Psychoanalysis and Psychodynamic Therapy
“The history of man is the history of his repression.” – Freud
The origin of psychoanalysis came from Sigmund Freud who was considered the father of psychiatry. Throughout the 20th century, psychoanalysis was the most influential therapy where virtually every major theorist was trained in a certain branch of psychoanalytic thought. Among the psychologists that really shaped and helped influence psychoanalytic theory are Erik Erickson, Anna Freud, Lacan and more. However, the formation of psychoanalytic theory was very much an original Freudian discipline. According to Theories of Psychotherapy and Counseling (2008), in order “to understand contemporary psychoanalytic thought, it is important to be aware of the five theoretical directions: Freudian drive theory, ego psychology, object relations, self-psychology, and relational psychoanalysis.” (Sharf, p.30) In drive theory, Freud focuses on the innate drives & instincts humans develop in relation to our preservation as a biological species and our culture as it relates to the instinctual structures of humanity. These purely humanistic structures represent two distinctive drives and motivations that create human civilization: Eros and Thanatos. Thanatos representing our self-destructive counterpart or our natural inclination towards aggression as a biological species and Eros representing our need for life. According to Eros and Civilization: A Philosophical Inquiry into Freud,
“The animal drives become human instincts under the influence of the external reality. Their original “location” in the organism and their basic direction remain the same, but their objectives and their manifestations are subject to change. All psychoanalytic concepts (sublimation, identification, project, repression, introjection) connote the mutability of the instincts. But the reality which shapes the instincts, as well as their needs and satisfaction, is a socio-historical world. The animal man becomes a human being only through a fundamental transformation of his nature, affecting not only the instinctual aims but also the instinctual “values” – that is, the principles that govern the attainment of aims. The change in the governing value system may be tentatively defined as follows:
Absence of repression
Restraint of pleasure
Security” (Marcuse, 2015, p.1)
These ideals of the biological transformation into humanistic qualities can be what Freud describes as the transition from the “pleasure principle” to the “reality principle.” “the reality principle supersedes the pleasure principle: man learns to give up momentary, uncertain, and destructive pleasure for delayed, restrained, but “assured” pleasure. This adjustment from animalistic pleasure implies a subjugation of the internal drives that make up our instincts and desires, therefore, creates a set of organized ego states within a fixed environment or society.” (Marcuse, 2015, p.4) Freudian psychoanalysis is a theory that relates greatly with social psychology, the “notion that a non-repressive civilization is impossible is the cornerstone of Freudian theory.” The largest part of the subjugation from the pleasure principle to the reality principle is the development of repressed states of consciousness. As an individual may have different parts of consciousness which make up someone’s conscious awareness, preconscious and the subconscious (our repressed experiences). An illustrative example of memory and the subconscious is painted further by Marcuse, “If memory moves to the center of psychoanalysis as a decisive mode of cognition, this is far more than a therapeutic device; the therapeutic role of memory derives from the truth value of memory. Its truth value lies in the specific function of memory to preserve promises and potentialities which are betrayed and even outlawed by the mature, civilized individual, but which had once been fulfilled in his dim past and which are never entirely forgotten.” (Marcuse, 2015, p.8) The expression of the pleasure principle and the reality principle can be seen in what Freud has chronicled as the three ego states: id, ego and superego. In the earliest stage of development, Freud’s theory is built around the antagonism of sex and life instincts. According to Theories of Psychotherapy and Counseling: Concepts and Cases, “When conflicts among the id, ego and superego develop, anxiety is likely to arise. It is the purpose of the ego and superego to channel instinctual energy through driving forces (cathexes) and restraining forces (anticathexes). The id consists only of the driving forces. When the id has too much control, individuals may become impulsive, self-indulgent or destructive. When the superego is too strong, individuals may have set unrealistically high moral or perfectionistic standards (superego) themselves and thus develop a sense of incompetence of failure.” (Sharf, p. 36) These drives are developed by what Freud has coined as the “psychosexual stages of development,” where Freud believed that the nature of conflicts among the id, ego and superego change over time as a person grows from child to adult. These conflicts make up 5 different stages Freud calls the oral, anal, phallic, latency and genital stage. Erik Erickson creates these stages of development by continuing to add in the eight psychosocial stages of development, which include infancy, early childhood, preschool age, school age, adolescence, young adulthood, middle age and later life. These developmental stages are all indicative of the child’s ability to resolve the internal conflicts of their transformation from the “pleasure” seeking principle to the “reality” principle. According to Freud, failure to resolve one of these stages could lead a child to become fixated in that stage, leading to an unhealthy personality. The idea of healthy childhood development according to psychoanalytic theory could be further examined by understanding the development of “ego states.” Ego states develop as a creative way to cope with an individual’s surrounding environment and allowing an individual to distinguish between acceptable social responses in social, home and school situations. An example