Psychoanalysis

Summary

Psychoanalysis is a theory of the mind and a method of psychological treatment, developed by Sigmund Freud in Vienna from the 1890s onward. It proposes that mental life is largely determined by unconscious processes, specifically drives, repressed memories, and unresolved conflicts, and that neurotic symptoms arise when these processes cannot be expressed directly. The treatment it prescribes is extended talk: free association, dream interpretation, and the analysis of the patient’s relationship to the analyst. Psychoanalysis dominated American psychiatry from roughly the 1920s to the 1970s and shaped Western culture’s vocabulary for discussing the inner life. Its displacement by biological psychiatry and the DSM-III diagnostic system in 1980 represents one of the more rapid shifts in the history of medicine.

The Intellectual Problem Psychoanalysis Addressed

By the late nineteenth century, psychiatry faced a specific problem: it had a detailed institutional apparatus for managing severe mental illness (the asylum) but almost no explanation for the neurotic complaints that afflicted middle-class patients who were not psychotic and did not require confinement. The first biological psychiatry, as Shorter calls the German university movement of the mid-nineteenth century, had made genuine advances in brain localization and clinical description for psychosis, but its focus on anatomy “detached it too completely from patients and their world,” leading to what Shorter describes as a dead end (Shorter, 1997). The result, by 1900, was what Porter characterizes as widespread therapeutic nihilism: “We know a lot and can do little,” as one German asylum doctor summarized (Porter, 1997).

Into this vacuum came a tradition of work on hysteria, suggestion, and the unconscious that Freud drew together and systematized. The context was a specific clinical population: nervous middle-class patients, many of them women, who presented with functional symptoms (paralyses, amnesias, phobias) for which no organic cause could be found. Before Freud, these patients had been treated by neurologists using rest cures, hydrotherapy, electrotherapy, and hypnosis, all of which Shorter characterizes as operating primarily through suggestion and the therapeutic relationship [sho97-ch05-006; sho97-ch05-011].

Philosophical Background: German Idealism and the Mind-Body Problem

Psychoanalysis drew on a tradition of German philosophical thinking about the mind that preceded Freud by a century. Kant argued that the mind does not simply mirror reality but uses a priori categories (space, time, causality) to structure the phenomenal world, while the noumenal realm of things-in-themselves remains unknowable (Makari, George, 2008). Schelling proposed that mind and brain were two facets of the same unified essence, a position called dual aspect monism (Makari, George, 2008). Schopenhauer went further, arguing that Kant’s a priori categories were material brain activity, that the brain projects colors onto a world that contains none, and that all mental representations are projections of a Will he identified as Kant’s unknowable thing-in-itself (Makari, George, 2008). Johannes Muller’s experimental work proved that the external cause of a sensation is only arbitrarily related to what we perceive, and that our perception is manufactured in the mind in the same way it makes hallucinations, so our empirical knowledge has no direct correspondence to reality (Makari, George, 2008). These ideas supplied Freud with the philosophical infrastructure for a theory of mind in which unconscious processes distort perception, dreams and symptoms encode hidden meanings, and the inner world operates by its own lawful principles distinct from external reality.

Sexology and the Study of Sexual Difference

The scientific study of sexuality gained prominence in Europe during the second half of the nineteenth century. Darwinism heightened interest in sexual selection, the scourge of syphilis forced doctors into brothels, and Karl Heinrich Ulrichs argued from 1862 that same-gender passion was a human variant rather than a vice (Makari, George, 2008). Richard von Krafft-Ebing’s 1886 Psychopathia Sexualis delineated four major perversions (sadism, masochism, fetishism, inversion) and dominated sexual studies for years (Makari, George, 2008). Schrenck-Notzing’s 1892 claim to have cured a large number of seventy sexual perversion cases using suggestive and psychic therapies seemed to prove that perversions were often psychological, contradicting biological and degeneration theories (Makari, George, 2008). Krafft-Ebing himself came to view same-sex attraction as most often a natural variation based on embryological evidence for inherent bisexuality (Makari, George, 2008). Sexologists argued that sexual differences were biological variants, degenerative heredity, or the psychological aftermath of premature stimulation, and into this debate Sigmund Freud entered (Makari, George, 2008). The intellectual terrain of sexology was one of the three fields Freud synthesized in creating psychoanalysis, alongside French psychopathology and German psychophysics.

Freud’s Predecessors

Three figures in particular created the conditions for psychoanalysis.

Jean-Martin Charcot at the Salpêtrière in Paris had established that hysterical symptoms could be induced and removed by hypnosis, apparently demonstrating that psychological states could produce physical effects. The young Freud spent time in Paris studying with Charcot in 1885-86. Porter’s assessment of Charcot is critical: the hysterical behaviors of his patient performers were “artefacts produced by his own personality and expectations within the theatrical and highly charged atmosphere of the Salpêtrière, not objective phenomena waiting to be scientifically observed” (Porter, 1997). Whether or not this verdict is fully fair, the hysteria work established that psychological intervention could alter symptoms, and Freud took this seriously.

Josef Breuer, a Viennese physician and Freud’s close collaborator, had developed what he called the cathartic method: encouraging a patient to narrate the origin of her symptoms under hypnosis, producing apparent relief when the original traumatic memory was verbally discharged. Freud and Breuer’s 1895 Studies on Hysteria proposed that hysterical symptoms arose from repressed memories and that cathartic recall could produce their permanent disappearance, founding psychoanalysis as a psychodynamic treatment.(Andrew Scull, 2015) The founding case was Bertha Pappenheim, known in the literature as “Anna O.”; she was Breuer’s patient, she invented the phrase “talking cure,” and after treatment was confined in the Bellevue Sanatorium — though she later became a prominent feminist activist.(Andrew Scull, 2015) Freud extended the method and eventually abandoned hypnosis in favor of free association.

Hippolyte Bernheim and the Nancy school had demonstrated that hypnotic suggestion could produce a wide range of effects in normal subjects, suggesting that suggestion and the unconscious were general features of mental life rather than pathological curiosities. This provided Freud with a theoretical opening: if suggestion worked through the unconscious, then the unconscious was a normal part of mind and its investigation was legitimate.

