We live in a pretty good time for mental health awareness and psychiatry right now. People are more open than ever about their struggles with their mental health issues, and luckily, with the advent of video content, we have more and more access to others sharing stories, professionals explaining concepts, and the feeling, perhaps, that we are maybe not alone in our own struggles.

This openness was not always the case, of course. As recently as 20 years ago, most people were close-lipped about their diagnoses, and those who did discuss it were considered a little eccentric for having done so. Let’s be real, there has always been a stigma around mental illness, which we discussed in a previous article on Foucault’s Madness and Civilization. You should read it.

All of this to say that the idea of mental illness and treatments for it has been a thing for a long. In ancient times and the Middle Ages, trepanning, that is, cutting a hole into the skull, usually to release evil spirits or something similar, was not incredibly uncommon. People like Robert Burton in the Elizabethan era were writing texts about “melancholy,” aided by older texts from Aristotle and Hippocrates. 

But psychiatry didn’t make it into its own as a medical science until well after medical science was a thing. Indeed, it wasn’t until the 19th century that people started seeing mental illness as just that, illness, and making diagnoses. Indeed, psychiatry as we know it, with all its diagnoses and some of its issues is only around 150 years old, all told. Much younger than medicine as a practice in general.

How we deal with psychiatry today really stems from a few (often unethical) people who decided to ask, “Why do people do these things? If you sit and listen to someone’s story, can you help heal them through talk?”

At the forefront of this movement through this sort of healing was a neurologist from Austria, a certain Sigmund Freud (1856-1939). Freud created a movement of people who observed behaviors and talked it out. In other words, psychoanalysis.

Case Studies: Anna O., Josef Breuer, and a Lot of Bad Decisions

Sigmund Freud, many would be surprised to hear, was actually trained as a medical doctor and did have an M.D. in neurology, which was, at that time, a scientific study of the brain and related subject matter. Freud came out of medical school with a fancy degree and the beginnings of ideas.

Freud got the once-in-a-lifetime opportunity to study under famous French neurologist Jean-Martin Charcot, who studied (and showed, through performance) the effect of hypnosis on the hysterical. Hysteria was, at the time, a catchall term for a variety of mental health issues, especially when it came to women and just different behaviors. But that is a whole other kettle of fish.

Freud, nodding to himself, took what he learned from Charcot back to his practice in Austria, where he consulted with Josef Breuer, who was dealing with a patient called pseudonymously “Anna O.” Instead of, Freud thought, suggesting silly stuff for the hypnotized people to do, what if he just used a sort of hypnotic state to help figure out the root of their suffering, through their own words?

Anna O was hysterical, by all accounts. And there are a lot of them, because he and his friend Breuer documented the heck out of them. These documentations were what we call “case studies,” in which a psych professional chronicles the way a person’s issues express themselves over time, how they were diagnosed, the course of treatment, and how (and if) they were resolved.

Anna O was Case Study Zero. Freud documented her strange behaviors, the way she stayed in bed like an invalid when she was not physically ill, and her abrupt changes in mood and outbursts. She invited the two men to help her, basically becoming an experiment for them to use their new method to see if it would help.

The story goes, that while Anna O. found the “talking cure,” as she called it, helped her immensely, Breuer backed out of the experiment because he wasn’t comfortable with some advances made on her part. Freud finished the job and made “Anna O.” famous, supposedly healing her of her “neuroses,” or odd behaviors, through something, in a lot of ways, similar to the talk therapy you’d have with your therapist.

While you can look through Freud’s work and find a heck of a lot of case studies, portraits of very peculiar people, the methods used in these case studies were not always ethical, the lines of the relationship between the psychoanalyst and patient often blurring. Famously, Freud’s student Carl Jung would play with this a little too hard, which is portrayed more dramatically in the film, A Dangerous Method (2011). 

Choices were made.

A photograph of Sigmund Freud's famous sofa, taken by Robert Huffstutter, courtesy of Wiki Commons. 