of this would be a child learning to ask permission at school to use the restroom. The second type of ego state is the ego state where we internalize various aspects of our parents and other important figures in our lives we grow up attached too. For instance, an adult may have a two-year-old ego state who experiences regression to time periods of unhealed experiences and memories. Ego states can also be created in responses to different traumatic events that develop throughout an individual’s lifetime. Addressing the developmental schema of the Freudian ego states as they pertain to our consciousness is also a way of overcoming the complexities of the formation of the id and the ego. “Anna Freud believed that the ego, as well as the id, should be the focus of treatment in psychoanalysis.” (Blanck and Blanck, 1986). The largest layer of our mental structures when it pertains to the development of our egos is formalized in the id, ego and superego. The fundamental, oldest and most connected layer is the id. “The id is free from the forms and principles which constitute the conscious, social individual.” (Marcuse, 2015, p.7) The id does not have a conscious drive or motivation for any other forms of pleasure or relationality other than striving “for satisfaction of its instinctual needs, in accordance to the pleasure principle.” (Marcuse, p. 8) The ego serves as the medium ownership of the id and the socially constructed world it makes up our “perceptual-conscious system.” Its job serves as a manager, constantly determining and reflecting back the true pictures of reality or what reality should serve as a means for survival and cooperation as a species. “In fulfilling the task, the chief function of the ego is that of coordinating, altering, organizing and controlling the instinctual impulses of the id so to minimize conflicts with the reality: to repress impulses that are incompatible with the reality, to “reconcile” others with the reality by changing their object, delaying or diverting their gratification, transforming their mode of gratification, amalgamating them with other impulses, and so on.” (Marcuse, 2015, p.20)
Overview of Anorexia
Steve Levenkron, a psychiatrist who specializes in eating disorders, has broken the development and progression of the eating disorder into four simple steps. According to the novel Anorexia: Biographies of Disease, “The first stage is the achievement stage.” This stage is developed by a subconscious need to increase our reproductive fitness. Many people will enter this stage in order to feel better about themselves physically and emotionally. For many individuals who develop anorexia, the reward system for pleasure is directly related to unconditional praise and attention they get for their physical appearance. However, recent neurobiological research proves that anorexia is a fairly genetic concern and involves an absence of 5-HT chemicals in the central nervous system.
However, one could argue that the development of this genetic abnormality was the consequence of evolutionary, sociocultural expectations within the realm of idealistic feminine beauty. Once seen as a symptom of hysteria by Freud, anorexia and eating disorders are now treated as their own neurobiological, complex issue. Anorexia was first seen in psychiatric units in the early 18th century. In Anorexia: Biographies of Disease, they say that psychiatrist “William Stout Chipley was the chief medical officer at the Eastern Lunatic Asylum of Kentucky. He was the first American physician who, in 1859, published the American Journal of Insanity descriptions of self-starvation in American insane asylums… Chipley then discussed another group of patients who refused food and tended toward hysteria. Typically, they were adolescent girls who had been brought to the asylum by their parents because they refused to eat. Chipley recognized that this group of girls felt that refraining from eating was an accomplishment that made them special and unique, and furthermore, that it was a way to attract attention, sympathy, and power from friends and family. ” (Stryer, 2009, p.17) Pierre Briquet first saw examples of anorexia in his hospital and observed symptoms which mainly consisted of adolescent females, which included “an aversion toward ordinary food, sometimes having an attack of hysteria if that ate a particular food, and acquired a strange appetite. Briquet observed that, no matter what type of food aversion they had, it always appeared to be influenced by unpleasant experiences and emotions.” (Stryer, 2009, p.17) During the early twentieth century, it seemed that values pertaining women’s status and respect in society shifted from highly moralistic aims (grace, love and joy) to values that directly reflected the exterior significance of female femininity. In Steve Levenkron’s next step for the four stages of anorexia, he says this is when individuals will enter what is called the security-compulsive stage. “Instead of stopping here, however, they begin to increase their weight loss efforts and develop a new goal, around two pounds a week. Yet, this time there is no end in sight. They become obsessed with measuring every part of their body.” In stage two and three, the illness of anorexia has taken over the individuals life and is now worrying their family members. In stage four, “the pseudo-identity stage,” anorexia is now a core-component to the individuals sense of identity, self-concept and self-esteem. They feel more in control of their lives when they’re achieving the reward of controlling their weight. Sociocultural theory, believes that anorexia is a disorder that was developed due to advent of Western cultural expectations on women’s femininity. However, applied through the lens of psychoanalytic theory one could argue that these expectations for feminine beauty is purely an example of the consequences of the construction of a civilized environment and adhering to the “reality” principle. The connection between an individual’s response or avoidance to eating might be directly linked to the way they are responding to unconscious feelings thoughts and memories associated and linked to deep childhood wounds.