The Core Theory

Psychoanalysis as a theoretical system (a term Freud first used in 1896) organized itself around three main areas, as Shorter summarizes from the doctrine’s early formulations: study of the patient’s resistance to thoughts pressing into consciousness from the unconscious; concentration on the causal significance of sexual matters; and an emphasis on the centrality of early childhood experiences (Shorter, 1997).

These three commitments developed into a structured account of mind. The unconscious contains drives and repressed memories that cannot pass the censor into conscious awareness without disguise. Repression is the mechanism by which unacceptable thoughts and desires are kept unconscious. Libido (the energy of the sexual drive) is the primary motivating force; its frustrated or redirected expression is the engine of neurosis. The Oedipus complex, the child’s desire for the parent of the opposite sex and rivalry with the parent of the same sex, is the universal organizing structure of early development.

Porter traces a specific discontinuity in the theory’s history. Freud initially argued that his patients had been sexually abused in childhood, the seduction theory. In September 1897 he abandoned this account, concluding that what his patients reported were fantasies rather than memories of actual events, and replacing it with the theory of infantile sexuality: the proposition that children have sexual desires from the start, independently of any external abuse (Porter, 1997). Porter’s assessment is blunt: “Without this volte face, psychoanalysis would not exist.” The theoretical core of the system — the unconscious and infantile sexuality — emerged specifically from this reversal.

The later structural model (id, ego, superego), introduced in 1923, reformulated the earlier topographic distinction between conscious and unconscious without abandoning the core libidinal framework.

Freud and Klein on Melancholia

The psychoanalytic contribution to the history of melancholia is concentrated in two texts: Freud’s 1917 paper “Mourning and Melancholia” and Melanie Klein’s 1935 paper “A Contribution to the Psychogenesis of Manic-Depressive States.” Together they shifted the theoretical framework for understanding severe depression from the humoral and neurological traditions of previous centuries to an account grounded in object-relations — the individual’s emotional ties to significant others.

Freud distinguished mourning from melancholia by a difference in what has been lost. In mourning, the loss is conscious and identifiable: someone or something external has been lost, and grief is the rational response. In melancholia, the loss is not clearly conscious; the subject experiences a draining of ego, a sense of emptiness, worthlessness, and self-reproach, without being able to say what they have actually lost (Radden, Jennifer (ed.), 2000). Freud’s explanation was that in melancholia the ego has identified with the lost object — through what he called narcissistic identification — so that the reproaches the subject directs at themselves are actually reproaches directed at the lost and hated object, now internalized (Radden, Jennifer (ed.), 2000). This mechanism explained the severity of self-accusation: it was displaced aggression.

A secondary observation — which Radden highlights as one of the most clinically striking — was Freud’s claim that melancholic patients often display a “keener eye for the truth” than healthy people: their self-criticism, however excessive in tone, is often factually accurate about the subject’s actual failings and the world’s indifference (Radden, Jennifer (ed.), 2000). This places the melancholic in a peculiar relation to reality — not deluded, exactly, but unable to employ the normal protective self-deceptions. The suicide of the melancholic was explained by the same mechanism: killing oneself is killing the object that has been installed in the ego — a literal murder of the internalized person (Radden, Jennifer (ed.), 2000).

Klein extended Freud’s account in a developmental direction, proposing that the capacity for melancholia was grounded in a universal phase of early psychic development. The “depressive position” — reached around the fourth to sixth month of life — is the infant’s recognition that the good and bad mother are the same person: the gratifying and the frustrating object are not separate but one (Radden, Jennifer (ed.), 2000). The psychic work of the depressive position is the rebuilding of a coherent inner world after this discovery — what Klein called the work of making reparation, of integrating love and hate for the same object (Radden, Jennifer (ed.), 2000). The manic defenses — triumphant denial of depressive anxiety, contempt for and omnipotent control of internal objects — represent the ego’s attempt to escape depressive reckoning rather than work through it (Radden, Jennifer (ed.), 2000).

The transition from melancholia as a humoral-physical disorder to melancholia as a disorder of object-relations and ego-structure represents one of the deepest conceptual shifts in the history of the category. The psychoanalytic account discarded the physiology entirely (black bile, brain, nervous system) and replaced it with an account of psychic structure and interpersonal loss. This made clinical treatment, in principle, a matter of making the unconscious mechanisms conscious rather than correcting physiological imbalance.

The Therapeutic Technique

The psychoanalytic method Freud developed consisted of several interlocking techniques. Free association replaced hypnosis as the primary access route to the unconscious: the patient was instructed to say whatever came to mind without censorship. Dream interpretation treated the manifest content of dreams as disguised expressions of latent unconscious wishes; analyzing the disguise revealed the underlying conflict. Transference analysis attended to the patient’s emotional reactions toward the analyst, understood as the projection of feelings originally directed toward early figures, as the primary vehicle of both resistance and therapeutic progress.

Freud encouraged the ideal practitioner to use “evenly suspended attention” and to function as a mirror reflecting the patient’s inner thoughts (Makari, George, 2008). Freud’s letter to Georg Groddeck, stating that recognizing transference and resistance as the most important aspects of treatment made one a member of the “wild army,” signaled a realignment: what defined a psychoanalyst was shifting from theoretical commitments to technique (Makari, George, 2008). Freud concluded that the unconscious compulsion to repeat caused the entire neurosis to be reenacted in the doctor’s office, and that this neurosis could itself be considered a “transference neurosis” amenable to resolution through analysis (Makari, George, 2008). He recommended that the patient be treated with “abstinence,” the analyst’s refusal to satisfy neurotic longings, to heighten the pressure on the patient to remember and work through the past (Makari, George, 2008).

Ferenczi argued that analysts must energetically oppose premature substitutive satisfactions because kindness and generosity could sap a patient’s desire to be cured; Freud agreed that passivity was ineffective for phobic and obsessional patients but cautioned against imposing the analyst’s ideals (Makari, George, 2008). After Ferenczi forbade a female patient from crossing her legs during sessions, she became tormented and lapsed into memories of early traumas that gradually led to improvement; he then forbade her from masturbating at home and reported her cured (Makari, George, 2008).

In 1913, Freud formalized a theory of aggression and created an anal-sadistic stage, attributing sadism and masochism to anxious retreat from genital pleasure (Makari, George, 2008). Jung and his colleague Honegger treated a paranoid patient whose mythic delusions they believed could not have been consciously acquired; Honegger’s presentation of the case caused a stir and bolstered Jung’s emerging theory of a collective unconscious (Makari, George, 2008).