Let’s Talk About Sex: From Victorian Repression to Freudian Expression

While his case studies were essential to understanding Freud, what everyone living today knows about is how he was so fixated (a Freudian word) on sex. With shows like Frasier and other pop cultural hints, many of us know what a “Freudian slip,” is (when you say something saucy “by mistake”), that Freud thought boys had the hots for their moms and that it sometimes translated to adulthood, and that “sometimes a cigar is just a cigar.” These are all fun times, for sure. But they are, in some ways, parodies of a revolutionary theory.

In a way, Freud was obsessed with sex. But sex was, you see, not talked about when he was growing up. As a society, it was kept more closed-door than a historical romance. This is not to say at all that sex was neither enjoyed nor represented in different ways in Victorian times. The photo camera was invented, and of course the next thing they did with it was invent photographic pornography. If you do that internet search, that is on you.

However, it was one of those things that you did in the privacy of your own boudoir (or brothel?), not something you shared with all and sundry. And while the silly idea of the first Bridgerton series about Daphne not understanding how sex works because we don’t talk about that is a bit much, people did not make free with sex in the same way that we do now. Even homosexuality wasn’t even coined as a term until the late 1800s. Different times.

So, having someone like Freud come out and not just want to talk about it, but claim that talking about it might even be healing, was seen as something of a revolution. 

But of course it gets weird.

Those Freudian Theories: Let’s Get Weird

Freud’s legacy is so big that, even after his death at the cusp of the 1940s, we can still make lots of Freud jokes. How many cartoons have you seen of a patient on a couch with an analyst saying something like, “Tell me how you really feel?” A lot of us know about the Oedipus complex, a claim of disordered love of a man for his mother, much like the subject of the Greek play of the same name. As a result, of course, the dude hates his father. 

We can go on. The Freudian slip, like when you say, “Oh, I really want a blow job…I mean, to blowdry my hair.” It tells us all what you really are thinking, but suppress. Penis envy: that women are envious of men’s having a penis because it gives them better positions in society, etc. Oh, and if you’ve ever heard a relative call someone “anal,” from the older generations, like, “She’s so anal about cleaning her bathtub in such a way,” it was the precursor to the way we say that people are “so OCD” about how someone cleans or tidies (also, don’t say that, because OCD is really hard for people living it).

Few medical professionals really made it into pop culture as hard as Siggy Freuddust (free shirt design, Markus–you’re welcome). But how? Because all of these things seem absurd to us with our 21st century eyes. For Freud, this was big news, at the edge of psychiatry and psychology.

Freud invented talk therapy, a form of which most mental health-style therapists who work today use. You may not be lying on a fancy couch, but you will be pouring out your soul as part of it. Freud wondered why talk therapy worked for people, and had a lot of very particular ideas about human nature and psychology.

First of all, Freud’s foundational idea is how the human brain works. You have two main parts to your mind: the conscious, and the unconscious. The way you think is separated between conscious and unconscious. The conscious stuff is what you are able to tell yourself throughout the day, that plays into understanding why you do what you do, surface level stuff. Unconscious, however, is hidden underneath these calm waters, and it can be murky AF. 

Imagine that you do things but you don’t know why you do them. Your unconscious does, and it’s informed by how you were raised as a child. Your traumas, your triumphs, your shame, informs your unconscious. These things that you keep bottled up inside, repressed. We could go into it for a long time, but your conscious and unconscious are sometimes at war. This can explain why you sometimes do things that you hate, but can’t seem to stop doing.

The basic idea of Freudian psychology is this war within, that is informed by childhood trauma. So focused was Freud on childhood that he created ideas about how we grow into our sexuality and become the sexual adults that we are, and how we experience and work through these urges as babies and children. And how these can become disordered.

For Freud, sexual pleasure in a human, libidinous, to use a related term, starts as a baby, and you rush through stages: the oral (babies getting pleasure from breastfeeding), the anal (babies getting pleasure from pooping), the phallic (toddlers figuring out and getting pleasure through masturbation), a latent stage (radio static from 6 years to puberty), and then adulthood/puberty, with a genital stage (using intercourse for pleasure). If a person lingers in any of these too long, they might develop a “neurosis” or a “psychosis,” basically a mental health issue that will affect their behavior.

