Sigmund Freud (1856-1939) is world renown as the father of psychoanalysis and when he put forward his theory in the 1890’s desires and fantasies of a sexual nature were not culturally acceptable. Therefore, these yearnings and flights of fancy were ethnically discouraged, much less talked about, and were repressed by the individuals experiencing them. However, after discussion with individuals exhibiting neurotic and/or hysterical symptoms, Freud concluded that their problems stemmed from these unconscious desires. He claimed that most of humankind’s mental activity is essentially unconscious; that is, the unconscious is a hidden reservoir filled with drives and impulses that govern an individual’s behaviour (www.rapidnet.com/~jbeard/bdm).
Freud’s theory is based on the principle that the personality is made up of three sections – the id, the ego and the superego. He claimed that the id is responsible for inherited biological instincts such as hunger, sex and aggression. Freud’s supposition was that the id is demanding and unreasonable and its instincts and impulses must be satisfied, regardless of how inconvenient these demands may be (Davies and Houghton, 2000). Because the id has no concept of “reality” it can be temporarily satisfied by artificial measures; for example, a hungry baby can be contented for a while if given a dummy to suck.
The ego develops from about the age of one year. Freud (1923) states that the ego is “that part of the id which has been modified by the direct influence of the external world through the medium of conscious perception” and that:
The ego seeks to bring the influence of the external world to bear upon the id and its tendencies ……. For the ego, perception plays the part which in the id falls to instinct. The ego represents what may be called reason and common sense in contrast to the id, which contains the passions …… (Freud, 1923).
The ego’s priority is the consequences of any given act rather than the act itself.
The superego represents the moral or sensible section of the personality. It consists of two subdivisions, the conscience which threatens the ego with punishment for bad behaviour (in the shape of guilt) and the ego-ideal which assures rewards (in the shape of satisfaction and elevated self-esteem) for good behaviour (Gross, 1992). All three elements of the psyche often conflict with each other. The ego delays the pleasure that the id desires straight away and the superego struggles with both the id and the ego because an individual’s actions often fail to properly represent moral conventions (Atkinson et al, 2000).
Carl Gustav Jung (1875-1961), meanwhile, was of the opinion that the causal factors of mental disorder went deeper than the personal. He claimed that all individuals are affected by what he called the “collective unconscious”, a section of the psyche that is common to all human beings, and stated that the function of sex was not as important as Freud had previously thought. He also disagreed with Freud’s claim that it was important to deal with an individual’s past and proposed that consideration should instead be given to humankind’s religious, artistic and other such needs (www.rapidnet.com/~jbeard/bdm).
Jung suggested that the collective unconscious was made up of archetypes (also known as primordial images) that had been historically inherited, though not necessarily from family ancestry. Among these archetypes were the mother, the father, the sun, the hero and death. Jung claimed that these archetypes are manifested by an individual’s imagination and each archetype is an attempt to symbolically represent something common to all humankind, e.g. the mother represents an individual’s inbuilt ability to recognise a primary care-giver, normally one’s own mother; the father symbolises a guide or authority figure and the hero is Jung’s equivalent of Freud’s ego. If an individual does not know anyone who signifies their archetypal image, they will invent one, which lends credence to the notion of mythology (www.ship.edu/~cgboeree/jung.html).
Jung studied dreams, folklore and other cultural constructs and noted that certain images often presented themselves in dreams but were also present in religious texts and ancient mythology, of which the dreaming individual was not familiar. Therefore, whilst Jung and Freud agreed that the unconscious existed, Jung claimed that Freud’s theory did not explain the common images present in the unconscious mind of every human being (Atkinson et al, 2000).
Jung would explain mental disorder as an individual’s psychological inability to make sense and meaning of the universe and their imagination, or to put it another way, to understand their archetypes (www.ship.edu/~cgboeree/jung.html).
