In this book, Freud explains psychoanalysis treatment as “an interchange of words between the patient and the analyst” (Freud, 1987, p. 41). The patient talks about his problems and the analyst listens and tries to direct the patients’ thoughts in a different direction. The analyst also observes the patients’ reactions of either understanding or rejecting his words. Freud repeats the importance of ‘words’ as his primary tool when using psychoanalysis to treat the patient.

     Parapraxes are “slips of the tongue” (p. 50). This happens when a person uses a certain word or phrase that he did not intend to use.  He may not be able to remember a name which he recognizes later, and has forgotten it for the moment. Freud says that a person can make a slip of the tongue for three reasons:  he is tired, excited, or occupied with other things (p. 57). These slips of the tongue could be viewed as accidental from a psychological point of view, but in many cases, Freud says, the person says exactly the opposite of what he intended to say (p. 59). He says parapraxes are a type of phenomenon which are unmistakable. For example, a joke will bring to light the solution to a problem that the person is trying to hide. This phenomenon is often called “a Freudian slip”.

     Dreams are a way of preparing for the study of neuroses (p. 111). Freud says if all persons were healthy, their dreams would be a map for following how to overcome neuroses (p. 112). Dreams are important because the mood we wake up with, is the result of a dream we had the night before. Mental diseases and delusions can originate from dreams, so dreams cannot be ignored. Certain historical figures have achieved greatness or failure as a result of their dreams. Freud defines a dream as, “mental life during sleep…an intermediate state between sleeping and waking” (p. 116). Freud says “dreamless sleep is best”, and if the person cannot achieve this state, he has not succeeded in establishing the type of sleep that took place in the womb. Sometimes, dreams are filled with visual images which are difficult to put into words. Freud says, this is not a reduced mental activity like that of a mentally handicapped person, but is a qualitatively different experience. There are very few commonalities among people who dream, but there are many differences: duration, clarity, affect on the dreamer, value, content, and how long one retains the dream. What is common to dreams is that they are reactions to stimulus that occur during sleep (p. 120).

     Interpretation of dreams according to Freud is accomplished by asking the person what the dream means to him (p. 129). Usually the dreamer says nothing and rejects the interpretation given to him. Freud rejects the dreamer’s answer of knowing nothing, and probes further. He claims the dreamer does not know that he knows – and so, he believes he does know it. Freud is trying to prove that dreams are psychical phenomenon and that the dreamer knows what he thinks he does not know. Freud uses the example of hypnosis to prove that a person knows more than he thinks he knows. He says that hypnosis and sleep are analogous, and hypnosis can be viewed as “artificial sleep” (p. 133). Freud says the first remarks about the dream offer clues to understanding and explaining it. When Freud asks a patient about a certain part of a dream, he is asking the patient to surrender himself to free association. For Freud this is the starting point toward understanding the dreamers’ complexes.  

     Freud’s lecture on The Manifest Content of Dreams and The Latent Dream-Thoughts speaks of using free association to uncover the hidden elements of a dream. Here, Freud makes an important differentiation. He says instead of viewing dreams as hidden, concealed or inaccessible to a person’s consciousness, it is the unconscious that holds this information. Freud clarifies by saying, free association and elements of a dream are available to the conscious mind, however, inaccessible information lies in the unconscious. The unconscious mind is the right place to find the information the analyst is searching for. Interpreting dreams will meet resistance by the patient as the analyst probes for details of the dream. This probing, that the dreamer is resisting, is a form of suppression and the answers to these types of questions are the most important ones.

     Manifest dream-content and the information that is not readily available to the analyst, Freud refers to as dream-thoughts (p. 151). This information in the unconscious and is what the analyst wants to uncover. The manifest dream is usually comprised of visual images; not thoughts or words.

     Interpreting one’s own dream can be more enlightening than trying to interpret the dream of another. However, while doing so, we may eliminate what appeas to be irrelevant, senseless and unimportant ideas. This elimination process may cause us to discard some of the most important information.  Freud says, do not stay too close to your starting point and dream element, and do not interfere with free associations. Sometimes, if we do not like an idea, it is rejected - and this is a mistake (p. 145).   

     Lecture 8 speaks of children’s dreams. No analysis is needed for these dreams and there is no need to question the child. The dream is simply a reaction to the days’ events (p. 158).  These dreams are important because here “the latent dream and manifest dream coincide” (p. 159). The child’s dream represents a fulfillment of wishes, and is not an effect of mental or somatic stimuli (p. 160). These dreams are not “disturbers” of sleep, but are rather, “guardians of sleep to get rid of disturbances” (p. 161).  

