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Home , Melanie Klein, Philippe Pinel

Jürgen Kriz / manuscript

1: Introduction: The Roots of

Man is a social being. More than any other species, he is physically and psychologically dependent on others – usually beginning with his parents – for his most elementary needs. The social structures which to a large extend condition his ability to experience, and hence his entire development, are to a large extent socially prescribed long before he appears on life’s stage. The general results of the work of society and other processes of interaction (tools and other materials altered by man, social roles and behavior patterns, and culture – language, writing, science, etc.), along with the specific historical, geographic, and socio-economic circumstances surrounding his birth and development, determine his life at least as much as the "phylogenetic experience" of Homo sapiens. Another feature peculiar to man (at least in the last few thousand years) is his reflexive consciousness: man’s behavior is determined less by and natural environmental stimuli (signals) than by his capacity to meaningfully structure his experience and to anticipate his behavior, along with some of its probable consequences, and thus to act intentionally. These mental structures are of course also to a large extent socially determined and are bound up in sign process (i.e., social stimuli whose significance is learnt; see, e.g., Kriz 1981, 1985).

This embedment in social role patterns has always resulted in psychotherapeutic action. On the one hand, everyone has his own ideas and expectations about "normal" behavior and feeling, which makes him in the social community very sensitive to deviations from this norm - although tolerance limits and value systems have varied extremely at different periods and/or in different societies (from "the extermination of subhuman beings" to the worship of "saints"). On the other hand, there have always been those in the social community who have tried through word and deed to mitigate psychological, physical or behavioral handicaps (from family members who took on a supportive function to those with specific roles to , such as medicine men). Thus, elementary psychotherapeutic practices in the broadest sense are presumably as old as mankind itself.

According to most authors, however, professional psychotherapy (in the modern sense) did not begin until the end of the nineteenth century. The most commonly accepted date for its birth is the publication in 1900 of ’s first comprehensive work, The Interpretation of Dreams, or, still earlier, Freud and Breuer's joint publication of the famous "Case of Anna O." in the essay "On the psychological mechanism of hysterical phenomena" in 1883 and in the Studies in Hysteria in 1885. These works document the beginning of an approach to psychotherapeutic treatment which, under the label , soon became so widespread that in the first half of the twentieth century psychotherapy and Freud's psychoanalysis were often considered to be identical. Although behavior therapy, for example, already had precursors in the nineteenth century, the focus there was on educational aspects. Freud's psychoanalysis from the very beginning was devoted to treating the mentally ill.

To be able to understand and appreciate Freud's extraordinary achievements, it is necessary to become familiar with the intellectual arena in which psychoanalysis originated, as well as with the influence psychoanalysis had on later developments.

1.1 The Psychological/Anthropological Image of Man in Freud's Time

Freud was born in Moravia on 6 May 1856. This was several years before Charles Darwin (1809-1882) published his major works of the theory of evolution - a theory that, as Hofstätter (1972) points out, was for a long time widely regarded as the "criminal wanderings of perverted imagination." As late as 1925, an American schoolteacher by the name of Scopes was brought to trial for disseminating Darwin's theories of evolution.

People’s view of their fellow men was chiefly governed by the Bible, or to be more exact, by the interpretations of the Bible common at that time (which today are considered rather peculiar). For instance, the eminent Swiss naturalist Louis Agassiz (1807-1873), who became professor at Harvard University after his emigration to America, posited with great authority the polygenetic theory, according to which the human races are different species. For this "reason," the blacks did not have to be granted "equality," since they represented a completely different form of life. The American standard work on the human races, Types of Mankind (published in 1854 by Nott and Gliddon), used line drawings to demonstrate similarity between gorillas and Algerian Negroes, orang-utans and Hottentots, etc. Darwin himself argued in 1871 that the gap between humans and lower apes would necessarily widen in the future because connecting links such as chimpanzees and Hottentots presumably would die out (Gould 1981).

In contrast to polygenesis, the second variety of scientific racism was monogenesis, which with regard to racial differences interpreted the Bible as follows: although all peoples are descended from Adam and Eve in the act of Creation, individual races represent different degrees of degeneration from the state of perfection in the Garden of Eden. This degeneration is least among the whites and greatest among the blacks.

Such views were scientifically "supported" or "proved" by apparently hard objective data obtained by the burgeoning use of measuring methods in the (natural-science-oriented) human sciences. The starting point was the works of Samuel G. Morton, who just before the middle of the nineteenth century had published several volumes of measurements and tables relating to brain size. The data were based on his collection - probably the largest ever - of sculls, which he measured by filling them with mustard seeds and later with lead grain. Proceeding from the generally accepted assumption that brain size would give a direct indication as to developmental stage or innate mental abilities, Morton was able to confirm the prejudice that in the human hierarchy whites were at the top, Red Indians in the middle and blacks at the bottom (Morton subdivided the whites even further, incidentally, ranking Teutons and Anglo-Saxons at the top, Jews in the middle, and Hindus at the bottom.)