The classical psychoanalytic treatment was lengthy, expensive, and available only to those who could afford repeated individual sessions over months or years. This structural feature shaped who received it and which populations psychoanalysis addressed.

The Vienna Circle and the International Movement

Freud gathered a circle of followers in Vienna from roughly 1902 onward, meeting in his apartment on Wednesday evenings (the origin of the Vienna Psychoanalytic Society). Carl Jung in Zurich and Sandor Ferenczi in Budapest became major early collaborators. The International Psychoanalytic Association was founded in 1910 with Jung as its first president, establishing an organizational structure that would govern training and legitimacy worldwide.

The movement was not peaceful. Jung separated from Freud in 1912-13, eventually developing what he called analytical psychology; Alfred Adler had separated earlier. Shorter characterizes these splits as reflecting a pattern in which “the master’s insights were to become articles of faith, incapable of disproof,” with dissent interpreted as evidence of “resistance,” personal pathology on the dissident’s part, rather than scientific disagreement (Shorter, 1997). Whether this is the most accurate framing of what were sometimes genuine theoretical disputes is contested; what is clear is that the analytic movement developed an unusual enforcement mechanism against internal criticism.

After 1870, Switzerland remained an open marketplace for French and German ideas, and the Swiss played an inordinately large role in synthesizing them, proving vital to the acceptance of Freud’s French-inflected psychology (Makari, George, 2008). Auguste Forel, who after retiring as director of the Burgholzli published The Sexual Question in 1905, argued that sexual abstinence was unnatural and doomed (Makari, George, 2008). At the 1907 Amsterdam International Congress of Psychiatry, attended by over 600 participants from 29 countries, Pierre Janet dismissed Freud’s theories as a derivative work of French psychopathology marred by German philosophical speculation (Makari, George, 2008) (Makari, George, 2008). The Nuremberg proposals of 1910, meant to unify the movement, ironically turned partial Freudians into non-Freudian psychoanalysts overnight, and Adler’s followers refused to equate psychoanalysis with Freud himself (Makari, George, 2008).

The movement’s internal tensions were matched by disagreements about technique. By 1911, published guides for conducting analysis were outdated, and practitioners used repudiated methods including catharsis, hypnosis, and dream analysis, all claimed as Freudian; most were flying blind (Makari, George, 2008). Analysts’ own unconscious drives made a working consensus on the unconscious difficult to achieve, since what one analyst in Budapest understood differed from what another in Zurich practiced (Makari, George, 2008). In March 1911, Stekel published The Language of Dreams, arguing dream symbols were a prehistoric language; Freud detested the book and attributed it to Stekel’s “perverse” unconscious (Makari, George, 2008).

When the humanist faction’s presentations were condemned as outlandish, the deeper problem emerged: if psychological statements could flip between objects of study and investigators themselves, the entire field’s objectivity was at stake (Makari, George, 2008). Stekel treated a bank cashier with a phobia of crossing a public square by uncovering unconscious struggles about his ill mother, after failing to find the sexual cause Freud’s theories predicted (Makari, George, 2008).

Paul Federn demanded an end to “intellectual communism” and that ideas not be used without their author’s consent; Freud’s response was more generous, offering his comrades the flexibility needed to develop a common identity (Makari, George, 2008). The I.P.A. considered issuing diplomas to standardize training, but Berliners on the Secret Committee were privately skeptical and the proposal quietly died (Makari, George, 2008). The 1922 I.P.A. Congress in Berlin hosted 256 people, more than double the previous record, and featured papers on libido theory alongside speculative biological theorizing about cells and embryology (Makari, George, 2008). The congress revealed growing tensions between abstract theoretical speculation and practical clinical needs, prompting Freud to establish a prize for essays connecting technique to theory (Makari, George, 2008).

American Adoption and Dominance

Psychoanalysis spread to the United States from roughly the 1910s onward and became dominant in American psychiatry between the 1920s and 1960s to a degree unmatched in Europe. The American Psychoanalytic Association, founded in 1911, eventually insisted that only physicians (and later only psychiatrists) could be trained as analysts, a restriction Shorter describes as “a self-interested ploy to exclude psychologists, psychiatric social workers, and other competitors” rather than a scientifically justified requirement (Shorter, 1997).

Shorter’s central explanation for psychoanalysis’s dominance in America is institutional rather than intellectual. The asylum was the alternative, and it was deeply unattractive: by 1933 the number of patients in American psychiatric institutions had more than doubled from 143,000 to 366,000, with most in facilities of over a thousand beds (Shorter, 1997). Psychoanalysis offered psychiatrists “a way out of the asylum into private office practice” (Shorter, 1997). World War I had accelerated public acceptance, since Freud’s ideas of the death instinct seemed to make the war’s irrationality legible (Shorter, 1997). The appeal, on Shorter’s reading, was economic and professional as much as scientific.

The emigration of European analysts under Nazi persecution accelerated this American dominance. European psychoanalysts, who were predominantly Jewish, were driven to flee to the United States; they reconstituted their institutes in New York and came to dominate American psychoanalysis.(Andrew Scull, 2015) Freud himself distrusted America deeply; his only academic honor from the country was the honorary doctorate awarded at Clark University in 1909, which he attended with evident reluctance, yet the United States became the place where psychoanalysis achieved its greatest institutional foothold.(Andrew Scull, 2015)

The American dominance also produced some of the theory’s most criticized applications. American analysts blamed mothers for schizophrenia, autism, asthma, and borderline disorders through what became known as the “refrigerator mother” theory; Bruno Bettelheim attributed autism to emotionally frozen parents and required what he called “parentectomy” — separating children from their families — at his Chicago school.(Andrew Scull, 2015)

European asylum psychiatrists, whose clinical focus was psychosis, resisted psychoanalysis on different grounds: they saw it as redirecting the discipline away from serious mental illness toward the neuroses of the well-off (Shorter, 1997). French psychiatry rejected psychoanalysis until the 1960s partly out of anti-German nationalism, with French clinicians claiming that Pierre Janet had anticipated Freud’s core insights; British mainstream psychiatry also rejected it.(Andrew Scull, 2015) The reception was thus partly a story of national and institutional context rather than theoretical evaluation.