Alfred Adler (1870-1937) was the first dissenter from Freud’s school of thought and became known worldwide as the founder of what he called “individual psychology”. He claimed that the motivating forces were not organic impulses, as Freud believed, but social relationships. He believed that every human being’s primary motivation is a “will to power” (Gross, 2000). His theory is founded upon his notion of the common requirement of children to be reliant upon adults. Adler claimed that this dependence brings about impressions of failure and weakness which he asserted that each individual must endeavour to conquer (http://en.wikipedia.org/wiki/Alfred_Adler).
Adler stressed the unity of the personality and saw any behaviour as a result of the behaviours and learning of worldly experiences. His way of thinking differs from that of both Freud and Jung in that the process frameworks he devised were related more to socio-cultural and environmental influences than biological or primordial effects.
Adler claimed that “we cannot think, feel, will or act without the perception of some goal” and illustrates his point with the example of a small child learning to walk. He asserts that even before the first step is taken, the goal of the infant’s movement has already been determined. He continues that “all psychic activities are given a direction by means of a previously determined goal” (www.therapycures.co.uk) and thus maintains that all psychical and psychopathological occurrences are pervaded by one unified life-plan.
Adler claimed that mental disorder occurs when an individual is unable to control the feelings of inferiority and the possibly resulting inferiority complex becomes a neurosis. This may lead to depression or the affected individual may overcompensate by developing a superiority complex in which they display a self-centred concern for their own safety and may seek superiority and/or power over others. They may also exhibit self-aggrandizing behaviour at the expense of others, which is a classic sign of psychopathic behaviour.
Psychoanalysis could be considered the best practice to deal with mental disorder because the individual cannot be forced into receiving the therapy. Firstly, an individual must agree to receive therapy and they can then choose how much they reveal to their analyst. However, a properly trained psychoanalyst will be able to detect if a client is holding anything back. It is a matter of building up trust between the two parties. Nevertheless, psychoanalysis is not a quick fix – therapy may continue for years at a rate of two or three sessions a week, which may be considered to be worst practice, particularly regarding the issue of expense.
One psychoanalytical method of therapy is that of free association, whereby the therapist introduces a topic and the analysand is encouraged to give carte blanche to their thoughts and feelings and say whatever comes to mind without changing it in any way or holding anything back. However, it has been suggested that Sigmund Freud may possibly have interrogated his clients so persistently with pointed questions and implications that they were led to reconstruct recollections of events that never transpired (Powell and Boer, 1994). Worse still, Esterson (1993) and Scharnberg (1993) have both accused Freud of actually exchanging his hypothetical suppositions for statistics.
Psychoanalysis is not scientifically rigorous, which could be considered to be both best and worst practice. The method is based on research with a limited sample, but is supported by extensive theory and practice. Anecdotal evidence carries no weight in the world of empirical research, yet psychoanalysis is a particularly well known method of therapy for mental disorder. However, this may be because of its intuitive appeal and evocative ideas (Flanagan, 1994).
Psychoanalysis could also be considered best practice by some because the client/therapist relationship is always one-to-one. Some individuals may find this more comfortable than discussing personal issues in the presence of a group of people. However, other individuals may feel more at ease within a group of people so would consider psychoanalysis to be worst practice.
Psychoanalysis lays great emphasis on early experiences and any present conflicts can be overlooked. Depending upon the individual receiving therapy, this could be considered to be either best or worst practice. The long road back to those early experiences can be a cathartic experience for some individuals (best practice) but could also reveal issues that have to be dealt with as additional “problems” (best or worst practice). The theories and models on which psychoanalysis are based are complex and contradictory, which could also be considered to be worst practice.
In conclusion, the notion of “cure” is extremely convoluted, particularly in the case of psychoanalysis where a cure cannot be characterised in terms of the removal of symptoms because the real issue is a fundamental struggle and not the symptoms themselves. As a result, if the underlying conflict is not effectively taken care of other symptoms will replace those that have been removed (Gross, 2000), yet this occurs comparatively rarely.
It would appear that what Smith et al (1980), quoted in Oatley (1984), stated about psychotherapy in general could just as easily be applied purely in the case of psychoanalysis:
(It) may not educate as well as schools; it may not produce goods and services as well as management science; it may not cure illnesses as well as medicine; but it reaches a part of life that nothing else touches as well. (Oatley, 1984)