We’ve covered a variety of topics in this series, such as perception,
morality, and social psychology, to name a few. One thing we haven’t talked a lot about
yet is the realm of clinical psychology. This branch of psychology is concerned
with the assessment and treatment of mental illnesses. In many schools,
general psychology and clinical psychology are completely separate programs. As we’ve seen,
general psychology researches a lot of different topics, while clinical psychology tends to be
much more focused on training therapists to help people and researching mental illnesses.
Over the next two tutorials, we will go through a very brief overview of clinical
psychology. First we will introduce Freud, the most famous figure in the history of psychology,
and his invention of psychoanalysis. Then we will examine modern-day therapy.
Sigmund Freud was born in 1856 in the Austrian Empire. He went to the University of Vienna,
where he studied philosophy, physiology, and zoology. He actually did a lot of work while at
school on the biology of nervous tissue in humans and other animals, and his research paved the way
for the discovery of the neuron. Freud became a doctor in 1881 and began his medical career
at the Vienna General Hospital in 1882. In 1886, Freud started a private practice specializing in
what was known at the time as “nervous disorders.” This would have encompassed things like depression
and anxiety. By 1896, he was using the term “psychoanalysis” to describe his method of
treating patients and the underlying theories. So how did psychoanalysis work in treating mental
illness? The goal of psychoanalysis was to bring repressed thoughts and feelings to the surface. In
acknowledging and understanding these repressed feelings, a patient would be cured of their
mental illness. One way Freud attempted to uncover repressed feelings was through “free association.”
Essentially, the patient was told to talk freely about whatever ideas or memories came up.
They were not supposed to think about these ideas or attempt to judge them in any way,
simply experience them. In this experience, repressed thoughts and feelings were supposed
to come up to the conscious level. In addition to free association, Freud would analyze the
dreams of patients as another way of uncovering and understanding the thoughts that the patient
was unconsciously repressing. Transference was another important component of psychoanalysis.
This is when the patient would redirect their feelings for someone in their life
towards their therapist. Did the patient have issues with a parent? If transference occurred,
they may start treating their therapist as their parent and feel angry or frustrated with them.
In recognizing the transference relationship, the therapist and patient can explore meaning
and thoughts behind the relationship. They even use transference to solve conflicts the patient
has with people they used to know, through a kind of role-play. Overall, by making the unconscious
become conscious, Freud believed that we can be cured of things like anxiety and depression.
But what about the theory behind psychoanalysis? Clearly, the unconscious mind was key to Freud’s
beliefs. This is the part of the mind which is inaccessible to the conscious mind, which is your
active awareness, but still affects behavior and emotions. His theory of unconsciousness began with
the theory of repression. In his view, there was a cycle of thoughts. Thoughts would be repressed but
not erased from the mind. These repressed thoughts could impact behavior, and in some cases, actually
reappear in the conscious mind. Freud ultimately believed that the unconscious mind impacts every
action we do. For instance, he believed that the unconscious is what drives misspeaks. Basically,
these “slips” reveal our true thoughts that are hidden in the unconscious. You might say
“vaginal” instead of “virginal” when reading aloud in class. Freud would say that this slip
means you are repressing sexual thoughts, and this misspeak brings these thoughts to consciousness.
We even refer to such errors as Freudian slips. Again, dreams played an important role in Freud’s
theory. He believed that dreams were the “guardians of sleep.” They were a way for
the mind to fulfill repressed wishes without waking the dreamer. Each dream, in other words,
is made up with the manifest content of the dream, or what we remember, and the latent content, which
is the underlying wish. Because the latent content is in many cases upsetting or anxiety-producing,
the dream changes the wish into something more acceptable. This lets us continue
sleeping while fulfilling our repressed wishes. In performing free association with our dreams,
Freud believed that we could come to understand our repressed thoughts and fantasies.
Now we talked briefly about Freud’s beliefs regarding the psyche when we discussed the history
of psychology. As you may recall, Freud believed the psyche was made of three parts: the id, ego,
and superego. The id is the completely unconscious part of your psyche. It is impulsive and
childlike, constantly seeking immediate pleasure and gratification. The id, according to Freud,
is the source of our basic impulses. It has no grasp on reality or that there are consequences
for actions. The id just wants. The superego is the moral component of our psyche. We can think
of it as the conscience of the mind. The superego can distinguish between reality and illusion,
and knows the difference between right and wrong. Freud believed that without the superego,
people would have no way of knowing what actions are immoral. Then the ego’s role is to create a
balance between the impractical, pleasure-seeking id and the impractical moralism of the superego.
The ego is what directly controls most of our actions. It seeks out pleasure while
at the same time understanding that reality will not let all of our desires be fulfilled.