This is Shorter’s reading, and it should be labeled as such. Shorter is writing explicitly against the view that psychoanalysis succeeded because of its clinical efficacy or explanatory power; he presents it as a “hiatus” in the evolution of biological psychiatry (Shorter, 1997). Many historians of psychiatry take a more complex view of psychoanalysis’s intellectual contributions, and the clinical literature on psychodynamic therapy (particularly shorter-term variants) is more contested than Shorter allows.

Andrew Scull’s Madness in Civilization (2015) offers a different framing: rather than treating psychoanalysis as a detour, Scull tracks its genuine cultural reach and its Americanization. Where Freud’s original vision was pessimistic — civilization and its discontents locked in “an indissoluble embrace” — American analysts remade the theory into something far more optimistic (Andrew Scull, 2015). Heinz Hartmann’s ego psychology, which played down psychological conflict and emphasized adaptation to reality, exemplifies this transformation (Andrew Scull, 2015). This Americanization was not purely corruption: it responded to the optimistic therapeutic climate that psychoanalysis itself had helped create. The World War II experience reinforced this: over a million neuropsychiatric hospital admissions in the US alone, with 40 percent of British soldiers discharged unfit classified as psychiatric cases, appeared to validate Freudian concepts of trauma and repression on a mass scale, and both Allied armies had entrusted their psychiatric services to analysts (Andrew Scull, 2015). By the 1960s, the majority of US psychiatric department chairs were analysts by training (Andrew Scull, 2015).

Scull’s account also takes seriously psychoanalysis as a cultural phenomenon rather than merely an institutional one. W.H. Auden’s 1939 elegy for Freud — “to us he is no more a person / now but a whole climate of opinion” — captures a diffusion that went well beyond clinic or consulting room: Surrealist painters, Hollywood films like Spellbound (1945), Benjamin Spock’s baby-care manual (selling 50 million copies), and the postwar literary imagination were all shaped by psychoanalytic categories (Andrew Scull, 2015) (Andrew Scull, 2015) (Andrew Scull, 2015). Whether or not this cultural reach constituted intellectual achievement is a separate question from whether it was historically significant, and it was.

Viennese Cultural Context and Reception

The reception of Freud’s work in Vienna was shaped by a distinct cultural milieu. In a 1912 poll, 75 percent of Viennese medical students reported that their first sexual partner was a prostitute (Makari, George, 2008). Around Hermann Bahr, a group of writers including Arthur Schnitzler, Hugo von Hofmannsthal, Felix Salten, and Richard Beer-Hoffmann, known as Jung Wien, made Austrian literary modernism famous (Makari, George, 2008). These restless intellectuals embraced an erotic, nervous, modern self and found in Freud’s psychoanalysis support, justification, and guidance for a more natural, healthier way of life (Makari, George, 2008). On December 21, 1905, Die Fackel published the first review of Freud’s Three Essays on the Theory of Sexuality, written by a young writer who compared it favorably to Auguste Forel’s work, asserting that Freud had surpassed him (Makari, George, 2008). Otto Soyka’s 1906 book Beyond the Boundaries of Morality became the first work to use Freudian psychosexual theory as the foundation for a new sexual ethic, insisting that sexual desires were not just procreative and that perversions were not diseases (Makari, George, 2008). Rosa Mayreder praised Freud for creating solid fundamentals for a novel theory that resisted conventional pseudo-psychology and offered deep insight into female sexuality by suggesting repression characterized female psychology (Makari, George, 2008). The Three Essays made Freud a hero of the Viennese coffeehouse scene, placing him at the center of a network of artists, writers, and reformers who believed the decay of Habsburg Vienna was due not to degenerative heredity but to centuries of unhealthy rules and regulations (Makari, George, 2008).

Ernst Mach’s idea that the self is nothing more than a stable bundle of sensations was taken up by his student Robert Musil, who described a man without qualities dissolved by the trickling streams of professional, national, civic, class, and geographic identities (Makari, George, 2008). Nature philosophy had earlier encouraged doctors to experiment with psychic therapies for physical disease, reasoning that since the psychic and physical were intimately connected, the mind might cure the body (Makari, George, 2008). Haeckel believed ontogeny recapitulates phylogeny, and Ewald Hering explained this through inherited unconscious memory, with unconscious memories of sexuality being highly conserved (Makari, George, 2008). Iwan Bloch’s anthropological fieldwork discovered that sexual perversity was no more common in advanced civilizations than in primitive ones, contradicting the degeneration thesis and providing Freud support for his claim that perversion was universal (Makari, George, 2008).

Psychoanalysis as Cultural Phenomenon

Whatever the clinical evidence for its therapeutic claims, psychoanalysis had an enormous impact as a cultural system. Shorter characterizes its appeal to educated classes as “a codification of the kind of search for self-knowledge that had run through bourgeois culture throughout the entire second half of the century. Psychoanalysis was to therapy as expressionism was to art” (Shorter, 1997). The theory provided a vocabulary (repression, projection, the unconscious, the Freudian slip) that entered ordinary language and shaped how Western culture described mental life.

Shorter’s own account acknowledges this cultural influence while insisting it was separate from clinical validity. Freud himself was uncertain about the therapeutic dimensions: he is reported to have responded with apparent surprise when told of a therapeutic success, saying “Oh yes, you can also cure people with analysis,” and on another occasion described analysis as “the only rational therapy” despite conceding its limited achievements (Shorter, 1997).

Porter’s framing in The Greatest Benefit to Mankind is somewhat more balanced. He presents Freud’s abandonment of the seduction theory as a decisive theoretical event rather than primarily as self-interest, and situates psychoanalysis within the broader tension between organic and psychological models of mental illness that defines the entire history of psychiatry (Porter, 1997). For Porter, psychiatry “lacks unity and remains hostage to the mind-body problem, buffeted back and forth between psychological and physical definitions of its object and its techniques” (Porter, 1997), a framing in which psychoanalysis is one major resolution of a genuine dilemma rather than simply a detour.

