I “discovered” Freud as a high school student, in the years that were not eaten by locusts, to use the expression of the well-regarded Serbian novelist Borislav Pekic. For me, these were years of intense growing up, of seismic movements in the deep layers of the mental field. My inner self mostly remained interior landscape unknown to the world. I did not have a partner to establish a relationship of trust on the intimate level, where information is exchanged that either resides in a virtual subjective space or is written on diary pages kept under lock and key, hidden under a mattress, or in some other secret place. I found relief from the need to understand the unmanifested in the way available to me, by reading books. Unrestrained freedom of choice revealed the personal worlds of others written on the pages of novels, stories, and poems. I remember the feeling of detachment and timelessness behind the closed door of the room, on the couch that housed my outstretched body immersed in a physical object held by hands and read by eyes.
In those days and nights, I met Freud for the first time. I well remember the set of selected works in a hardcover dark orange binding. It was sitting on the shelf of the National Library in Pancevo. I pulled out a book Introduction to Psychoanalysis. I thought if an introduction is in the title, it must be the best way to start reading Freud. And I wasn’t wrong. Intuition led me in the right direction. It was written for lay people in the form of lectures, in the velvety style of the master narrator. Concepts that logically build a house of cards (or steel) of the psychoanalytic theory of neuroses, dreams, and errors of speech are easily presented. For me, as the saying goes, a balm for the soul, an in-depth psychology of revelation, a scientific presentation of Viennese middle class sexual preoccupations at the turn of the century; an unknown environment in which I recognized myself. An adolescent with erotic tension and thoughts finds an intellectual home and explanation of sexual drive as the leading energy (libido) in the psychology and psychopathology of everyday life, without shame and disgrace, evolutionary and civilizational inevitability present in all pores of society, though often hidden or denied.
And now what? I threw myself with all the passion of the Slavic soul to understand the personality of Freud. I read a lot and identified myself with him even more. I searched for and found a strong male figure whom I admired for the courage to dive into the depths of his soul and, through self-analysis, emerge with the discoveries he presented to the conservative Vienna Medical Society, which had viewed him with suspicion because of his Jewish origin. Over a period of ten years, he underwent an intensive personal, clinical, and intellectual development that transformed him from a scientist and neurologist to a clinician, psychiatrist, and scholar. In his relatively long life, he never stopped revising and editing his theories, although many accused him of dogmatism and rigidity, which speaks more about his followers than about Freud. It is true that he endeavored to preserve the main premises of his theory, but he remained curious and open to the contributions of science. He was broadly educated so that psychoanalysis had easily grown from a method of treating mental disorders to a civilizational phenomenon evident in language, art, literature, social and natural sciences.
Freud helped me to get to know and understand myself better and to find a guiding post that would direct my mental energy in a certain direction. His theories and psychoanalytic method of treatment were popular in the former Yugoslavia. I became a member of a tribe with which I identified and found a common language. I possessed knowledge that separated me from the “ordinary man” and gave me confidence (almost an arrogance) in understanding everything that exists. The circularity of this nearly closed school of thought sometimes aroused my skepticism, but the seduction and reliance on more experienced members of the psychoanalytic family were too appealing and satisfied my need for belonging. Of course time does its thing. The expansion of horizons and knowledge strengthened objectivity and critical thinking and reduced the “infatuation” with classical, Freudian, psychoanalysis. I wanted to enroll in the postgraduate training after completion of Medical School and to continue education in the field of psychodynamic psychotherapy, a child of psychoanalysis, but the need to find a job and provide financial support for the family thwarted those plans. When I was interviewed for a job in America, I almost didn’t get it due to my interest in psychoanalysis because it had lost relevance it had in previous decades.
Despite my own evolution as well as a pendulum shift in psychiatry, I still believe that there are many lasting merits of Freud’s psychoanalytic method. I am personally enriched and professionally better equipped due to my “first love”. I owe to psychoanalysis the orientation towards psychotherapy and the understanding of the importance of the unconscious, transference, and defense mechanisms, to single out these three concepts which I will briefly present in the continuation of the text.
Freud placed the study of the unconscious at the center of the treatment of neurosis because he correctly understood the power of instinct, desire, timelessness, irrationality, and dominance of this psychic structure where the principle of pleasure rules and social and objective reality is an unknown component. He used the metaphor of an iceberg to pictorially depict the mass of the unconscious immersed in the inaccessible depths of the psyche such as an iceberg largely drowned beneath the surface of the ocean. Freud writes: “We live in the shadow of a forgotten past that colors the present. The first decade of life is a time of intense drama that has been largely repressed. Some of these experiences are based on fantasies rather than real events.”
Manifestation of the unconscious through the symptoms of illness and dreams is proof of its existence, and the method of free associations and interpretations is a way of gaining insight into fears, motives, immoral aspirations, shameful and traumatic experiences, and other repressed contents unacceptable to Ego anchored in time and space of the surrounding culture to whose requirements it is constantly adapting to. Just as Copernicus dealt a blow to human narcissism by moving our planet from the center of the universe, and Darwin did not give us a special place in the living world, Freud proved that man is not even the master of his “own house.” Unconscious processes determine our thoughts, feelings, beliefs, and behaviors. The contents of the unconscious are basically inaccessible, and are revealed to us only through dreams, slips of the tongue, mannerisms, and illness. Symptoms and behaviors are overt representations of unconscious instincts, fantasies, conflicts, and fears, which are unacceptable or unbearable for the conscious mind.