Eros and Obsession: A Fixation Divulged from Civilization, Manifested through Emptiness
Anorexia is a disorder that corresponds with an individual’s subconscious desire and need for control in a subterranean culture and climate. According to “the implication of the sadistic superego in anorexia,” consumerism in America is a defining concern in the development of distorted body schema and the drive for obsession. However, one could argue that this obsession is deeper involved within the intrapsychic connection between the individual and their longing for emotional attachment and unconditional love. By analyzing Eros and Civilization and the self-destructive nature that our ego predicates in our lives, we’re able to step into the shoes of what an individual coping with reality by denying, restricting or overeating might be experiencing. If you were to look at Eating Disorders through a psychoanalytic lens, you would see that the ego has taken control of the individuals life and the individual is coping with their existence of reality in a way that provokes their subconscious desire for death. According to psychodynamics, “a psychodynamic viewpoint regards the etiology of Anorexia Nervosa as largely developmental in nature. It views the disorder as a response to deficits in development whereby a lack of parental nurturing led to a failure in the now anorexia patient to develop a coherent sense of self.” (Marlow, p.64) In Erik Erickson’s model of development, we find that the early life stages of 2-6 are incredibly important for connecting an individual to a caregiver and developing a proper sense of security, attachment, and love. According to Lacan, “a individual experiences herself as a mass of separate experiences and requires the nurturing presence of an empathic and loving caregiver to bring these experiences together into a coherent whole.” (Lacan, 2007). When an individual is not given the proper love and attachment needs they need to experience as a basis for biological self-preservation, they are thus taught to transform those emotions through the “reality principle.” Their avoidance and rejection of food are directly tied to a natural biological need for survival. However, this need or biological “craving’ is actually configured in reality as something that is undesirable or wrong. In the sociocultural atmosphere thinness, health and appearance are considered a women’s most valued reproductive variables. At a young age, if an individual is not given the formation of a sound and secure personal identity, our ego develops states of consciousness which help us compartmentalize the confusing messaging that our ego, id, and superego develop in relation to our surrounding environment. Plainly, a narrative for the self-destructive client coping with reality by restricting and suppressing their desire for food might look something like the following:
An individual’s mother tells her she is not good at school and never going to get anywhere in life. The individual being at the age of 10 has not developmentally, categorized her existence apart from the perception and world of her mother’s views. Unable to identify or understand how her mother could not love her and be in love with someone else. The patient feels shame for wanting simple biological needs like love and attachment. This shame is deeply connected to our biological need for food and life. Due to extra stimuli in the patient’s environment about women’s rights and sexual reproductive features, the patient feels a continued sense of shame for her “pleasure” seeking drives (i.e. food and love). Processing these stimuli and the mixed incoherent messages about reality and what is “wrong” or “right,” the patient’s ego creates a separate illusion of principle and guidelines. This looks something like, “I am not good at school, I do not deserve food” or “I am not pretty enough, I must throw up.”
- This illustration is a process that is similar to how Herbert Marcuse describes the formation of our superego, “In the course of development of the ego another mental “entity” arises: the superego. It originates from the long dependency of the infant on his parents; the parental influence remains the core of the superego. Subsequently, a number of societal and cultural influences are taken in by the superego until it coagulates into the powerful representative of established morality and “what people call the ‘higher things in human life.” Now that the “external restrictions” which first the parents and then other societal agencies have imposed on the individual are “introjected” into the ego and become its “conscience;” henceforth, the sense of guilt – the need for punishment generated by the transgressions or by the wish to transgress these restrictions (especially in the Oedipus situation) – permeates the mental life. (Marcuse, p.56)