The Frankfurt School and Freud as Social Theory

While psychoanalysis was being domesticated into American ego psychology and adjustment-oriented therapy, a parallel tradition on the European left was reading Freud as a radical social theorist. The Frankfurt School philosophers — particularly Herbert Marcuse, Erich Fromm, and Theodor Adorno — took Freud’s late cultural writings (especially Civilization and Its Discontents) as the starting point for a critique of modern industrial society.

Marcuse’s Eros and Civilization (1955) argued that Freud had failed to historicize his own categories. The “reality principle” as Freud described it was not a universal law but the specific form it takes under capitalism, which Marcuse called the “performance principle” — organized around labor discipline, competitive achievement, and economic productivity. Under the performance principle, the level of instinctual repression demanded of individuals exceeds what civilization actually requires; this excess Marcuse called “surplus repression,” repression serving domination rather than communal life (Marcuse, Herbert, 1955)(Marcuse, Herbert, 1955).

Marcuse’s epilogue attacked the neo-Freudian revisionists — Fromm, Horney, and Sullivan — for converting a therapeutic improvement into a theoretical regression. By minimizing sexuality, the death instinct, and the primal horde hypothesis, the revisionists had flattened the depth dimension of Freud’s conflict between individual and civilization and proclaimed a false solution to what Freud had recognized as a deep structural antagonism (Marcuse, Herbert, 1955). Marcuse defended Freud’s “biologistic” orientation as more truthful than the revisionists’ emphasis on interpersonal relations and personal growth, arguing that Freud’s focus on primary instincts captured the universal repressive fate more accurately than optimistic accounts of human potential (Marcuse, Herbert, 1955)(Marcuse, Herbert, 1955).

This reading of Freud — as a theorist of civilization’s costs rather than a therapist of individual adjustment — represents a line of interpretation largely absent from clinical psychiatry but influential in the humanities and social sciences.

Anthropological Extensions

While Totem and Taboo (1913) is often read as a work of speculative cultural history, it is also a direct extension of psychoanalytic method: Freud attempted to apply to the collective what he had worked out in the clinic for the individual. The book’s explicit starting point was Tylor’s animism — the anthropological concept of the belief in spiritual beings as the minimum definition of religion.[fre13-ch03-01] Freud accepted Tylor’s framework but added a psychological mechanism to explain why animism arose and why it persisted.

The mechanism was what Freud called the omnipotence of thought: the primitive’s implicit belief that wishes and mental acts have direct causal power over the external world.[fre13-ch03-03] This belief, Freud argued, was not peculiar to any one culture but universal — and its modern residue was legible in obsessional neurosis, where the patient’s rituals expressed precisely the conviction that thought could harm or protect. The parallel between primitive magic and neurotic compulsion was Freud’s route from anthropology back into the consulting room.

Freud organized the history of human thought into three stages, each corresponding to both a historical era and a stage in individual libidinal development:

1. The animistic stage, in which humans ascribe omnipotence to themselves — the stage of magic, soul-doctrine, and spirit-causation.
2. The religious stage, in which omnipotence is ceded to the gods, though prayer and sacrifice attempt to reclaim it.
3. The scientific stage, in which omnipotence is renounced and humans accept the reality principle.[fre13-ch03-04]

The parallel with individual development was explicit: the animistic stage corresponds to narcissism (the infant who does not yet distinguish self from world); the religious stage to the child’s attachment to idealized parents; the scientific stage to the mature adult who has subordinated the pleasure principle to reality.[fre13-ch03-05] The schema thus made psychoanalytic ontogeny a template for cultural phylogeny — individual development recapitulated, in miniature, the history of civilization.

The final chapter of Totem and Taboo extended the argument to totemism and the origin of religion itself. Freud’s central thesis was that the totem animal is a father-substitute for the entire clan, and that the two primary totemic prohibitions — do not kill the totem, do not marry within the totem clan — correspond exactly to the two repressions of the Oedipus complex: the prohibition on parricide and on incest.[fre13-ch04-03] Drawing on Robertson Smith’s account of the sacrificial feast — in which the totem animal is periodically and ceremonially killed and consumed by the whole clan, an act otherwise absolutely forbidden — Freud read the feast as a ritual re-enactment of an original crime, with mourning followed by festivity corresponding to guilt followed by relief.[fre13-ch04-04]

The origin myth Freud constructed was the primal horde hypothesis: in the earliest human social organization (following Darwin’s speculation), a dominant patriarch monopolized the females and expelled his sons. The sons eventually banded together, killed and ate the father, and were then — stricken by guilt — compelled to institute the very prohibitions they had violated. Totemism and morality were, on this account, memorials to the founding parricide.[fre13-ch04-05] The guilt did not diminish over generations; through what Freud called “deferred obedience,” it intensified — the dead father became psychically more powerful than the living father had been, an early formulation of what would later become the concept of the superego.[fre13-ch04-06]

This was the Oedipus complex writ large: the individual drama of father-desire, rivalry, and guilt written at the scale of the entire species and its institutions. Freud acknowledged that the hypothesis required a Lamarckian assumption — that each generation inherited not just biological structure but psychical content from collective ancestral experience — and that this was its most vulnerable point. Subsequent anthropology found little empirical support for the primal horde scenario, and both the Lamarckian inheritance mechanism and the projection of Oedipal dynamics onto totemic societies have been widely rejected. The sequence Freud described was criticized for treating as universal what may have been culturally specific and for deriving the origin of social institutions from a single speculative event. Nevertheless, the theoretical moves Freud made here — that guilt has a phylogenetic depth, that social norms bear the shape of ancient prohibitions, and that religion repeats in institutional form what the individual repeats in neurosis — influenced thinkers from Marcuse to Lacan and continued to structure psychoanalytic social theory well beyond Totem and Taboo itself.