Similar arguments were put forward by Paul Broca (1824-1880), the French surgeon and anthropologist after whom the motor speech center in the forebrain is named. Broca measured a number of different skulls and bodies, and on the basis of resulting indices tried to prove the innate stupidity of the inferior races. In a random sample of 60 whites and 35 blacks, the average skull length behind occipital foramen was 100.385 mm for whites and 100.875 mm for blacks, but the average skull lengths in the front of the occipital foramen were 90.736 mm and 100.404 mm respectively (note of the amazing measuring "precision," which psychological/anthropological research occasionally strove for, even back then!). In 1872, Broca concluded: "It is thus incontestable...that the physical build of the Negro, in this respect as in many others, is close to that of the ape." Ten years earlier, Broca had abandoned a further "criterion" - the length of the forearm bone in proportion to that of the upper arm bone (!) - with the argument: "...I find it difficult to say that the extension of the lower arm is a characteristic of degeneration or inferiority, since Europeans in this respect fall between Negroes, on the one hand, and Hottentots, Australians, and Eskimos, on the other" (both quotations from Gould 1981). The idea that such indices were somewhat dubious for the precise reason that non-Europeans were also "normal" humans, and not "degenerate" or "inferior," was not in keeping with the zeitgeist.

Naturally enough, favorite prejudices current within the whites as a whole were upheld with the same kind of scientific authority and similarly "proved" on the basis of "hard data." To begin with, women had to take their place in the hierarchy at a respectful distance below the men. According to Broca (in 1861): Women (are) on average a bit more stupid than men - a difference which should not be exaggerated, but which nevertheless exists." Broca's colleague Herve stated in 1881: "Men of the black races have a brain which is barely heavier than that of the white women." Similar statements were made in 1879 by Gustave Le Bon, a well-known disciple of Broca and author of The of the Masses, which is still quoted today: Among the most intelligent races, like the Parisians, for example, there are many women whose brains are closer in size to those of gorillas than to the most highly developed male brains...Every psychologist who has studied female intelligence acknowledges today...that this is one of the most inferior forms of human development. (All quotations are Gould, 1981, who also gives an impressive and detailed account of unmasking of these "objective" data as methodological flaws.)

Turning now to minorities with "deviant" behavior, the theory developed by Cesare Lombroso (1836-1910), an Italian professor of in Turin, although controversial was very influential for a long time. According to this theory, criminal tendencies are innate and can be diagnosed on the basis of anatomy. Lombroso's major work, The Criminal, appeared in 1876, when Freud was already 20 years old. The impact of Lombroso's thoughts and those of his followers (e.g., a work on the "abnormal morphology of prostitutes' feet," presented by Jullien at the 4th International Congress on Criminal Anthropology in 1896) lasted into the twentieth century. As Gould reminds us, up to the First World War criminal anthropology was the subject of a regular international conference of judges, lawyers, government officials, and scientists.

Gould also points out that a revival of the "born criminal" theory enjoyed remarkable popularity in the 1960s, namely, in the form of "fairy tales about criminal chromosomes." Based on a rare chromosome abnormality in men, the XYY combination, a connection founded largely on elementary methodological errors was claimed to exist between XYY and criminality. The longing for a simple world in which the most complex characteristics of human behavior have the same cause as the color of Johann Gregor Mendel's sweet peas in 1865 continues to govern much thinking even today.

1.2 The Medical Image of Man

The period in which Freud studied medicine in and in which he began his first works marked the furthest point of the swing of the intellectual pendulum from the now abandoned age of (religious) belief to an extremely deterministic, mechanistic, materialistic, and somatogenetic view of the world. In 1885, as Bitter (1977) points out, the best-known gynecologists still regarded castration as a possible cure for hysteria.

The natural-scientific somatogenetic explanation of mental diseases dates back to (460-377 BC), who divided psychological disorders into three categories: melancholy, mania, and phrenitis (brain fever). Hippocrates believed the cause of these disorders to lie in faulty mixing of body fluids, which in turn affected the brain. A few centuries later, however, this theory has disappeared. A long period followed in which mental disease was regarded as divine punishment of sinful or evil souls, or as a sign of possession by the devil, and "treated" accordingly - sufferers were either locked up and tortured, or condemned as witches and burned. The seventeenth century, in particular, is regarded in Europe and America as the period in which this witch-hunting reached its peak.

As religious fanaticism subsided in the eighteenth century, the "mad" were locked up in prison-like madhouses, often chained to the walls. Although some physicians in the sixteenth, seventeenth, and eighteenth centuries pleaded that such persons should be regarded not as evil or possessed but as sick (e.g., Johann Weyer in Germany in the sixteenth century, Robert Burton in England in the seventeenth century, and in France in the eighteenth century), it took until the second half of the nineteenth century for views to finally change.