     In Lecture 9, Freud explains censorship of dreams. When a dream is known to us, it is the “hallucinated fulfillment of a wish” (p. 168). Sometimes, dreams can be distorted and may seem beyond interpretation. Freud says: 1) he wants to know where this type of dream comes from, 2) what it does and, 3) how it does it (p. 168).  If one can only remember certain parts of a manifest dream, the parts that are blocked-out are being censored. When a part of a dream is barely remembered, this is also a form of censorship. By censoring, the person is keeping the meaning of the dream vague, and is not allowing the true meaning to surface.

     Lecture 10 explains symbolism in dreams. There comes a point in dream interpretation when the use of the dreamer’s associations is no longer needed. If a dream-element and its meaning continue to occur regularly, the dream-element can be called a “symbol of the unconscious dream-thought” (p. 183). The phenomenon of recurring symbols in dreams allows the analyst to forgo questioning of the patient (in certain cases).  However, the patient may express extreme resistance to the relationship between dreams and the unconscious. Freud credits K. A. Scherner as the discoverer of “dream-symbolism” however, Freud made some modifications to his findings (p. 185). Symbolic dreams, in most cases, draw comparisons.  The dreamer may, or may not, agree with the analysts’ interpretations of the symbols derived from the dream-element.   Symbolism of the person’s sexual life is the most important part of Freud’s dream theories. He says the great majority of symbols in dreams relate to sexuality (p. 187). Freud makes it clear that psychoanalysis does not shy away from sexual issues. He offers many examples of sexual symbols to prove his point (P. 188). Freud admits, even if the person does not engage in dream censorship, it is still a difficult task to interpret dreams. The analyst must try translating the symbolic aspects of a dream into the waking thoughts of himself and the patient. Freud is making it clear that sleeping and waking are two entirely different worlds. Each has its own language and perspective (p. 203). He says that even the most educated people will resist dream interpretation because of its connection to sexuality.  

     In Lecture II, The Dream Work, Freud explains four “main relations” when studying dream-elements and their meanings: 1) relation of the part to the whole, 2) illusion or approximation, 3) symbolic relation and, 4) plastic representation of words (p. 204). When the latent dream is transformed into the manifest dream, this is called dream-work (p. 204). The manifest dream is a condensed version of the latent one.

     Condensation is usually an important part of dream-work, and the manifest dream is never more extensive than the latent one. An example of condensation is a composite figure that represents many people.  

     Displacement is caused by dream censorship. A latent element of a dream is replaced by an illusion, or the focus of the dream changes from importance to unimportance. When displacement occurs the dream becomes surreal or unfamiliar. These illusions replace genuine information with “remote and external relations” and make the dream difficult to interpret (p. 209). However, after unraveling the illusion and identifying the genuine information, the dream interpretation may not be taken seriously. Displacement and dream censorship are only successful if it is impossible to uncover the genuine information.

     Dream-work is the transformation of thoughts into hallucinations (p. 250). Freud says this is a mysterious process and a problem for psychology. (p. 250). Wish fulfillment is one of the primary aspects of dream-work that needs to be understood. In distorted dreams, wish fulfillment is more difficult to uncover. Dream censorship is responsible for the distortion of dreams and makes the dream difficult to interpret. There are three types of wish fulfillment complications that cause emotional distress: 1) the dream does not succeed in creating the wish fulfillment, 2) wish fulfillment causes anxiety to the dreamer due to dream censorship and, 3) wish fulfillment causes a punishment due to unpleasant dream events.

     Dreams are always open to interpretation, and such interpretation is a technique of psychoanalysis, but is every dream a manifestation of wish fulfillment? Can dreams be viewed as thinking during the night, as thoughts are viewed as thinking during the day? Freud defends his position by saying that from a scientific standpoint, wish fulfillment is consistent as the most effective form of interpreting manifest dreams (p. 260). Dreams may be warnings, intentions or cries for help by the unconscious for fulfillment of a wish. Freud establishes wish fulfillment as a constant characteristic found in dream-work.

     Latent dreams are residual accounts of the prior day’s events. These daily ‘residues’ are the result of unconscious wishes (p. 264). However, these residual effects are only a portion of latent dream thoughts. Another aspect of latent dream interpretation is the addition of “powerful, but repressed wishful impulses” (p. 264).

