On December 22, the Delhi Police said the six individuals accused in the Parliament breach incident underwent psychoanalysis at a government institute in the city in order to ascertain their motives.
The term ‘psychoanalysis’ is usually restricted to the medical literature on mental health when it isn’t provoking suspicious questions. For example, in my own practice, many of my clients have asked me, “Are you psychoanalysing my mind?” Psychoanalysis is an important tool but is often misunderstood.
How did psychoanalysis originate?
Psychoanalysis isn’t a form of psychotherapy but in fact a worldview. It was the first modern Western system of psychotherapy. The Viennese psychiatrist Sigmund Freud coined the term and developed it with many of his colleagues and peers. He developed psychoanalysis as a treatment modality for people presenting with symptoms that other physicians were unable to treat.
The prominence of such ‘classical psychoanalysis’ has declined over time, while the topic has itself evolved to become less authoritarian and more practical. Its evolution has been influenced by developments in neurology, psychiatry, psychology, philosophy, and the social and natural sciences.
Psychoanalysis aims to give people a greater degree of agency by facilitating awareness of their unconscious wishes and defences.
In 1886, Freud collaborated with physician Josef Breuer, known for his dramatic successes in treating clients with “hysteria”. Their approach involved nudging people to talk about themselves in a bid to recount buried traumatic experiences. Breur found that when these people were able to recall traumatic experiences in an affectively charged fashion, their symptoms diminished. This approach came to be known as “the talking cure”.
What is the unconscious?
The unconscious is conceptually central to psychoanalytic theory. Freud posited that certain memories and associated affects are cut off from consciousness because of their threatening nature. Over time, he came to believe instinctual impulses and associated wishes – in addition to traumatic memories – were also not allowed into awareness, and that this happened via cultural conditioning: in which people believed such instincts were ‘unacceptable’.
For example, a person angry with their colleague may disavow these feelings and push them out of awareness by repressing them. Repression is an important psychoanalytic construct characterised by the unconscious forgetting of painful ideas or impulses in order to protect the psyche.
Freud elaborated on this idea by distinguishing between the id, the ego, and the superego. The id is the part of the psyche present from birth and is based on instincts. It presses for instant gratification and discounts situational realities. The ego, emerging out of the id, is its more rational counterpart. Unlike the id, the ego weighs situations before pressing for gratification. It also delays gratification by channeling instinctual needs in a socially acceptable manner. The superego emerges by internalising social values and norms. This psychic agency can be overly harsh and demanding, often leading a person to adopt a punitive stance towards their own instinctual needs.
Many contemporary psychoanalysts no longer find this distinction useful, and instead view the mind as being composed of multiple self-states that emerge in different contexts.
What are fantasies, defences, and resistance?
Freud posited that fantasies served numerous psychic functions, including the need to feel safe, regulate self-esteem, and overcome traumatic experiences. He’d previously theorised that fantasies were linked to sexual or aggressive wishes and provided imaginary wish fulfillment. Since fantasies were expected to motivate a person’s behaviour, he believed exploring and interpreting them was vital for psychoanalysis.
A defence is an intrapsychic process that helps individuals avoid emotional pain by pushing thoughts, wishes, feelings, and fantasies out of conscious awareness. Via projection, individuals can attribute their own threatening feelings or motives to another person. And via reaction formation, they can deny a threatening feeling by claiming they’re experiencing the opposite.
Using rationalisation, an individual can find excuses that justify unacceptable behaviours when self-esteem is threatened. Splitting is a way for individuals with borderline personality disorder to think in extremes, regarding people as either perfect or deeply flawed, exclusively nurturing or rejecting, etc.
Individuals with serious physical illnesses may deny being informed of the illness because that would threaten their reality. Through displacement, individuals can shift emotions from one object onto a less threatening one so that the latter replaces the former. (A person who loses a child in a road accident, and thereafter devotes themselves to campaigning against dangerous driving, is exhibiting displacement. From a psychoanalytic perspective, the emotion attached to the child is replaced by emotions attached to the ideals of the campaign.)
Through identification, a victim may assume the faults of the opponent. For example, a woman facing domestic violence may believe she deserves to be beaten to justify her husband’s aggression. Via sublimation, a person may transfer unacceptable impulses onto more acceptable alternatives, like channeling anger into political activism.
Freud formalised the concept of resistance when he found his clients were reluctant to work with him. He responded by asking them to engage in free-association: that is, they could say anything that came to their minds, without self-censorship.
What are transference and countertransference?
It wasn’t uncommon for his clients to view him as tyrannical if they had a tyrannical father. In Freud’s view, his clients were transferring a template from the past into the present. He believed transference provided a window of opportunity for a person to gain insights into the effects of adverse past experiences on current behaviour.
He also believed that if a therapist maintained anonymity, by withholding information about the therapist’s own life or views, the person became less likely to develop transference towards the therapist.
Freud also held that the therapist may have their own unresolved unconscious conflicts and that they paved the way for the therapist to develop feelings towards the client. So, in his view, the therapist had to work through their own countertransference via personal supervision or self-analysis.
How does psychoanalysis help?
It was common practice for Freud to interpret his and his clients’ dreams. He considered dreams to be forms of wish fulfilment, and believed interpreting them to be central to psychoanalysis. Contemporary psychiatrists disagree, however.
Change generally involves making the unconscious conscious. In Freud’s view, humans are driven by unconscious wishes that aren’t in our awareness and that this lack of awareness drives self-defeating behaviour. He reasoned that individuals deluded themselves about the reasons for their behaviour and that the self-deception limited their choices.
According to psychoanalysis, the therapeutic relationship is itself a change mechanism. By acting in a different way than a client’s parents did, the therapist can present a new relational experience that challenges the client’s maladaptive models.
Traditional psychoanalysis involves four to six sessions per week, and often lasts for years. Contemporary psychoanalysts believe longer-term intensive treatment has certain advantages. While circumscribed symptoms can change in the short term, more fundamental changes in personality functioning need more time to manifest. However, long-term intensive treatment isn’t always feasible, practical or even desirable.
Contemporary psychoanalytic practice involves shorter term consultations happening once or twice a week.
Dr. Alok Kulkarni is a senior geriatric psychiatrist and neurophysician at the Manas Institute of Mental Health and Neurosciences, Hubli.