Since what stamped the nineteenth century was the scientific and technological revolution, the visible progress of which determined and legitimized a materialistic view of life that denied the existence of anything not demonstrable by physical and chemical methods, those seeking new, enlightened models and classifications of mental diseases naturally turned to somatogenetic theories. S.A. Cartwright, for example, a well-known physician in the American South who presented his work at the Annual Meeting of the Louisiana Medical (among other places) in 1851, had some remarkable ideas. According to Cartwright, the cause of the frequent escape attempts made by slaves was a mental illness by the name of "drapetomania" - the mad desire to rum away. Cartwright had another disease handy to explain other problems of the blacks, "dysthesia," in which the blood in the lunges was in sufficiently cleared of carbon dioxide. It was, he asserted, the deficient oxygenation of the blood, in conjunction with a deficit of brain mass, that was the true cause of that reduction of intelligence which made the African peoples unable to care for themselves. Treatment for this condition included hard labor in the open and in the sun, to force the blacks to expand their lungs - labor such as chopping wood, logs, or sawing (Gould 1981).

But Cartwright was not the only one to regard psychological disorders as brain disease: almost everybody did. Psychiatry was essentially neurology, especially since cerebropathology had been able to prove scientifically that specific localized areas in the brain were associated with certain psychological functions (e.g., Paul Broca's notable discovery of the motor speech center). In Germany in the middle of the nineteenth century, Wilhelm Griesinger (who in 1867 was elected chairman of the newly founded Berlin Medical Psychological Society, renamed in 1885 the Society for Psychiatry and Neurological Diseases) insisted that in every diagnosis of a psychological disorder a physiological cause must be specified. His successor, (1856-1926), proposed in his psychiatry textbook in 1883 a system of classifying mental diseases that emphasized their organic cause - a classification system, incidentally, which still underlies the categories of orthodox psychiatry.

These single-cause views were supported by the advances made in general medicine toward the end of the last century after Louis Pasteur (1822-1895) had developed the micro-organism theory of disease and the technique of immunization. Other contributory advances included Robert Koch's (1843-1910) discovery of the tuberculosis pathogen (1882) and the cholera bacillus, as well as the proof that the "mental disease" called "general paresis" was a result of syphilis (1905) and the discovery of the cause of the latter, spirochaeta pallida.

1.3 Freud's Intellectual Precursors

There were, of course, other currents of thought. Sören Kierkegaard (1813- 1855), for example, the founder of , and Friedrich Nietzsche (1844-1900), from their very different positions - the first more Christian, the second more anti-Christian - paved the way for (and also, to a certain extent, - see Chap. 12), with their strong emphasis on subtle, subconscious feelings and values (Nietzsche, with his The Will to Power, had more of an influence on Freud's follower, , than he did on Freud.) The works of Arthur Schopenhauer (1788-1860), written long before Freud's time, contain psychological everyday experiences and observations regarding unconscious processes. Heigl-Evers and Nitzschke (1984) even regard the "parallels in Schopenhauers's and Freud's thinking" as "amazing": Schopenhauer already talks about the primacy of will, of the unconscious, of sexuality; intellect and consciousness appear as secondary phenomena; affects, dreams, , repetition compulsion, death wish, bisexuality, repression, rationalization, sublimation, determination of all psychological events, particularly of "free" associations, are addressed; "" is seen as a disorder of conscious reminiscence due to traumatic incidents in the biography of the individual concerned. Very similar topics turn up again later in Freud's work.

Eduard von Hartmann (1842-1906) wrote a Philosophy of the Unconscious as early as 1869. Poets like Goethe (1749-1832) and Schiller (1759-1805) in Germany or the Russian novelist Dostoyevsky (1821-1881) described the influence of social and psychological factors in the development of conflicts and mental diseases. Before Freud, however, such concepts were not assembled into a unified structure, let alone applied systematically to the treatment of the sick. Scholarly views which from today's standpoint can be seen to bear a close affinity to Freud's theory - those of Juan Luis Vives (1492-1540), for instance, a Spanish philosopher and psychologist who brought out very clearly the significance of associations, unconscious motivations, and sexual for psychopathology, or those of Theophrastus Bombastus von Hohenheim (1493- 1541), known as Paracelsus, who described unconscious goals in childhood neuroses - such views were regarded by the materialistic and somatogenetic nineteenth century, as being long outdated.

Of far more influence at that time were the successes of Anton Mesmer (1734- 1815), a Viennese physician who fled to after being driven out of Vienna. Pongratz (1982), for instance, calls Mesmer the father of , which Freud's teachers Breuer, Charcot, Janet, Liebeault, and Bernheim (see below) successfully applied in the treatment of hysteria. But although, after pointing out the primacy of somatological explanations in medicine (and in psychiatry) in Freud's time, Pongratz concludes that "the psychological countermovement was launched by...Mesmer," it must be remembered that Pongratz' attribution of Mesmer's curative success to suggestive and hypnotic effects is made from the modern standpoint. Mesmer himself regarded hysteria as a strictly physical disorder and attributed his successes to the influence of magnetic flow - in the strictly scientific sense. In any event, despite his strangely mystic appearance, he used chemicals and metal rods which were supposed to transfer "animal magnetism." A similar figure in England was James Braid (1795-1860), who experimented with hypnosis; his Neurohypnology or the Rationale of Nervous Sleep (1843) was the first work in which such terms as "hypnotism," "hypnotize," etc., were used, and he too was convinced of the physiological origin of the phenomena he studied. (He also believed in phrenology, i.e., that mental capacity is indicated by the shape of the skull.) Even Charcot (see Sect. 1.4) at first took a somatogenetic position on hysteria. Not until some students tricked him with patient whose hysterical symptoms they had induced by hypnotism did Charcot begin to take an interest in nonsomatic origins.

