Freud had a 100% CURE for all psychiatry let’s resuscitate it -- using his 1896-insights, not his needlessly convoluted psychoanalytics.

In 1896, Freud was 40. He was at the top of his game, the peak of his powers. His confidence in what he knew and what he was about, verged on the brash, certainly on provocation. Look at the very title of the paper he was then bold enough to read to the medical establishment in Vienna – “The Aetiology of Hysteria” – i.e. the causative factors for diseases of the mind. He was basically lecturing his fellow clinicians on where the plethora of so far utterly inexplicable mental symptoms came from. If your patient came in with a cough, you could diagnose TB. If they came in with an arm they told you was paralysed, or a torso they said was numb – then you were as much in the dark as anyone had ever been for millennia. The mind spoke a foreign language, that all doctors could huddle together and agree neither to translate nor to attempt to comprehend (much as they have always done).

Yet here was a 40-year-old medical colleague declaring not only that there was a regular and consistent cause (which you had so far missed) in each case, but that he personally believed until every single feature of insanity, or as he termed it “all functional psychical disturbances” became equally obvious, and just as simply curable then psychiatry would be incomplete. So clear, so logical, so rational, that it can be expressed succinctly in a single sentence, included below.

What a stroke Freud pulled off. Bold, if not to the point of folly? I should say so. Which intrepid doctor nowadays would have the temerity, even impudence, to repeat this overt challenge to his or her fellow doctors?

Freud however, knew he had the crown jewels of psychiatry in his hands – so much so, that with some of his clinical illustrations, he was merely toying with them. And yet, within 18 months, he found himself compelled to throw the whole thing under a bus. He felt forced to smash the whole structure, simple as it was, to smithereens. Why? It was as if, having opened say, a Pharoah’s tomb and seen brilliant treasures, some invisible agency had drifted out, and driven this unprecedented psychiatric pioneer, mad. He could account for everyone else’s madness, and he did so then, and in terms that even a teenager could understand. Yet when certain events in his own personal life unfurled, he reneged on the whole thing, withdrew his confidence, obliterated all his earlier therapeutic successes, of which he had been so justly proudly and had recently and so courageously displayed. Not content with this elementary sabotage, he proceeded to shroud the whole topic in psychic mud, as if to prevent any in posterity benefiting from his valiant explorations. What a tragedy. What a travesty.

Until this monumental Freudian volte-face is cleared up, psychiatry remains in the doldrums, leaving doctors twiddling their thumbs. If medics cannot solve such a blatant psychiatric mystery, perpetrated by one of their own, who can? Happily, some 140 years later, not only can the whole mess be sorted, deploying his very own 1896 insights, but this also allows his dream of curing every mental symptom there is, to come starkly into view, precisely as he predicted it would – after all, he had concluded his lecture by saying –

“Thus it inspires us with the hope of a new and better understanding of all functional psychical disturbances. I cannot believe that psychiatry will long hold back”.

Before proceeding to more excerpted texts, let’s review the simplest case. Suppose as a GP, you were asked to treat a woman, let’s call her Elsie, whose mind was paralysed by fear – fear that her deceased father would axe her to death, as he had threatened to do when he was still alive and she was very small. Everyone else knows that dead people cannot brandish axes – why doesn’t Elsie? Sounds crazy – or at least partly insane. Everything about it is unreal – except for the symptoms, which are crippling. If there really were a mad-axe-man, then you would be daft not to take precautionary action – but if it all ceased happening 30 years ago, and the perpetrator was dead and buried – how could you possibly account for the prevailing terror, which continued much as it would have done at the original event?

In simple terms her mind was on the blink. From which it follows that the obvious cure would be to convince her that her father, now being dead, could no longer harm her. If this could be achieved, then this indeed would be a 100% cure.

But first, she would have to bring the whole painful topic to mind, before either you or she would have any idea what it was that underlay her emotional turmoil. And here was Freud’s breakthrough. He could see that the reason Elsie and crew, did not bring these so-potent matters to mind, was that they were far too frightening per se, to do so. Fear stops you even remembering them. Freud’s genius was to note that parts of the patient’s past were real, but un-re-callable – they were, in his favourite term, ‘unconscious’. For my part, he went on to abuse this term, and to divorce it from its proper ‘defensive’ context and role – so I much prefer to avoid it altogether, labelling this process ‘blockage’, as happens easily enough in ‘once bitten twice shy’.

