Sigmund Freud was mentored by Jean-Martin Charcot, a renowned Psychiatrist of his time. He was the first to use hypnosis in treating patients that were diagnosed with hysteria. However, Freud abandoned the practice later in his career, finding it to be ineffective. Freud's own success came from dealing with patients who had psychosomatic illnesses. He theorized that the symptoms, which these patients were experiencing, were due to repression of sexual desires. Consequently, Freud postulated that treatment of these symptoms was by bringing these suppressed desired into the conscious mind.
Freud's work has generated a lot of controversy, especially among feminist groups. They view Freud's work as a sexist. However, newer theories into human sexuality are still based on the original Freudian theories. These opponents are particularly offended by the use of the term "normal". They argue that normal is subjective and thus Freud's work is flawed. Freud did also observe that people with "normal" sexual tendencies were not normal afterall. He claimed that there was no normal sexual behavior. On the issue of pedophiles, Freud had an interesting observation. He characterized such perverse feelings as originating form fear. For instance, animals, which were unable to mate successfully with others, would take their frustrations out on young ones. Thus, he observed that pedophilia was not innate but rather grew out of fear.
Despite the major flaws, Freud does make a number of important points. This work was based on famous sexologists of his time. He read their theories and observed their work before coming up with his own theory. The first part of this work is dedicated to studying sexual behaviors that were not "normal". In his work, Freud observed a number of different sexual orientations, which he had observed such as homosexuality and bisexual tendencies. Freud observed that some of this individuals have always had this attraction since birth while others developed this "condition" after a certain trigger.
Sigmund Freud was the first to give detailed description of how children experienced sexual pleasure. He described that children experience pleasure through mechanical processes such as being flung in the air. He claimed that the sense of fear they experience followed by a sense of calmness was an intense source of sexual pleasure. In his work, Freud also suggested that children had specific erogenous zones through which they would experience sexual pleasure. For instance, the act of a child sucking on their thumb was for sexual pleasure. He also postulated the anal area could be converted into an area of sexual pleasure where the child experiences pleasure by exerting pressure.
On his explanations on the stages of sexual development in children, Freud claimed the first stage was borne out of curiosity. A young boy will wonder why they are built different from girls. He also suggested that girls on discovering they do not have a penis develop what he termed as "sexual envy". Freud suggested that this early developments in the child of a life had a great influence on them later on in life. He suggested boys would develop a fear for their father and thus try to mimic him in an attempt to appease him. This fear was the fear of castration. According to Freud this fear came out of sexual desire for his mother. He also postulates he discovery of the penis to be the origin of misogyny. Freud suggested that when the boy made the discovery that the opposite sex lacks a penis, he would henceforth look down on the as lesser men. Freud suggested that later on, this feeling would disappear but re-emerge later in puberty. At this stage, the person's sexual desire and relationships would be staged by the early stages of development. One of his wildest claims was that the desire for intellectualism was driven by sexual desires.
The essays also do briefly touch on sadomasochism. He explained that the drive men had to be aggressive was rooted in more than a desire to mate. He postulated that men were driven by the dire to completely dominate the female in every way. He also observed that this trait was common in most men. However, it existed in varying degrees among different men.
The original Freud theories have been revised over the course of more than a hundred years. Although most of his work has been disproved. He did make some very progressive a point for a man of his time. For instance, he gave an explanation to what were seen as perverse sexual nature of people at the time. In essence, Freud was challenging the long held notion that all sexual desire came from a biological desire to mate. Here in lies the contradictory nature of Freud's work. Although he clearly described sexuality developing independently from a desire to mate, he still viewed it as perverse. Freud also viewed sexuality as fluid and not fixed, thus it developed over the course of an individual's life.
From the aforementioned summary, it is quite clear that Sigmund Freud was obsessed by development of human beings as rooted in sexuality. However, his work does raise some interest. For instance, Freud's attributes the rise of monotheism and the strong hold it had at the time to psychosexual development. In addition, Freud attributed the ease with which strongmen in most states at the time ruled with absolute authority to development of human sexuality. His work was controversial during his time and still is even today. However, Freud's contribution to modern psychoanalysis is not in doubt.