Makari’s Three-Phase Framework

George Makari’s Revolution in Mind: The Creation of Psychoanalysis (2008) offers the most thorough intellectual history of the movement through 1945. His account is organized around three phases. In the first phase (1890s–1910), Freud’s theories were received and transformed through an extended set of debates in which French, German, and Austro-Hungarian traditions of thought about mind, hysteria, hypnotism, and sexuality all played formative roles; the field was shaped not by Freud alone but by collaborators, critics, and contemporaries who pushed his ideas into forms he had not anticipated.(Makari, George, 2008) In the second phase (1910–1920), the International Psychoanalytic Association was established and the movement began to develop institutions, training standards, and a mechanism for adjudicating disagreements between rival schools; the splits with Adler and Jung defined the outer boundaries of what psychoanalysis would be.(Makari, George, 2008) In the third phase (1920–1939), psychoanalysis consolidated into a professional discipline with formal training requirements modeled on the Berlin Institute’s 1923 curriculum, developed competing theoretical schools around Anna Freud’s ego psychology and Melanie Klein’s object relations, and then was scattered across the globe by Nazi persecution.(Makari, George, 2008)

The institutionalization of training was a decisive step. In 1923, Max Eitingon’s committee at the Berlin Institute published a plan requiring three components: a didactic (personal) analysis, theoretical training, and supervised practical work. Eitingon presented this plan at the 1925 IPA Congress in Bad Homburg, and it became the international standard.(Makari, George, 2008) The Berlin model defined psychoanalysis as a profession as much as a theoretical commitment: membership was determined not only by what one believed but by what one had done.

By 1934, the movement had become an intellectual community organized around a common technique transmitted through universal training, yet much remained under genuine debate: the status of the death drive, whether character analysis had replaced neurosis treatment as the primary focus, and whether the structural model (“I” psychology) and the earlier topographic model could coexist.(Makari, George, 2008)

The Nazi persecution destroyed continental European psychoanalysis. By 1940 the institutional network had been wiped out; by 1941 no German-language psychoanalytic publications existed.(Makari, George, 2008) At the 1949 Zurich Congress, Jones confronted a list of the dead that included at least fifteen members murdered by the Nazis alongside prewar founders including Freud, Eitingon, Brill, Simmel, Fenichel, Sachs, Schilder, Isaacs, and Staub; of the original 1908 Salzburg group, only Jones and Hitschmann remained.(Makari, George, 2008) Yet the IPA had grown to eight hundred members, over half of them American; four of the five largest psychoanalytic communities in the world were now in the United States.(Makari, George, 2008)

In July 1936, the Psychoanalytic Institute in Berlin was dissolved and incorporated into the Nazi Matthias Goring’s German Institute for Psychological Research and Psychotherapy (Makari, George, 2008). From exile in Oslo, Otto Fenichel maintained an epistolary community of Marxist analysts, believing psychoanalysis’s future lay in America even as he viewed American psychoanalytic knowledge as abysmal (Makari, George, 2008). The French translated Freud’s “Ich” as le moi (“the me”), and after the war, led by Jacques Lacan, developed a strong critique of American ego psychology (Makari, George, 2008). Before a medical crowd in New York, Sandor Rado called Freud’s death drive a highly speculative hypothesis, and after Federn’s outraged response, Rado accused Federn of doctoring the transcript (Makari, George, 2008).

In America, Heinz Hartmann consolidated theoretical authority. One of Freud’s last training cases, he served as director of education then president of the New York Society and of the IPA, setting the theoretical agenda for American ego psychology for three decades together with Ernst Kris and Rudolf Loewenstein. In support of the new Freudian orthodoxy, myths about Freud as a solitary genius were propounded by a cohort of Viennese refugees including Anna Freud, Ernst Kris, Kurt Eissler, and Ernest Jones. In their account Freud “created psychoanalysis in splendid isolation, unaided by contemporaries and attacked by prigs and rebellious followers who often suffered from grave mental illness.”(Makari, George, 2008) Heinz Hartmann, one of Freud’s last training cases, served as director of education then president of the New York Society and president of the I.P.A., and together with Ernst Kris and Rudolf Loewenstein set the theoretical agenda for American ego psychology for three decades (Makari, George, 2008). Hartmann’s twin research in the 1920s had found that differing environments affected character structure but not intelligence, leading him to conclude that character was created through adaptation to the social world rather than being biologically fixed (Makari, George, 2008). After more than half a century of work, psychoanalysis had become the richest systematic description of inner experience in the Western world, but its theories were culturally situated in western and central Europe and would be remade when transplanted elsewhere (Makari, George, 2008).

After 1945, psychoanalysis entered what Makari calls a cold war: groups retreated from one another, published in separate forums, and pursued divergent visions: Kleinians in South America, Hartmann and his allies in North America, and Jacques Lacan in Paris developing his own amalgam outside the IPA.(Makari, George, 2008) By 1945, no single answer to what defined psychoanalysis was possible: different communities could not agree on whether charismatic authority, shared investigative methods, strict empiricism, or orientation toward discovery rather than cure should constitute the field’s center.(Makari, George, 2008)

The Physical Treatment Challenge

While psychoanalysis dominated office practice for neurotic patients, the asylum population of seriously ill patients remained largely untouched by it. The interwar decades (1918-1945) saw psychiatrists working with psychotic patients develop a series of physical therapies out of what Shorter describes as therapeutic desperation.

Julius Wagner-Jauregg won the 1927 Nobel Prize for inducing malarial fever in neurosyphilitic patients, achieving the first genuinely successful physical therapy in psychiatry and “breaking the therapeutic nihilism that had dominated psychiatry in previous generations” (Shorter, 1997). Manfred Sakel developed insulin coma therapy in 1933, and Ladislas von Meduna proposed convulsive therapy in 1934 (Shorter, 1997). Ugo Cerletti and Lucio Bini introduced electroconvulsive therapy (ECT) in Rome in 1938 (Shorter, 1997). Prefrontal lobotomy, introduced by Walter Freeman in the United States from the late 1930s, was “a genuine but extreme intervention adopted out of therapeutic desperation before better options were available” (Shorter, 1997).

These physical approaches existed in parallel with psychoanalytic office practice, serving a different patient population, and they form the background against which the pharmacological revolution would develop.

Chlorpromazine and the Biological Turn

The most consequential challenge to psychoanalytic dominance came not from argument but from drugs. Chlorpromazine was synthesized by Rhône-Poulenc in 1951 and first used psychiatrically in Paris in early 1952, discovered serendipitously by surgeon Henri Laborit as a surgical potentiator (Shorter, 1997). Heinz Lehmann’s 1953 trials at Montreal’s Verdun Hospital showed that acute schizophrenic patients became symptom-free within weeks of treatment: something Lehmann said he had “never seen before” and considered a “fluke” until it happened repeatedly (Shorter, 1997). Lithium’s calming effect on mania had been described by John Cade in Australia in 1948, though it was initially ignored (Shorter, 1997). Iproniazid (1957) demonstrated antidepressant effects.

