-
Chapter 5. The Freudian Revolution
- Johns Hopkins University Press
- Chapter
- Additional Information
CHAPTER FIVE The Freudian Revolution F F F FREUD’S ACHIEVEMENTS The emergence of Sigmund Freud as the dominant psychiatric theorist of the first half of the twentieth century was a central turning point in the history of anxiety. Previous diagnosticians usually viewed anxiety as an aspect of a broader entity, be it Hippocratic melancholia, Cheyne’s nervous disorders, or Beard’s neurasthenia; they did not distinguish anxiety-related conditions from depression , psychosomatic problems, or hysteria. When neurologists and psychiatrists began to recognize particular anxiety disorders, such as agoraphobia and panic attacks, in the nineteenth century, they did not connect them to a broader class of anxiety conditions . Freud’s early works unified a variety of somatic and psychic expressions that previously had been considered distinct under the broad umbrella of anxiety conditions. His later works then moved anxiety to the core of psychiatric nosology.1 Despite the scorn that psychiatry now heaps upon his views, Freud was a major precursor to current thinking about anxiety. His work is generally acknowledged as the inspiration behind the first modern psychiatric manuals, the psychodynamically based DSM-I and DSM-II, which emphasized the dynamic relation75 76 Anxiety ships between unconscious motivations and conscious actions. In fact, it also foreshadowed the symptom-based approach of the subsequent manuals, DSM-III through the DSM-5. Paradoxically, Freud’s early writings on anxiety that distinguish a variety of anxiety conditions anticipate the “neo-Kraepelinian” approach to psychiatric diagnosis. In current DSM-style, Freud used symptoms to identify distinct anxiety syndromes, a process that not only split anxiety from the broader conceptions encompassed in neurasthenia and hysteria but also identified the major anxiety conditions that persist in present-day psychiatry. Freud’s interest in anxiety disorders was apparent in his earliest writings and his deep concern with them never wavered throughout his career, despite substantial changes in his conceptions of their nature and origin. Although his particular etiological claims are no longer influential or even credible, Freud helped forge the scientific study of anxiety and build an enduring foundation for outpatient mental health treatment. FREUD’S BACKGROUND Sigmund Freud (1856–1939) was a nonobservant Jew who lived nearly his whole life in Vienna. For most of his life, the city was the capital of the sprawling Hapsburg Empire and the center of a vibrant cosmopolitan culture. It was also the medical hub of the world at the turn of the nineteenth century. Freud initially trained as a neurologist and spent ten years studying brain processes in a variety of species. He began his psychiatric career as an acolyte of French neurologist Jean-Martin Charcot (1825–1893) after studying with Charcot for a few months in 1885–1886. In accord with French medicine at the time, Charcot fervently believed in the hereditary and organic grounds of hysteria. Freud’s early development , therefore, occurred in an environment steeped in hereditarianism and biological studies of mental illness. In the embryonic stage of psychoanalysis, Freud teamed with Austrian physician Josef Breuer (1842–1925) to study hysteria. Far more than either Beard or Charcot, Freud and Breuer emphasized how intrapsychic factors led to neuroses. In particular, they [3.84.7.255] Project MUSE (2024-03-28 22:03 GMT) The Freudian Revolution 77 highlighted the importance of suppressed memories of traumas in generating neurotic conditions and of hypnosis as a technique for recovering them. Freud, however, quickly repudiated his initial view that hysterical symptoms symbolically reproduced repressed traumatic experiences, and he came to stress how unconscious memories more likely resulted from patients’ fantasies than from actual traumas. This was a “decisive turning point in psychoanalysis ” because it moved Freud to study unconscious intrapsychic dynamics and their ambiguous relationship to tangible experiences.2 FREUD’S EARLY WRITINGS ON ANXIETY Although psychiatrists had started to pay attention to panic, phobias , and obsessions by the time Freud began writing in the early 1890s, the study of anxiety remained in the shadow of neurasthenia and hysteria. Most symptoms of what were to become the various psychoneuroses were seen either as distinct syndromes or as manifestations of the capacious neurasthenic diagnosis, which was so broad that it encompassed virtually every sort of psychological symptom that general physicians and neurologists were likely to encounter. Freud was well-versed in Beard’s writings, regarding them as too vague and overinclusive to be useful. During the last decade of the nineteenth century, Freud came to reject Charcot’s theory of hysteria and began to develop a unique psychological theory...