And ooooh boy does Freud extrapolate from here. For instance, if your anal stage doesn’t go well for some reason (basically, if you end up holding back the poop), you could end up far too anxious and fastidious. But if it doesn’t go well in the opposite way (like pooping everywhere and not caring), you can become messy and chaotic. Looking at these through a modern eye, you can really see that, while these are theories, they are a little more than skip.

Other psychologists over the 20th century would contend with these theories, many of them dismissing them altogether, to the point where Freud remains, but as a somewhat creepy relic of another time.

Laughter and Legacy: The Footprint of Freud and Modern Psychiatry

To legitimize itself as a science, modern psychiatry eventually broke ways with the old psychoanalysis of Freud and many of his pupils. To reiterate, psychology and psychiatry were very, very new as discreet subjects of study. People had come a long way from Robert Burton’s melancholy and drilling holes in the heads of sufferers (the latter not entirely, though).

How do you legitimize yourself as medicine and as a science? You start using, for one, the scientific method. For Freud, who relied a lot on case studies and his own imaginative extrapolations, you were not going to get a sample size, a control group, or more than some lengthy notes. In this way, a lot of what Freud wrote might be considered almost esoteric by today’s standards.

The psychiatry of the 20th century sought to have both a larger and smaller scope than Freud and his ideas. Psychology as a whole went to a whole lot of places, many good, some very scary, but psychiatry, getting into the nitty gritty with people with mental health issues, moved forward by leaps and bounds with the discovery of medications to help alleviate symptoms.

As such, psychiatry in particular aimed to prove itself as an actual science, as a practical way to help people, and to consider that weird behaviors and people suffering in ways you can’t see might be able to have some relief, in the same way as giving a diabetic insulin might provide relief. In wanting to prove themselves as scientific medicine, therefore, psychiatry moved away from Freud, the DSM-styled practitioners of today having a little chuckle over some Freud-themed merch their partners may have bought them.

It can be hard to contend with Freud, and his theories can really fill twenty of these blog posts, but while a lot of his work is problematic in a lot of ways (and with some problematic successors), there are some good things we can take away from Freud, that modern psychology and psychiatry would probably agree with. That the first few years of human life are essential to our later lives and issues, for instance. What traumas we experience as children can be really hard to overcome in later life. Attachment theory, for instance, relies heavily on this.

Additionally, the idea that things that are hidden should have a safe environment to be open, and that it is OK to talk about them with a professional revolutionized therapy for mental health. And while therapy styles have changed over the century and some change, many of them rely on a face to face style that revolves around the telling of problems and secrets, in hopes of helping change and improve lives and behaviors.

And while literally not everything is sex, that Freud, while apparently obsessed, opened it up to the public discourse is not entirely a bad thing. The more we hide things, often, the worse we cope with things. We should not at all be ashamed of our own proclivities (obviously unless they are harming ourselves or someone else, in which case seek some help). 

Does this, on the other hand, open the world to some very different but also not great ideas on sex and its discussion? Did Freud help hypersexualize the broader culture? I am not that qualified to say.

As a teenager in an AP (Advanced Placement) Psychology class, I became obsessed with Sigmund Freud and his weird ideas. I went through my Freud phase, just like many others my age probably went through their metal or their boyband phase. It was just so weird, like some horrifying historical trainwreck.

I won’t lie to you and say that I became a Freud scholar before entering college, but I definitely learned the chuckles that Freud would get from the practitioners who dealt with my mental health issues. I have been on several couches over the past 20 years, but never lay down. Talk therapy has always been (and I think Freud himself would agree) what the patient or client puts into it. If you want the healing and do the work, the healing comes, though it may be slow. It will be worth it, in my humble opinion.

Can we get anything out of Freud in the 21st century, when people are finally starting to feel OK enough to open up about their mental health struggles? 

What do you think?