Except for his views in the areas of philosophy and poetry, Freud the physician stood entirely within the paradigm of mechanistic/somatic medicine and natural science, and this naturally characterized his view of the world up to an advanced age. Thus, his theory, psychoanalysis, initially borrowed clearly from the scientific models of mechanics, hydrodynamics, and neurophysiology. Freud, too, characterized psychological processes as "quantitatively determined states of specifiable material particles" (Freud and Fliess 1954 p.355), and he hoped until he died that his theory would one day be shown to have a psychological and biochemical basis (see Chap. 2). Freud's extraordinary importance is due to the fact spite of (or perhaps because of) his hope for a reduction to somatic, physiological factors, he devoted himself intensively to psychological processes and correlates of clinical phenomena (without crossing into the field of experimental psychology, Russian reflexology or American behaviorism, all of which dealt with nonclinical phenomena). Besides being the founder of psychoanalysis, Freud was equally important as the catalyst for a number of very important disciples of his, who in turn became founders of their own schools. Before we go into the basic concepts of psychoanalysis and the other forms of therapy that grew out of it, we should first take a look at the general development.

1.4 The Beginnings of Psychoanalysis

Despite the predominance of purely somatic thinking in medicine, psychogenetic explanations for mental diseases were already current even at the time when Freud was studying, especially in Vienna, Paris, and Nancy. As a medical student in Vienna, Freud had early on attached himself to Joseph Breuer (1842-1925), a practising physician working with hypnosis. In 1885/86, he studied with Charcot at the Salpêtrière, the large women's hospital in Paris. Hysterical conditions, especially tics, paralysis, anesthesia, disturbances of consciousness and speech, and (hysterical) blindness were relatively frequent at that time compared to now.

Here we see, incidentally, how strong the influence of social factors is on the ways in which hysteria is manifested. A common form in those days, the grand hysterical attack or arc de cercle, in which a supine woman goes rigid with her body arched to an extreme degree, is nowadays totally "out of fashion." Moreover, as a diagnosis "hysteria" was in something of a special position since the name of disease, which originally indicated a connection with the womb (the Greek word for womb was hysteria), had been used centuries before and been distinguished from other psychological disorders. Before Kraepelin, the other disorders had been combined under general terms such as "madness," "lunacy," or "mania."

Jean Martin Charcot (1825-1893), followed by his pupil, (1859- 1947), systematically researched the relationship between hysteria and hypnosis. As Bitter (1977) shows, they demonstrated that hysterical symptoms could be induced by hypnosis. It then seemed obvious that the reserve must also be true, i.e., that hysterical symptoms are acquired in an exceptional mental state, like that of hypnosis. Janet in particular was able, on the basis of numerous case histories, to confirm the psychological origin of hysterical phenomena, in men as well as in women. He found that hysteria is often the result of a shocking experience. Terms such as "psychic trauma" (injury) and the "traumatic origin of hysterical symptoms" began to be used.

After Freud returned to Vienna, he took up private practice as a psychiatrist and resumed his work with Breuer, who was also researching hypnosis as a therapeutic tool (see Chap. 2). Later, in 1889, Freud also went to study briefly in Nancy, where the two famous psychiatrists Liebeault (1823-1904) and Bernheim (1840-1919) were also teaching the use of hypnosis. Watching Bernheim gave Freud the idea for the technique of free association, although he did not develop it further until later, after he had become estranged from Breuer.

Freud also absorbed Bernheim's view that the boundary between health and illness was very fluid. Where Charcot believed that the ability to become hypnotized was a hysterical symptom in itself, Bernheim maintained that everyone in hypnotizable to a certain degree. One of the reasons he studied sick people was to build up an impression of the psyche oh healthy people. Later on, Freud went much further in this direction by attributing repression of instincts not only to the ill but also, to varying degrees, to every healthy individual as well.

While Janet, in keeping with the zeitgeist sketched out above, ascribed the hysterical splitting of consciousness, as he called it, to innate weakness of the nervous system in regard to integrating the different parts of the psyche, Breuer was already teaching that this splitting of consciousness was not caused by degeneration, but was rather a secondarily acquired symptom following a pathogenic experience. Breuer's discovery was that these hysterical symptoms are related to scenes (traumas) in an individual's life which made a strong impression at the time but have since been forgotten. By instructing the hypnotized patient to recall these scenes and to describe them in words and gestures, the trauma was relived. When the patient awoke - after the procedure had been repeated several times if necessary - the symptoms were gone. Breuer called this a purging, cathartic process.