The most important aspect of psychoanalytic therapy is transference analysis. The first relationships in a child’s life are with people who are consistently present in its surrounding. These are usually parents, siblings, and other family members. The child establishes emotional relationships with them and as an adult tends to transfer those same emotions unconsciously and compulsively to the important people in the present life. When the patient comes to psychotherapy, the psychoanalyst creates the conditions for these emotions to be expressed as strongly as possible towards him (so-called transference neurosis) so that they can be analyzed and resolved because they represent the most important problem for the patient. The reverse process, countertransference, also occurs during therapy in which the psychoanalyst unconsciously responds to the patient and especially to his transference. This is a very demanding process and requires education and especially the training-analysis in which the future psychoanalyst undergoes psychoanalytic therapy in order to experience transference and countertransference reactions on his own skin. In addition, supervision by an experienced analyst must be practiced for many years.
A brief example of the transference is described in a recent article. A third-year medical student was treating a hospital patient ready to be discharged. Then the student fell ill and missed a day of work at the hospital. When he returned the next day, the patient was unusually irritable and depressed and claimed she was not ready for discharge. Our student was confused by this sudden change. The patient began to talk about the history of rejection by boyfriends, as well as the relationship with the older brother characterized by her unrequited desire for closeness with him. All of a sudden, the student realized that she experienced his absence as another rejection and thus transferred previous feelings for important others to him.
I did not undergo training analysis, but I was supervised by psychoanalyst, which helped me in my work with patients. Knowing the importance of transference and countertransference, I have always monitored the reactions and behaviors of the patient as well as my own emotions and used these observations in therapy. Positive transference is useful as well as controlled positive or neutral countertransference. The problem arises when negativity is the dominant state and dangerous if the transference / countertransference becomes eroticized. This happened to many psychoanalysts in the early years of psychoanalysis and rarely ended well if it was not recognized or was misunderstood as “true love.” I encountered situations of a similar nature but fortunately I have acknowledged the nature of such feelings and reacted in a therapeutic way. Sadly, several of my colleagues did not understand the power of transference and countertransference, which led to catastrophic outcomes. I think Freud’s courage to look into “transference love” objectively had led him to the important discovery. He recognized the importance of the relationship with the patient and the therapeutic benefits when that relationship is properly analyzed and directed.
The last concept that I will briefly addressed is the defense mechanisms, the self-deceptions of the mind that provide various illusions for filtering pain and calming the unbearable anxiety. Defense mechanisms are involuntary mental regulatory processes and strategies. They can change internal psychological conflict by denying or distorting the original desire or need, conflict with people, reality, or conscience. Defense mechanisms are for the mind what the immune system is for the body. As such, they serve to regulate the disturbed state, but if not used wisely, they lead to an untoward outcome in a similar way an overreaction of the immune system is unhealthy, and development of the autoimmune diseases could be disastrous. Much of what is referred to as mental illness simply reflects the unwise use of defense mechanisms. They are divided into psychotic, immature, neurotic and mature. Psychotic defenses profoundly change the perception of external reality. Immature defenses are used by people with severe character disorders. Neurotic defenses are encountered in neurosis and under acute stress. They are the most common defenses encountered by psychoanalysts. Finally, mature defenses are seen in healthy people because they integrate reality, interpersonal relationships, and private feelings. Mature adaptive defense facilitates healing, not disease. An appropriate response keeps us healthy by reducing strong emotions or pain without anesthetizing them, redirecting the feelings instead of blocking them, orienting towards a long-term goal rather than offering a temporary solution, and attracting people instead of repelling them.
For contemporary mental health professionals, defense mechanisms are the least understood concept of psychoanalysis. We all have them. They are built into the matrix of our mental apparatus, hidden in the deep recesses of the mind, deployed imperceptible without awareness to protect us from the overwhelming power of emotions and realities of life. In meeting with patients or acquaintances, we can see them in action, but we must not use this insight carelessly, because the defense they use is purposeful and uncovering it can do more harm than good. A careful approach is necessary using the tools of confrontation, clarification, interpretation, and elaboration. Regrettably, I have to confess that I often witnessed when professionals respond to patients using their own defense mechanisms rather than the above mentioned and proven therapeutic techniques. The rule of thumb is that if the defense mechanism used by a person is more intense, rigid, exclusive, and lead to distortion of reality, the reason for the defense is more urgent and the person is more vulnerable and unable to cope without it, hence extreme caution is necessary.
In this brief account, I focused my attention to the profession of a psychiatrist as it relates to the contribution of Freud to the field. I didn’t discuss many other important elements of Freud’s psychoanalysis such as the theory of personality, the psychosexual development and infantile sexuality, the Oedipus complex, Eros and Thanatos, and so on. Many of his conceptualizations have become obsolete or are discarded. Also, this text would get too long and that is not my intention, so I will stop here with the remark that the beard, I have been wearing since the end of high school, may also be my debt to Freud.