In sum – in the simplest terms, not something you commonly find in psychiatry, certainly not in psychoanalysis – the cure is obvious. As obvious as the fact that today’s reality differs markedly from childhood’s – in that dead men however closely related in the family, can no longer harm you. In other words, however terrifying or paralysing the childhood trauma had been, it was no longer happening in today’s reality, if you could once persuade the sufferer to look.

Freud knew this. It’s his crown jewels, or as he prefers, his Caput Nili, the Head of the Nile. He sums it up in a single pithy sentence, as follows

“With our patients, those memories are never conscious; but we CURE them of their hysteria by transforming their unconscious memories of the infantile scenes into conscious ones.”

In the original German this appears as –

“Bei unseren Kranken sind diese Erinnerungen niemals bewußt; wir HEILEN sie aber von ihrer Hysterie, indem wir ihnen die unbewußten Erinnerungen der Infantilszenen in bewußte verwandeln.”

Pop this into Google translate, and that unfashionable word ‘CURE’ comes out every time. It makes sense. It adds up. Can it really be that since doctors decline to seriously read the 1896-Freud, that’s the reason they pour cold water on the notion of psychiatric cure? Elsie was terrified, aged 6. She continued to be terrified by the same cause decades later. It didn’t make sense. In a word it was irrational. And Freud, bless him, put it down to the fact that fear prevented her bringing the sickening event back into consciousness, where, alone, it could be brought up to date. He recognised, something that not enough doctors yet do, that the infantile scenes desperately needed transforming into conscious memories. Once they were, he declared they were cured. Who can rationally or logically dispute this conclusion? And if it remains valid, isn’t it time doctors implemented it, universally.

Please remember this was in April 1896. We have now to deal with what happened between then and September 1897, when Freud met his Waterloo as it were, and he implemented his cataclysmic demolition.

Let’s start with the assumption that Freud’s 1896 reasoning holds water. If it does, then we are justified in applying it to the great man himself. Something has to be found to explain his euphoria of April 1896 which leaks through the page in torrents, at least if you look for it. This, compared with his almost pathological gloom on 21 September 1897, when in his crucial letter to his intimate friend Fliess he discusses his innermost thoughts and emotions.

This letter, included below, has none of the confidence, the brashness that prevailed in the preceding year. Indeed it is positively convoluted, going from one low, to the next, in a bewildering and non-rational manner. “I have more the feeling of a victory than defeat (which is surely not right).” Spot on Sigmund – your buried memories are twisting your cognition and emotions, just as they did Elsie’s and all those with hysteria or obsession you cured. Sadly, and it’s a real tragedy with such an important man, that there was no one around he trusted enough, and who was at the same time skilled enough, to say, as I instruct my trainees –“I’m interested in Parenting Footprints Sigmund – have you got any?”

Of course to open this channel, you need to be fully confident as to what you need to do next – and this takes much training, including of course, crucially, the elimination of any ‘buried’ memories of your own. On a personal note here, looking back, though I would fiercely have denied it at the time, I was frighted of my father until I was 49. Thereafter through a series of events, not all under my control, I was reassured enough, and provided with enough genuine emotional support to rid myself of this ‘buried’ fear, such that when Elsie came along, and she is a real patient, I was able to allow her to be frightened of her father, having only recently become unafraid in that quarter myself.

Back to Freud. The critical line in his 1897 letter is “‘. . . the surprise that in all cases, the father, not excluding my own, had to be accused of being perverse.” You might wonder if this in itself would be enough to distort his approach out of all recognition – but Parental Figments, as I call them, such as the one which persecuted Elsie, take their full power from the one that existed when the sufferer was a child. And there, on cue, is Freud relating to us in his Interpretation of Dreams, that on one occasion, aged about 7 or 8, he pissed in his parents’ chamber pot, to his father’s volubly expressed outrage. Here is the episode in question, which Freud describes with his usual clarity, robustness, and unarguability.