The starting point of the work in this direction was the treatment by Breuer of "Anna O." (the name Freud and Breuer used in their publications to refer to Berta von Pappenheim). Fully documented by Freud and Breuer, this case has become one of the most famous in the clinical literature. Presumably, the process of this therapy was an important source of Freud's later work, even though we know today that Anna O. was far from cured when Breuer stopped treating her and that she continued taking morphine. Davison and Neale (1978 p.21) conclude: "It is fascinating and ironic to consider that psychoanalysis traces its roots back to an improperly reported clinical case." [Note that there is an analogous situation for behavior therapy: the classical conditioning of anxiety in the well-known case of "little Albert" in 1919-20 by Watson (Watson and Rayner 1920) was an extremely dubious, non-reproducible experiment. Nevertheless, a "cleaned-up version" served for decades as a cornerstone of behaviorism and the "theories of anxiety" (see Chap. 8)].

Breuer and Freud's association did not last. Breuer held that hysteria was caused by traumatic experiences and affects that were repressed instead of being lived out. The dammed-up of these affects was stored in the unconscious and converted into symptoms. Freud went beyond this in assuming that the repression of affects was less to external events than to sexual instincts which for moral reasons could not be released. This energy is transformed into physical symptoms, a process Freud called conversion. Freud's emphasis on the energy of sexual instinct, the (he did not oppose the aggressive, destructive tendency, the death instinct, until much later), is essentially what led Breuer to leave Freud.

After this separation, Freud soon turned from the technique of hypnosis to free association, in which the patient is asked to say without reservation whatever comes into his mind. Here Freud discovered a phenomenon which hypnosis had largely hidden: resistance. Dream work, the "royal road" to the unconscious, was integrated, and the concept of was developed. In the years which followed, Freud proceeded to construct a theoretical model that became more and more unified: this was psychoanalysis (see Chap. 2)

As has already been mentioned, Freud's theory had and still has a tremendous influence on almost every other form of psychotherapy. Practically all of today's important psychotherapeutic approaches trace their history back to psychoanalytical concepts (one reason being that almost all of the founders of the newer schools of therapy started out as psychoanalysts). Although behavior therapy is an exception, it too was strongly influenced by psychoanalysis and its clinical successes (see Chap. 8). All together, the impact of Freud and of psychoanalysis on other schools of therapy is less that the latter directly adopted certain concepts but rather that these were the concepts which they had to confront and critically consider. Perhaps the most remarkable thing about Freud and his theory is precisely that they attracted a circle of significant personalities who became "pupils," but that these then - often against a background of violent clashes and battles with their teacher - disassociated themselves from him and left to develop their own schools of therapy.

The catalytic function of Freud and his psychoanalytic approach is in my opinion at least as important as his actual work itself. In what follows, therefore, I shall discuss some aspects of this catalytic function and the critical debate that went with it. Some of these aspects will be picked up again in later chapters and dealt with more thoroughly.

1.5 Freud and His Followers

In the autumn of 1902, the Psychoanalytic Wednesday Society, consisting of Adler, Kahane, Reitler, and Stekel, started to meet at Freud's house once a week. Gradually, other members were added, the best known being Abraham, Ferenczi, Jones, Rank, and Reich. In 1906, the first psychoanalytic work in English was published by James J. Putnam at Harvard. In 1908, the first Psychoanalytic Congress was held in Salzburg. Between 1909 and 1914, six annuals for psychoanalytic and psychopathological research were published by Freud and Bleuler. In 1910, the International Psychoanalytic Association was founded in Nuremberg with Jung as President and the monthly Zentralblatt für Psychoanalyse appeared (editors Adler and Stekel), which in 1912 became the Internationale Zeitschrift für Psychoanalyse (editors Ferenczi, Rank, and Jones).

1.5.1 Alfred Adler

The first to part ways with Freud was Alfred Adler (1870-1937). In 1911, Adler and nine other socialists resigned from the Vienna Psychoanalytic Society, over which Adler had presided. However, the fact that (1871-1950), a socialist and for many years an official representative of Freud, remained in the group shows that Adler's reason for withdrawal were not political in the narrower sense. His defection was more due to Freud's extending his concept of drives to include social aspects: the drive for recognition, for instance (see Cap. 3). Adler named his school, which had strong social-psychological traits and was particularly popular among educators, - something of a misnomer for a social-psychologically oriented approach.

In addition to his children, Alexandra and Kurt, Adler's immediate followers included Meiers, Starr, Raymond J. Corsini, and, in Germany (though he lived in the USA from 1937 on), Rudolf Dreikurs. Adler's ideas had such an influence on Freud's followers and , as well as , that according to Dienelt (1973) these three could just as well be called neo-Adlerians as neo-Freudians. Some elements of Adler's theory are also found in a few of the other schools presented in this volume. Both the of Fritz S. Perls (1893-1970), a disciple of Karen Horney (but also of Freud's follower ), and 's rational-emotive therapy (RET) owe a particular dept to Alfred Adler.