These drugs did something psychoanalysis demonstrably could not do for psychotic patients: they produced rapid, measurable symptom relief. Porter notes that psychopharmacology from the 1950s (lithium, phenothiazines, imipramine) “restored therapeutic optimism and accelerated deinstitutionalization and community care” (Porter, 1997). Shorter argues that deinstitutionalization was primarily driven by chlorpromazine and economics rather than by the antipsychiatry movement of Szasz and Laing (Shorter, 1997), though this remains contested.

Arvid Carlsson’s subsequent work established that antipsychotic drugs blocked dopamine receptors, providing a neurochemical basis for what Shorter calls the second biological psychiatry, the successor to the dead-end microscopy movement of the nineteenth century (Shorter, 1997).

DSM-III (1980) as the Institutional Turning Point

The formal displacement of psychoanalysis from its dominant position in American psychiatry is conventionally dated to the publication of the Diagnostic and Statistical Manual, Third Edition (DSM-III) in 1980. Shorter characterizes the DSM-I (1952) and DSM-II (1968) as reflecting analytic dominance, since they embedded psychoanalytic concepts and discouraged rigorous categorical diagnosis (Shorter, 1997). DSM-III, by contrast, had its intellectual roots in the St. Louis Neo-Kraepelinian group (Eli Robins, George Winokur, Samuel Guze) and derived its inspiration from Kraepelin’s longitudinal, descriptive approach rather than from Freudian theory (Shorter, 1997).

Robert Spitzer’s DSM-III task force introduced operational diagnostic criteria tested on five hundred psychiatrists evaluating twelve thousand patients (Shorter, 1997). Harvard psychiatrist Gerald Klerman called it “a victory for science” (Shorter, 1997). The practical significance was large. Erwin Stengel had noted as early as 1959 that both analysts and Meyerian psychiatrists “discouraged categorization” of mental disorders (Shorter, 1997), meaning that differential diagnosis, and therefore the clinical research that depended on it, was systematically impeded. The availability of drugs that worked specifically for mania versus schizophrenia made diagnosis practically urgent: “distinguishing between mania and schizophrenia, once an interesting academic exercise, might now determine how a patient was treated” (Shorter, 1997).

A study comparing American and British psychiatry illustrated how far theoretical tradition had diverged from clinical reality under analytic dominance: when forty-six American and two hundred five British psychiatrists watched the same videotaped patient, 69 percent of the Americans diagnosed schizophrenia; only 2 percent of the British did so (Shorter, 1997). This level of diagnostic disagreement was incompatible with a science of treatment.

Current Status

The account given above is largely Shorter’s, and his reading of psychoanalysis as primarily a “hiatus” rather than an advance is his interpretive position, not a settled historical verdict. What is not in dispute is that the institutional dominance psychoanalysis held in American psychiatry from the 1920s to the 1960s has ended. Psychodynamic therapy (adapted, shorter-term descendants of classical analysis) continues as one therapeutic modality among many, particularly for certain presentations of personality disorder, chronic depression, and relational difficulties. The theoretical claims of classical psychoanalysis, particularly the hydraulic libido theory and the universality of the Oedipus complex in the forms Freud described, are not defended in mainstream clinical psychiatry. The unconscious, as a general concept, has been extensively reformulated by cognitive science and neuroscience in ways that do not map straightforwardly onto Freudian theory.

Porter’s final assessment is that psychiatry “lacks unity and remains hostage to the mind-body problem, buffeted back and forth between psychological and physical definitions of its object and its techniques” (Porter, 1997), a description that fit the situation as of the 1990s and, in broad outline, still applies.

See Also

• sigmund-freud
• jean-martin-charcot
• emil-kraepelin
• herbert-marcuse
• erich-fromm
• biological-psychiatry
• deinstitutionalization
• hysteria
• animism
• totemism

Sources

• shorter-historypsychiatry-1998/ch04
• shorter-historypsychiatry-1998/ch05
• shorter-historypsychiatry-1998/ch06
• shorter-historypsychiatry-1998/ch07
• shorter-historypsychiatry-1998/ch08
• shorter-historypsychiatry-1998/ch08
• porter-greatestbenefit-1997/ch16
• freud-1913-totem/ch03
• freud-1913-totem/ch04

[fre13-ch03-01]: Freud, Totem and Taboo (1913), ch. 3. Animism as not merely belief in spirits but the first complete Weltanschauung — a comprehensive theory of the universe explaining all phenomena through spiritual agencies, the primitive analogue of modern science.

[fre13-ch03-03]: Freud, Totem and Taboo (1913), ch. 3. The “omnipotence of thought” — the animistic belief that wishes and mental acts have direct causal power over the external world — as the psychological foundation of all magic and, by structural parallel, of obsessional neurosis.

[fre13-ch03-04]: Freud, Totem and Taboo (1913), ch. 3. Three-stage schema: (1) animistic stage, in which humans ascribe omnipotence to themselves; (2) religious stage, in which omnipotence is ceded to the gods; (3) scientific stage, in which omnipotence is renounced.

[fre13-ch03-05]: Freud, Totem and Taboo (1913), ch. 3. The three worldview stages parallel individual libidinal development: animism = narcissism; religion = object-finding (attachment to parents); science = maturity under the reality principle.

[fre13-ch04-03]: Freud, Totem and Taboo (1913), ch. 4. The totem animal as father-substitute for the whole clan; the two totemic prohibitions (do not kill the totem, do not marry within the totem) correspond exactly to the two repressions of the Oedipus complex: parricide and incest.

[fre13-ch04-04]: Freud, Totem and Taboo (1913), ch. 4. Robertson Smith’s sacrificial feast — periodic ceremonial killing and consumption of the totem animal — read by Freud as ritual re-enactment of the original parricide, mourning followed by festivity corresponding to guilt followed by relief.

[fre13-ch04-05]: Freud, Totem and Taboo (1913), ch. 4. The primal horde hypothesis: the sons killed and ate the dominant father-patriarch, then — stricken by guilt — instituted the prohibitions they had violated, founding totemism, morality, and religion as memorials to the founding parricide.