"When I was seven or eight years old there was another domestic scene, which I can remember very clearly. One evening before going to sleep I disregarded the rules which modesty lays down and obeyed the calls of nature in my parents' bed-room while they were present. In the course of his reprimand, my father let fall the words: “The boy will come to nothing.” This must have been a frightful blow to my ambition, for references to this scene are still constantly recurring in my dreams and are always linked with an enumeration of my achievements and successes, as though I wanted to say: 'You see, I have come to something.'

Just a note, he describes the dreams he mentions here, in more detail, but since doing so advances him not an iota, this goes to show they are not the highway to health he alleged.

But to continue the thread – Freud’s father had died in October 1896. While he was still alive, Freud could continue his emotional explorations, unhindered. I had a patient in general practice whose troubles also began on his father’s death – he suddenly acquired unrequitable monsters under the bed. In Freud’s case, unacknowledged paternal fear was enough for him to abandon his Caput Nili, to melt down his crown jewels, and forego his well-earned place as the father of modern psychiatry.

Confirmation of the impact of paternal terror comes in 1937, when Freud is by now 81. In Moses and Monotheism, he writes of fathers – “He must be admired, he may be trusted, but one cannot help being also afraid of him.”

Ergo, if your deep-seated emotional problem relates to fear of your father, do not seek help from a Freudian, since Sigmund has advised nothing can be done. Compare this with the ebullient confidence of 1896, and you can see the tragedy of not allowing past memories to be detoxified in consciousness – he was right then, and wrong thereafter, alas.

~~~o0o~~~

CONCLUSION

Let’s look at the facts – (1) in 1896 Freud is clear, definitive and confident; (2) in 1897 he throws it all away in a miasma of negative emotions, almost you might say, in a prolonged tantrum. These two could hardly be more different, so it makes sense to talk of TWO FREUDS – an 1896 version, and then an 1897 one – FREUD-1 and FREUD-2. In the first he strides through the incomprehensibilities of irrational symptoms with masterly confidence, which was unprecedented then, and is desperately needed today. In the second, he mumbles along, as if driven by the same covert but destructive forces he had only just clarified. The challenge for all mental healthcare workers, including, of course, the world’s psychiatrists and legislators is to puzzle out what impacted on Freud-1, that turned him into Freud-2 – what had the former uncovered that the latter threw away. Until our medical profession grasps this painful clinical nettle, and answers this clear and unavoidable challenge, progress towards his original sparkling ideal will be slow, if not backward.

~~~o0o~~~

Professor Bob Johnson, Consultant psychiatrist (retd).

DSc(hon), MRCPsych, MRCGP, PhD(med computing), MA (Psychol), MBCS, DPM, MRCS, School of Psychology, University of Bolton, BL3 5AB, UK. GMC num. 0400150

Thursday, 28 November 2024

Masson, J.M. (1985) (Ed.)

The complete letters of Sigmund Freud to Wilhelm Fliess, 1887-1904.

Cambridge, MA: Harvard University Press.

His letter to Fliess Sigmund Freud (1856-1939)

letter dated 21 September 1897.

[Dear Fliess}

Here I am again, since yesterday morning, refreshed, cheerful, impoverished, at present without work, and having settled in again, I am writing to you first.

And now I want to confide in you immediately the great secret that has been slowly dawning on me in the last few months. I no longer believe in my neurotics [theory of the neuroses]. This is probably not intelligible without an explanation; after all, you yourself found credible what I was able to tell you. So I will begin historically [and tell you] where the reasons for disbelief came from. The continual disappointment in my efforts to bring a single analysis to a real conclusion; the running away of people who for a period of time had been most gripped [by analysis]; the absence of the complete successes on which I had counted; the possibility of explaining to myself the partial successes in other ways, in the usual fashion -- this was the first group. Then the surprise that in all cases, the father, not excluding my own, had to be accused of being perverse -- the realization of the unexpected frequency of hysteria, with precisely the same conditions prevailing in each, whereas surely such widespread perversions against children are not very probable. The [incidence] of perversion would have to be immeasurably more frequent than the [resulting] hysteria because the illness, after all, occurs only where there has been an accumulation of events and there is a contributory factor that weakens the defense. Then, third, the certain insight that there are no indications of reality in the unconscious, so that one cannot distinguish between truth and fiction that has been cathected with affect. (Accordingly, there would remain the solution that the sexual fantasy invariably seizes upon the theme of the parents.) Fourth, the consideration that in the most deep-reaching psychosis the unconscious memory does not break through, so that the secret of childhood experiences is not disclosed even in the most confused delirium. If one thus sees that the unconscious never overcomes the resistance of the conscious, the expectation that in treatment the opposite is bound to happen, to the point where the unconscious is completely tamed by the conscious, also diminishes.