Things went pretty much the same way for Adler, incidentally, as they did for Freud: his followers and friends broke away from the movement and started their own schools. Rudolf Dreikurs and Alexandra Adler broadened the theory and directed it more toward group therapy and work in youth welfare, while Fritz Künkel ("character science"), Johannes Neumann, and Rudolf Allers strayed even further from Adler's approach. The founder of , Viktor E. Frankl (born 1905), initially a follower of Adler and Allers, was even barred from membership of the Society for Individual Psychology in 1927, along with Allers.

1.5.2 Carl Gustav Jung The controversy with Carl Gustav Jung (1875-1961) was as important for Freud and the burgeoning of new directions in psychotherapy as was the break with Adler and the splitting off of individual psychology. In 1913, the discord between the two resulted in Jung's quarrelling with Freud and starting his own school of .

Jung was from 1900 to 1909 assistant to Eugen Bleuler (1875-1939) a the Burghölzi Mental Hospital in Zurich. It was not until 1907 that he joined Freud and his Wednesday Society. In 1912, Jung's book Symbols of Transformation (1912/56) (original German title Symbole und Wandlungen der Libido) was published, in which the term "libido" was extended from the narrow context of sexual energy to include mental energy. For Jung, the unconscious formed the "creative matrix of the conscious," and comprised both personal contents originating ontogenetically - the - and collective contents inherited phylogenetically - the collective unconscious.

At the Fourth Congress of the International Society for Psychoanalysis held in Munich in 1913, Freud sharply attacked Jung's book. Although Jung was reelected President of the Association for another 2 years, the rupture had taken place (and Jung, regrettably, did not abstain from racist polemics against Freud during the Third Reich). Jung continued to call his theory analytical psychology, and later complex psychology, into which he also incorporated religious and mystical concepts (see Chap. 4).

In contrast to Adler's individual psychology, Jung's complex psychology has not broken down into subschools - one reason being perhaps that Jung lived until 1961. Dienelt (1973) mentions only Hans Trüb, a student of Jung's who went beyond his teacher's approach and developed a more metaphysical view of man. For Trüb, the Beziehung zum Du, the personal encounter in interpersonal contacts played an essential role in man's relation to the world (an important concept in humanistic psychology; see Chap. 12). Another important follower of Jung's who also went out on his own in the area of depth psychology of the female and of the creative individual was Erich Neumann (1905-1960). Gustav Richard Heyer (1890-1967), a pupil of Jung's and cofounder of , was long considered a representative Jungian psychology in Germany. The connection between the ancient Eastern schools of wisdom and Western psychotherapy that was central to Jung's work is found in the work of Jung's disciple Hans Jakob; the circle around Karen Horney also assimilated these elements (Dienelt 1973 p.40).

1.5.3 Other Followers

Wilhelm Stekel (1868-1940), coeditor of the Zentralblatt für Psychoanalyse, withdrew from Freud's Psychoanalytic Society in Vienna in 1912, i.e., even before Jung did. The causes of his disagreement with Freud, apart from his rejection of the libido theory, were the technique of analysis and the interpretation of dreams. Stekel developed a short form of psychoanalysis which he called active method.

Other disciples of Freud parted company with their mentor in a less spectacular fashion than Adler, Jung, and Stekel. Nevertheless, almost all of them developed ideas that differed from Freud's (this was often a fertile source of controversy) and thus became the founders of new schools of therapy, which grew away from their origins to become independent forms of Freudian psychoanalysis.

Freud's theory was passed on in its "purest" form by (1898-1946), who until his premature death made great efforts to preserve psychoanalytic theory against more biologistic (e.g., ) and environmental- theoretical (e.g., Karen Horney) modifications.

A close follower of Freud's was (1877-1925). Abraham did a great deal for the theoretical and institutional propagation of psychoanalysis in Germany. Originally a intern under Bleuler in Berne (1904-1907) and introduced to Freud by Jung, Abraham started private practise in Berlin in 1907 and a year later founded the Berlin Psychoanalytic Society, an association analogous to the Vienna Group. After World War I, he founded the Psychoanalytic Polyclinic and Training Institute, where many famous analysts were trained and some of them taught. The first official "trainee" was Franz Alexander (1891-1964), who made important contributions to the development of psychosomatic medicine. Melanie Klein (1882-1960), Karen Horney (1885- 1952), and were analyzed by Abraham, and Erich Fromm (1900 - 1980), (1896-1970), and René Spitz (just to mention a few of the analysts who have become well known) came from this institute. Abraham was known particularly for extending the theory of libido and breaking it down into six stages, and for his contributions concerning character development and the psychoanalytic treatment of psychotic psychopathology.