The word on the street is that psychiatry has lost the mind in its quest for the brain. Is discussing this paper going to change that? My task is simply overwhelming. First, I will review the essay. Then, I will find my teaching points.
According to Freud, this essay was his second most important work (the first being The Interpretation of Dreams). In this essay he states that sexual tension promotes development from infancy through adulthood. For turn of the century Vienna, this was a revolutionary concept. He describes that the sexual experiences from 0-5 create the underpinnings of personality, yet are also sequestered from narrative memory. At 5, the child enters a period called latency in which dams in the form of disgust, shame and morals, allow the child to enter into a period of learning at school. Freud, ahead of his time, said that these dams are "organically determined". In essence, our DNA (yet to be discovered) creates a latency period so that a child can learn in school and not be preoccupied by sexual urges. This sexual energy gets buried and then resurfaces in the form of productive activities. Freud calls this reaction formation and sublimation.
His evidence that sexual forces occur throughout life is based on the child's way of self-soothing. He points to thumb-sucking as an example of a rhythmic repetition of a sucking contact by the mouth. The baby has transformed the location for nourishment into the location for sensual pleasure. This constitutes the oral phase of development. Likewise, the anal zone is transformed from an area responsible for somatic functions into an area where control can be exerted and the child can feel a sense of power.
Children can find sexual pleasure in a variety of ways. Freud said that children have a "polymorphously perverse disposition". Instincts can center around an erotogenic zone such as the mouth or the anus, or it can be a component instinct where the child is sexually excited by looking at other people (voyeur) or by having other people look at them (exhibitionism). Children are also extremely curious about sexual activities. Freud called this "the sexual researches of childhood". In this "sexual research" boys try to find out why they are different than girls. In so doing, boys realize they have a penis and that this is so precious that they then develop castration anxiety. Girls, on the other hand, realize they don't have a penis and so, according to Freud, they develop penis envy. These feelings quiet down as the child enters school-age, but then resurface in puberty. Freud calls this trajectory "diphasic".
Freud was the first one to describe how children experience sexual pleasure. This sexual pleasure comes in the form of mechanical excitations. For example, children love being thrown up in the air and they love to rock. The thrill of a child's rocking horse would be another good example. The familiar play of "rough housing' would be another example of a child's sexuality. Further, Freud goes on to say that feeling states are innately sexual. The child's fear is a source of sexual excitement in that jumping from high up creates fear followed by a sense of mastery in a parallel way to sexual activity. Finally, he says that passion about intellectual work is also a form of sexual satisfaction.
An interruption....a drug representative for Abilify comes to my office....I happily take some samples...I am invited to a dinner program chaired by my highly esteemed colleague.....I return to thinking about Freud and sexuality.....the mind and the brain converge.
The ever-present force of sexuality is described in this 1905 paper. Our skin and our sense organs are stimulated and we are excited. Certain areas are particularly excitable and these are termed our erotogenic zones. Pleasure can end and pain can begin when the intensity exceeds our tolerance. Freud then does self-promotion. He touts the "novelty" of his approach to this sensitive subject of child sexuality. Although lacking in humility, Freud importantly reminds us that there are varieties of sexual constitution. That is, each person is different (thanks to our DNA-which again, the discovery came after his time). Second, that sexuality and bodily functions are forever linked and that disorders of the body (such as Irritable Bowel Disorder) could result from sexual excitation which cannot find a suitable outlet and so the energy gets turned towards an organ.
So, I conclude by asking myself what I want these residents to learn from this "classic" article. First, I want them to read Freud like great literature. In fact, Freud won the Goethe prize. Second, I want them to see motivation as a complicated force, which in no small measure is determined by sexual energy and our pre-programmed need to reproduce. Finally, I want them to think developmentally, both that childhood history is always important to adult assessment, but in particular, I want them to think about the adult patient in terms of how his sexual needs were dealt with as a small child. This way of thinking might help them understand the underpinnings of their patient's symptoms.
Abilify helps a lot of patients be "more able". Psychoanalytic thinking does likewise.