Freud believed that each element of our psyche is incompatible with the others,
so they will inevitably come into conflict. To protect itself from becoming overwhelmed, the ego
can use various defense mechanisms. This could be things like denial, like when a smoker denies that
smoking is bad for their health, or displacement, which is when you satisfy an impulse with a
substitute object, like if someone were to kick a dog when they really want to punch their boss.
Freud also had a theory of psychosexual development. As a disclaimer, this aspect
of his work is quite controversial and not really supported by the field anymore. But
as we are discussing Freudian theory, our examination would be incomplete without it.
Essentially, Freud believed that children are born with a libido, or an urge for sexual pleasure.
As a child develops, they go through different stages where they seek pleasure from different
objects. First is the oral stage, which takes place from birth until about 18 months of age.
In the oral stage, infants seek pleasure through their mouths. There is a fixation on tasting and
sucking as a way of producing pleasure. A person who is fixated, or stuck, in the oral stage may
develop habits like thumb-sucking and over-eating. The oral stage is followed by the anal stage,
which lasts until one reaches three years old. Instead of the mouth, the child’s pleasure-seeking
centers are the bowels and bladder. Children in the anal stage get pleasure from defecating.
The anal stage is also when the ego is supposed to develop. At this stage, a child understands that
they are their own person and that their desires could put them in conflict with society’s demands.
Once through the anal stage, one reaches the phallic stage. As you might guess,
the pleasure center in the phallic stage is the genitals. According to Freud, this is the stage
where children discover masturbation and realize that there are anatomical differences between
sexes. Between five or six years old and puberty, Freud believed children were in the latency stage.
In this stage, there is a reduced sexual interest and activity. There are no pleasure centers in the
body, and children can develop social skills and find pleasure through interactions with friends
and family. The final stage of psychosexual development is the genital stage. The genital
stage lasts through puberty and ends at adulthood. In the genital stage, we experiment sexually with
others. The genital stage ends when we are in a loving, stable relationship with another person.
Freud argued that neurosis and perversion were the result of people getting stuck in or regressing
to one of these previous stages. If a person can get to the genital stage and remain there,
they will be a well-balanced, healthy adult. Another important component of Freud’s
psychosexual development theory is the Oedipus complex. The Oedipus complex is named after the
Greek mythological figue of Oedipus, a man who accidentally killed his father and married his
mother. The Oedipus complex describes a conflict of jealousy and fear in boys and begins during
the phallic stage. When a male child displays this complex, the young boy wants to be the
sole possessor of his mother for pleasure. To do so, he wants to get rid of his father. But the boy
also thinks that if the father were to find out about his desire for his mother, his father would
take away what the boy loves most, his penis. So now the boy has castration anxiety, and is
worried that the more powerful man in the house, his father, will take away his penis. Boys resolve
the Oedipus complex by imitating and mimicking masculine, fatherly behaviors. According to Freud,
this is how boys take on the male gender role. In girls, a similar complex is called the Electra
complex. This complex is a little less fleshed out, however. Essentially, a young girl develops
penis envy and wants to be a boy. Why? Because she desires the father but realizes she can never have
him because she doesn’t have a penis. To resolve the Electra Complex, the girl substitutes her
desire for a penis with a desire for a baby. She also blames her mother for her ‘castrated state’,
which causes tension. She removes the tension by repressing her feelings, and ultimately identifies
with the mother to take on the female gender role. So, that was quite a lot. And once again, to be
perfectly clear, most experts of today do not believe any of these aspects of Freudian theory.
For instance, Freud believed that the ‘proper’ sexual outlet is heterosexual intercourse,
which certainly is no longer regarded a legitimate sentiment. Most people also
think that the Oedipus and Electra complexes are largely nonsense. In addition, Freud was very
good at making up stories, but not a lot of them were scientifically testable. While his stories
could explain behavior, they couldn’t predict it. His theories are largely unfalsifiable.
Since we can’t test them scientifically, we can’t demonstrate them to be true or false.
Still, Freud represents an important part of how we understand psychology and treat mental
illness. Some of his ideas have some truth, as oral and anal personalities do seem to exist,
and depression and anxiety can be treated in part by free association and open dialogue between
a therapist and patient. Therapists today may use psychoanalysis as a way to uncover
hidden thoughts and feelings. Regardless, psychoanalysis has become overshadowed by
cognitive psychology and more biologically relevant ways of treating mental illness.
We’ve only scratched the surface on Freud and his beliefs, but as we will see in the next tutorial,
some aspects of psychoanalysis are still present in therapy today. Freud wasn’t
perfect or right about everything, but he and his followers gave psychology an excellent start.