Another follower and long-time close friend of Freud's was Sandor Ferenczi (1873-1933), who did a great deal for psychoanalysis in Budapest both theoretically and institutionally. As a counterpart to Abraham's theory of stages in the development of the libido, Ferenczi worked out stages in the development of the sense of reality, starting from the unconditional omnipotence of the intrauterine experience and going up to realistic thinking and acting. He had differences with Freud because of his therapeutic technique, in which he mothered and pampered patients whose ego he thought needed strengthening. Probably Ferenczi's most famous follower, Michael Balint (who also began his psychoanalytic training in Berlin), dealt with object relations in early childhood long before René Spitz. He developed a theory of regression and stressed strengthening the ego (ego pedagogy) to overcome the "crippled ability to " of many patients. The Balint groups also became famous: these were training and supervision seminars for doctors (and later for psychologists, marriage counsellors, and social workers) with a strong emphasis on personal experience and role-playing during the case discussions.

1.6 The (Further) Breakup of the Psychoanalytic Movement

Freud himself expended a great deal of energy on organizing and spreading the psychoanalytical movement. In 1912/13, the suggestion of his English disciple (1879-1958), he formed the so-called Komitee, the initial members of which, along with Freud, were five close followers of psychoanalysis: Karl Abraham, Sandor Ferenczi, Ernest Jones, , and Hanns Sachs. In 1919, Max Eitingon joined. The task of this committee was to take charge of the further propagation of psychoanalysis, to relieve Freud of some of the load, and to protect him against the outside world. This close group around Freud were in communication from 1920 on through memos that went out from Vienna (Freud and his personal secretary, Rank) to Berlin (Abraham, Sachs, and Eitingon), London (Jones), and Budapest (Ferenczi). Freud had given each member of the group an antique Greek intaglio set in a ring, for which reason the group also became known as the "ring bearers."

In addition to the growing differences between the theoretical views, the political situation also ensured the further breakup of the psychoanalytic movement. In Germany and Austria it was just about completely destroyed under national socialist (Nazi) rule. The Psychoanalytischer Verlag, the publishing house with offices in Vienna and Leipzig, was closed down; the books were carried away to be destroyed.

Since Freud and many of his followers were Jews, they were forced to emigrate - as were many of their relatives - in order to escape torture and death in the concentration camps. Almost all went to England or America, which explains why there has been such a strong Anglo-Saxon influence on psychoanalysis, and still is today. Freud emigrated to London in 1938, accompanied by his daughter and pupil, Anna (1895-1982), who became known for her work on defense mechanisms and in child analysis. Freud probably chose England because it was the home of Ernest Jones, his disciple and biographer. Jones had already, in 1926, summoned to his side Melanie Klein, who like devoted herself to child psychoanalysis.

Most of the European analysts emigrated to the United States: Heinz Hartmann (1894-1970) and Ernst Kris (1900-1957), both of whose main contribution to psychoanalysis was their work in ; René Spitz (1887-1970), who became known for his observations of infants and for establishing a theory of the stages in the development of an object relationship; and (born 1902), who (with others) formed the New York Group. Karen Horney and Erich Fromm also emigrated to New York; however, they broke with classical psychoanalysis and redesigned psychoanalytic theory along the lines of twentieth-century social psychology. In 1943, together with Harry Stack Sullivan (1892-1949), Horney and Fromm started a school of neoanalytic psychiatry in Washington DC.

These names (along with those of Adler and Jung) herald developments of depth psychology that strayed still further from Freud's concept. While the "Freudians," despite differences among themselves adhered in the main to their libido theory, to the genetic developmental dynamics of the individual, and to Freud's instinct and affect theory, "Neo-Freudians," or the "neo-analysts" (Horney, Fromm, Sullivan, Rado, and others), played down the significance of the libido theory and the role of sexuality, attaching greater importance to the social, cultural, and political factors in the development of an individual. In Germany, neo-analysis is associated with the name of Rado's pupil, Harald Schultz-Hencke (1892-1953), who strove to reconcile the views of Freud, Adler, and Jung (and who also advocated reducing the time spent in analysis to 150- 200 h a fraction of the usual period).

1.7 Further Influence of Freud on Schools of Therapy

A further current of depth psychology consisted of more philosophically oriented therapeutic concepts, the advocators of which, although they knew Freud well, did not belong to his close circle of followers. One of these was Viktor E. Frankl, who is actually more regarded as a (later rejected) disciple of Adler's, but who also corresponded with Freud for quite some time. Frankl's logotherapy, which focuses on the quest for meaning, is also referred to as the Third Viennese School of Psychotherapy (see Chap. 15).

Ludwig Binswanger (1881-1966), the founder of existential analysis, was also friends with Freud for years, a relationship marked by frequent visits and a lively correspondence. Binswanger too had come from the Burghölzi and had received his doctorate under Jung. The second major supporter of this school, Medard Boss (born 1903), had even been analyzed by Freud. Binswanger had already been influenced by the philosophy of Edmund Husserl (1859-1938) and - even more - by Husserl's pupil, Martin Heidegger (1889-1976). The main goal of his psychotherapeutic treatment is to gain an understanding of the structure of human existence, and to regain the power of disposal over one's own inherent existential possibilities.