I was so far influenced [by this] that I was ready to give up two things: the complete resolution of a neurosis and the certain knowledge of its etiology in childhood. Now I have no idea of where I stand because I have not succeeded in gaining a theoretical understanding of repression and its interplay of forces. It seems once again arguable that only later experiences give the impetus to fantasies, which [then] hark back to childhood, and with this the factor of a hereditary disposition regains a sphere of influence from which I had made it my task to dislodge it -- in the interest of illuminating neurosis.

If I were depressed, confused, exhausted, such doubts would surely have to be interpreted as signs of weakness. Since I am in an opposite state, I must recognize them as the result of honest and vigorous intellectual work and must be proud that after going so deep I am still capable of such criticism. Can it be that this doubt merely represents an episode in the advance toward further insight?

It is strange, too, that no feeling of shame appeared -- for which, after all, there could well be occasion. Of course I shall not tell it in Dan, or speak of in Askelon, in the land of the Philistines, but in your eyes and my own, I have more the feeling of a victory than defeat (which is surely not right).

How nice that your letter has arrived just now! It induces me to advance a proposal with which I had intended to close. If during this lazy period I were to go to the Northwest Station on Saturday evening, I could be with you at noon on Sunday and then travel back the next night. Can you clear that day for an idyll for the two of us, interrupted by an idyll for three and three and a half [of us]? That is what I wanted to ask. Or do you have a dear guest in the house or something urgent to do elsewhere? Or, if I have to leave for home the same evening, which would then not be worthwhile, do the same conditions obtain if I go straight to the Northwest Station on Friday evening and stay with you one and a half days? I mean this week, of course.

Now to continue my letter. I vary Hamlet's saying, "To be in readiness": to be cheerful is everything! I could indeed feel quite discontent. The expectation of eternal fame was so beautiful, as was that of certain wealth, complete independence, travels, and lifting the children above the severe worries that robbed me of my youth. Everything depended upon whether or not hysteria would come out right. Now I can once again remain quiet and modest, go on worrying and saving. A little story from my collection occurs to me: "Rebecca, take off your gown; you are no longer a bride." In spite of all this, I am in very good spirits and content that you feel a need to see me again similar to mine to see you.

There remains one small anxiety. What can I still understand of your matters? I am certainly incapable of critically evaluating them; I shall hardly be in a position to comprehend them, and the doubt that then sets in is not the product of intellectual work, like my doubt about my own matters, but is the result of mental inadequacy. It is easier for you; you can survey everything I bring and criticize it vigorously.

I have to add one more thing. In this collapse of everything valuable, the psychological alone has remained untouched. The dream [book] stands entirely secure and my beginnings of the metapsychological work have only grown in my estimation. It is a pity that one cannot make a living, for instance, on dream interpretation!

Martha came back with me to Vienna. Minna and the children are staying in the country another week. They have all been exceedingly well.

My pupil, Dr. Gattel, is something of a disappointment. Very gifted and clever, he must nevertheless, owing to his own nervousness and several unfavorable character traits, be classified as unpalatable.

How all of you are and whatever else is happening between heaven and earth, I hope -­anticipating your reply -- to hear soon in person.

Cordially your

Sigm. (Masson, 1985, pp. 264-266)

The Aetiology of Hysteria (German: Über die Ätiologie der Hysterie) is a paper by Sigmund Freud about the sexual abuse of children below the age of puberty and its possible causation of mental illness