[fre13-ch04-06]: Freud, Totem and Taboo (1913), ch. 4. “Deferred obedience”: guilt for the parricide intensified over generations; the dead father became more powerful as a psychical force than the living father had been — an early formulation of the superego concept.

(Makari, George, 2008): makari-revolutioninmind-2008 ch07 “In Critique of Pure Reason, Kant gave great weight…” (Makari, George, 2008): makari-revolutioninmind-2008 ch07 “Schelling suggested that Kant’s work shouldn’t be seen…” (Makari, George, 2008): makari-revolutioninmind-2008 ch07 “In a generative misreading, Schopenhauer claimed that…” (Makari, George, 2008): makari-revolutioninmind-2008 ch07 “Muller’s experimental findings shocked those who clung…” (Makari, George, 2008): makari-revolutioninmind-2008 ch07 “Nature philosophy also encouraged scientists to study…” (Makari, George, 2008): makari-revolutioninmind-2008 ch17 “Haeckel believed he had discovered a fundamental law…” (Makari, George, 2008): makari-revolutioninmind-2008 ch17 “Freud also turned for support to anthropological evidence…” (Makari, George, 2008): makari-revolutioninmind-2008 ch20 “According to Nordau, the European fin de siecle…” (Makari, George, 2008): makari-revolutioninmind-2008 ch20 “Ernst Mach had posited that the self was nothing…” (Makari, George, 2008): makari-revolutioninmind-2008 ch21 “Around Bahr, there congregated a group of writers…” (Makari, George, 2008): makari-revolutioninmind-2008 ch21 “Some of these restless troops embraced an erotic…” (Makari, George, 2008): makari-revolutioninmind-2008 ch22 “In 1912, a poll asked Viennese medical students…” (Makari, George, 2008): makari-revolutioninmind-2008 ch23 “On December 21, 1905, Die Fackel’s readers were…” (Makari, George, 2008): makari-revolutioninmind-2008 ch23 “In 1906, he published Beyond the Boundaries of…” (Makari, George, 2008): makari-revolutioninmind-2008 ch23 “Writing in the Wiener klinische Rundschau, she…” (Makari, George, 2008): makari-revolutioninmind-2008 ch23 “The publication of the Three Essays made Freud…” (Makari, George, 2008): makari-revolutioninmind-2008 ch24 “An anxious bank cashier had come to see Stekel…” (Makari, George, 2008): makari-revolutioninmind-2008 ch27 “Paul Federn stepped in, declaring that the group…” (Makari, George, 2008): makari-revolutioninmind-2008 ch28 “After 1870 when bitter nationalism forced the French…” (Makari, George, 2008): makari-revolutioninmind-2008 ch28 “After his retirement in 1898, this upstanding Swiss…” (Makari, George, 2008): makari-revolutioninmind-2008 ch33 “In 1907, the monumental First International Congress…” (Makari, George, 2008): makari-revolutioninmind-2008 ch33 “More than any before, the Amsterdam conference laid…” (Makari, George, 2008): makari-revolutioninmind-2008 ch42 “The irony was that while the Nuremberg proposals…” (Makari, George, 2008): makari-revolutioninmind-2008 ch42 “It began when Jung and his junior colleague, Johann…” (Makari, George, 2008): makari-revolutioninmind-2008 ch48 “In 1913, Freud formalized a theory of aggression…” (Makari, George, 2008): makari-revolutioninmind-2008 ch51 “I.P.A. consider issuing diplomas…” (Makari, George, 2008): makari-revolutioninmind-2008 ch53 “By 1911, the published guides for conducting…” (Makari, George, 2008): makari-revolutioninmind-2008 ch53 “If an analyst in Budapest was not the same…” (Makari, George, 2008): makari-revolutioninmind-2008 ch53 “In March 1911, this dream-meister published…” (Makari, George, 2008): makari-revolutioninmind-2008 ch54 “Just as the patient was to try to lay out…” (Makari, George, 2008): makari-revolutioninmind-2008 ch54 “Freud replied: I have to claim you…” (Makari, George, 2008): makari-revolutioninmind-2008 ch54 “From this perspective, human beings appeared to…” (Makari, George, 2008): makari-revolutioninmind-2008 ch54 “Freud recommended that the patient be treated…” (Makari, George, 2008): makari-revolutioninmind-2008 ch56 “The 1922 I.P.A. Congress in Berlin hosted 256…” (Makari, George, 2008): makari-revolutioninmind-2008 ch56 “The congress revealed tensions between abstract…” (Makari, George, 2008): makari-revolutioninmind-2008 ch57 “He reasoned that if frustration made the neurotic…” (Makari, George, 2008): makari-revolutioninmind-2008 ch57 “Ferenczi noticed that the woman had a habit of…” (Makari, George, 2008): makari-revolutioninmind-2008 ch64 “Hitler began to remilitarize Germany. In the fall…” (Makari, George, 2008): makari-revolutioninmind-2008 ch64 “To develop such a theory, Hartmann referred back…” (Makari, George, 2008): makari-revolutioninmind-2008 ch65 “From a new home in Oslo, Otto Fenichel worked…” (Makari, George, 2008): makari-revolutioninmind-2008 ch67 “As for the French, they stuck closer to a more…” (Makari, George, 2008): makari-revolutioninmind-2008 ch69 “Before this medical crowd, Rado did not mince…” (Makari, George, 2008): makari-revolutioninmind-2008 ch70 “In New York, Lawrence Kubie would be cast off…” (Makari, George, 2008): makari-revolutioninmind-2008 ch70 “After more than half a century of work, psychoanalysis…” (Makari, George, 2008): makari-revolutioninmind-2008 ch14 “During the second half of the nineteenth century…” (Makari, George, 2008): makari-revolutioninmind-2008 ch14 “Krafft-Ebing’s renown came from his work in sexual…” (Makari, George, 2008): makari-revolutioninmind-2008 ch14 “In 1892, he presented his stunning findings in…” (Makari, George, 2008): makari-revolutioninmind-2008 ch14 “Over time, Krafft-Ebing changed his position…” (Makari, George, 2008): makari-revolutioninmind-2008 ch14 “Some sexologists argued sexual differences must be…” (Makari, George, 2008): makari-revolutioninmind-2008 ch26 “Wittels’s presentation was condemned as outlandish…”

Editorial Notes

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The Core Theory