Another of Freud's followers, and a major influence in the development of what are known as the body therapies, was Wilhelm Reich (1897-1957). Reich taught that the libido was not limited only to the erogenous zones, but filled the entire body (see Chap. 5). Reich also supported socialist ideas and later carried out spectacular and highly controversial scientific experiments (particularly in connection with orgone energy, a concept he invented). These two activities led to the start of an unparalleled campaign in America in 1954/56 in which, under the pretext of economic and health-political reasons, all of Reich's books were banned, his "orgone accumulators" destroyed, and his writing burned before the eyes of members of the government - 21 years after the Nazis had burned Freud's books in Berlin. Reich died in prison.

From Freud through Rank the line finally also leads to (1902-1987), the founder of client-centered therapy. Rogers was the first to carry out intensive empirical research on the processes in psychotherapy and on the qualities needed in a psychotherapist.

Freud and psychoanalysis also had an influence on humanistic psychology, although this was considered a third major independent psychological movement (we cannot call it psychological theory because of the heterogeneity of the concepts subsumed under it), after psychoanalysis and behaviorism, with its offspring behavior therapy. In the spirit of humanism and existentialism, humanistic psychology perceives man anew in his daily social reality, as a unique, organic, meaning-oriented whole striving for self-actualization and autonomy within society (see Chap.12).

These elements were particularly emphasized in the schools of humanistic therapy to which several of the approaches presented in this volume belong: Rogers' client-centered therapy, Perls' Gestalt therapy, Moreno's (which itself, largely independently of Freud, had a strong impact on humanistic psychology; see Chap. 12), Frankl's logotherapy, Lowen's bioenergetics, and Berne's . However, no really hard and fast line can be drawn around the "humanistic approaches": they are at many points closely interwoven with psychoanalytic concepts, as is evident from the fact that in this book some of the "humanistic" therapeutic approaches named above are included in the part on depth psychological theories. The neoanalysts Horney, Fromm, and Sullivan are also regarded as representatives of humanistic psychology. Adler and Rank (along with Moreno) are considered to be forerunners.

Recently, another heterogeneous group of therapies has come to the force. The common denominator of these therapies is that they all focus not on the individual but on the family. They regard the person who according to conventional conceptions is "sick" and in need of therapy merely as the "index patient," the immediate manifestation - the symptom bearer - of the sick system. A similar thing happened here as with the humanistic therapies: out of a variety of perspectives and therapy concepts there developed, almost simultaneously, one underlying, broadly unified viewpoint and intent, for which a single name can be justified - . Some further developments in psychoanalysis also belong to this group of theories. These developments applied Freud's psychoanalytic concepts more to the structure of systemic interactions (Chap. 19).

1.8 The Family Tree of Psychotherapy

In this chapter, I have attempted to trace the roots of psychotherapy along a central line of development characterized by Freud and psychoanalysis. Undoubtedly, there were persons and theories in the area of psychotherapy who were hardly or not at all affected by this development and who nevertheless made major contributions to psychotherapy overall as we know it today. These include large sections of behavior therapy (determined in its essentials by Skinner, Wolpe, and Eysenck; see Chap. 8) and subgroups of systems and family therapy (e.g., the Palo-Alto group led by Bateson, Watzlawick, Satir, and others; see Chap. 16). Jacob Moreno (1889-1974) deserves special mention. With his theoretical concepts and therapeutic approach (psychodrama), Moreno is not only to be considered a pioneer of humanistic psychotherapy, but has also achieved sociological importance with his theory of sociometry (see Chaps. 12,15). Surprisingly, although he worked as a psychiatrist in Vienna until 1925 (and then went to America), he stayed pretty much out of the realm of influence of Freud and psychoanalysis.

Integrating these and other important roots of psychotherapy into this introductory chapter would have disrupted the continuity, which, as it is, has been only barely maintained. Some aspects, therefore, are discussed for the first time under the therapeutic approaches concerned (particularly in Chaps. 5, 12, 16). The same restriction applies to the "family tree" shown in Fig.1.1, which traces the lines of influence between the various schools.

This diagram attempts to give a clear representation of the relationships that were most important for the development of psychotherapeutic concepts (largely confined to depth psychology). Naturally, there are many other important contacts, encounters, and influences between the persons listed (and others not listed) that could be mentioned, which have been left out for the sake of clarity. , for example, the founder of Gestalt therapy, was granted a cool "four-minute audience" with Freud in 1936, and his presentation on "oral resistance" at the Psychoanalytic Congress the same year was more or less a flop. He understandably had expected a more amicable reception, since he had just founded an institute for psychoanalysis "for Freud" in South Africa. This was an essential factor in Perls' defection from psychoanalysis and in the development of Gestalt therapy: he himself said he was deeply grateful that in rebelling against Freud he had been enabled to develop himself so far (Perls 1969).

However, such and other relationships are not included in Fig.1.1, and in fact the selection is further restricted by the particular perspective chosen. The diagram has been designed chiefly from the angle of Freud's influence on the founders of other schools of therapy. An alternative angle would have been, for instance, the influence of the different schools of philosophy and their theories.

(Fig. 1.1. from Kriz´-book)