kept many women confined to home, wheel chair or bed. When Freud shifted his attention to these problems he was on the road to psychoanalysis and many of the ideas that are still in use today. What were these?
1. Childhood Trauma:
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Freud and his brilliant medical colleague, Hans Breuer, examined these paralyzed and ill young women. In intensively collecting background information they discovered a common denominator in all of their lives: they had suffered severe and repeated trauma as young teenagers and adolescents. The trauma was mostly some type of sexual molestation and mostly by a member of the family. Unable to cope with their feelings of shame and guilt as well as anxiety and depression associated with those events, they repressed these traumatic events into their unconscious minds and became physically ill.
The importance of this discovery was that it focused attention on the fact that children are in great need of protection while they are growing up. In addition, it was recognized, for the first time, that the events that occur in the lives of children deeply impacts on their later lives. In many ways, this was the beginning of the field of child psychology.
Ultimately, the growing awareness of trauma during childhood led to concern about all types of child abuse, from sexual trauma to corporal punishment and neglect. One has only to read the novels of Charles Dickens, which were autobiographic, to learn how pervasive the abuse of children was during the nineteenth century.
Although most professionals no longer subscribe Freud's theory of psychosexual stages of development from infancy to adulthood (oral, anal, phallic, latency and adolescent sexuality) everyone now thinks in terms of stages of development with regard to children. This was a radical departure from the way children were viewed during the middle nineteenth century and before. During those earlier times society tended to view children as small sized adults. For instance, during the history of the city of London it was not unusual to hang children for theft along with adults.
When Freud focused attention on the fact that there are complicated stages of growth and development from birth to adulthood, a revolution occurred in the way human life was viewed. So powerful was his impact in this area that today it is impossible to imagine children in any other way than through a developmental schema.
Even if you reject Freud's theory about the oedipal conflict it is not possible to reject the fact the he helped open the topic of human sexuality open to discussion and understanding. Many of the female suffers who came to Freud for consultation were found to be suffering from repressed sexual longings. At a time when the double standard ruled, in which sex was acceptable for men but not for "nice women," female sexual thoughts and strivings had to buried deep into themselves.
3. Talking Therapy
One of Freud's major contributions to mental health was the discovery that patient improve when they talk to a therapist. He developed a particular technique for talking that was part of psychoanalysis named free association. Today, many people misunderstand free association to be an opportunity for the patient to meander aimlessly during a psychoanalytic session while the therapist sits back and relaxes. In actuality, Freud used interpretations of what the patient was saying to help him recover forgotten memories that he believed were at the root of the psychiatric symptoms being experienced. Freud, the exacting and precise scientist was not about sitting back relaxed while patients filled the hour talking aimlessly.
The major point here is the fact that talking helps, particularly when the therapist is both listening and involved with the patient. Unlike the stereotyped of the psychoanalyst who listens and takes notes while saying nothing, Freud was active and involved in the sessions as his patients talked. If he remained objective it did not mean that he was silent. Most studies today show that therapists who are involved, interactive and empathic are most beneficial to their patients' recovery of health. In addition, most studies today show that it is a combination of anti depressant medications and psychotherapy that help most.
It is also true that the practice of psychotherapy has progressed and grown since the time of Freud. Today, psychotherapy often involves the use of cognitive-behavioral therapy to treat depression, anxiety and many other disorders. These practices are based on different theoretical pillars than those constructed by Freud. Nevertheless, many practitioners today use a combination of psychodynamic and cognitive-behavioral techniques to help patients achieve their goals.
Unbeknownst to many people is the fact that Freud, medical doctor/neurologist that he was, predicted that medications would one day be discovered that would cure mental suffering. At this point in time a cure for mental illnesses has not been found. However, medications are being used to alleviate conditions which were once viewed as hopeless. Bipolar Disorder is controlled with medications so that most suffers can return to work and normal family lives. The most acute illnesses, the psychoses and schizophrenias, are being treated with medications which relieve the most severe symptoms of those diseases. Those symptoms include delusional thinking and hallucinations. While the medications for the schizophrenias do not represent any kind of cure and many serious symptoms persist, most of these patients no longer have to be confined to mental hospitals for their own safety and the safety of the public. Some are even able to live with their families and work part time if they remain compliant with their medications. As medical science learns more about the brain and its billions of neurons and neurotransmitters, more effective medications will be discovered that will, one day, bring greater relief to the suffers of these acute mental illnesses.
In the area of the more prevalent mental disorders, medications are used to relieve depression and anxiety experienced by millions of people around the world. Among those millions are individuals who, at an earlier time, would have been at great risk for committing suicide in order to escape their suffering. Instead, with the help of these treatments, people are able to live normal and productive lives.
As we approach the 150th anniversary of Freud's birth I believe it is important for us to recognize his achievements. It is important to remember that he was a pioneer. If he has proved to be incorrect about some things, that is only to be expected of any pioneer. It is important to remember that Freud gave us new ways of thinking about children, trauma, human development and personality. We have now moved beyond Freud in learning about the human brain and human behavior. Yet, even now, neurological studies reveal the fact that there is such a thing as the unconscious mind and that it does contain forgotten memories, memories that are stored away in the brain.
Freud laid the foundations for today's awareness of the damaging effects of child abuse, both sexual and violent, and of child neglect.He also opened the whole topic of sexual behavior, human development and human personality. While most practitioners no longer practice orthodox psychoanalysis, most incorporate some aspects of his thinking into their approach to mental health.
We have learned a lot more since Freud and we will continue to improve in our understanding and treatment of mental health. We owe him a debt of gratitude for setting us on the course of learning about mental health.