     Freud admits to many problems in dream interpretation. Certain elements of the dream may not be understood by the analyst, and many interpretations are possible depending on the choices made by the analyst. Over-interpretation is possible, and symbols in manifest dreams can be a misinterpretation of the underlying latent dream thoughts. 

     Freud makes clear that psychoanalysis is not a speculative system (p. 282). He says it is an empirical study with direct observations and outcomes of processes that have been worked on in a justifiable manner. Freud argues that many people have not taken notice of his “self-corrections” and continue to criticize him for theories that have been abandoned (p. 284).

     Freud clarifies his position on the psychoanalytic view of neuroses. First, he gives examples of symptomatic actions which are important and deserve the attention of the analyst. He says ideas that are illogical and not based in reality are delusions. These delusions did not originate from reality, so they must come from somewhere else (p. 289). At this point, the analyst investigates the person’s family history to find out why the delusion was created, what emotional purpose it served, and seeks to find the intention and relationship to something in the unconscious. Freud argues that this type of psychical investigation is completely justified as an “irreplaceable instrument of scientific research” (p. 295).

      Obsessional neuroses and hysteria are forms of neurotic illnesses. The person with an obsessional neuroses has thoughts he is not interested in. His obsessions are irrelevant to him, but they are a starting point for him to “surrender himself most unwillingly” (p. 297). He goes through a process of discussing his most difficult problems and his behaviors are noted by the analyst. What may surface are pathological ideas, impulses and actions that are classified by Freud as neurotic illnesses. Psychiatry gives general names to these character traits, but does not explain how to treat these individuals (whom Freud classifies as degenerates).

     Neurotic symptoms, like paraplexes and dreams, are intimately connected to the person’s experience (p. 309). Through analyses, interpretation and translation of neurotic symptoms, the analyst will discover a connection between ‘senseless ideas and pointless actions’, and past situations and experiences of the person ((p. 310). The goal is to find out what purpose or action the idea served at a certain time. Neuroses can also be equated with a traumatic illness caused by an inability to deal with a powerful experience (p. 315).

     The phenomenon of fixation is more common than that of neuroses. However, every neuroses includes a form of fixation, but not every fixation leads to a neuroses (p. 316). Freud gives the example of mourning as a fixation that allows the individual to escape from the present and future (p. 316). There are times when a patient can find no motive for his behavior, but realizes the cause while undergoing psychoanalysis. When the conscious mind understands the reasons for obsessional behavior, which is coming from the unconscious mind. Freud calls this phenomenon, “unconscious mental processes” (p. 318).     

    While attempting to restore the patient’s mental health, strong resistance is encountered by the analyst. The patient does not realize he is resisting treatment, and there is no point in telling his relatives about this obstacle. Meanwhile the patient is suffering, and those around him are suffering as well (p. 327). The patient will resist treatment in many ways even though his mental anguish can be treated.  To overcome these difficulties, the analyst instructs the patient to go through the process of free association, which is used in dream interpretation. Freud recommends leading the patient through feelings, thoughts and memories, regardless of how “disagreeable or indiscreet….or unimportant, irrelevant or nonsensical” they may seem (p. 328). The patient should only follow his ideas that are on the surface, and should not criticize any part of the free association process. Freud insists that this method is crucial for the success of treatment.

     From a patient’s past experiences, there are ways to reconstruct the causes of his symptoms. The goal is to lead to a resolution of his mental suffering. If these causes are conscious, they are easier to treat. If they are still unconscious, the causes are deep and powerful enough to create a symptom. The analyst must transform whatever is in the unconscious, into the conscious, so he can find a resolution. When a patient is strongly opposed to this process, Freud defines this type of resistance as repression.

     The process of repression causes the construction of the patients’ symptoms. Thought impulses in the unconscious are not recognized by the conscious. When these impulses move into the conscious, but are turned away by the conscious; Freud calls this phenomenon: repression. When certain thought impulses cross the threshold into the conscious, they are still not necessarily conscious (p. 337). They only become conscious if the conscious becomes aware of them. This phenomenon Freud refers to as the preconscious.

        Repression is only a precondition of the construction of symptoms (p. 339). Symptoms are a result of substituting thought-impulses for those being repressed in the unconscious. The challenge for the analyst is trying to understand this structure of substitution and how to bring ideas out of the unconscious and into the conscious.

     There are three disorders which are grouped together known as transference neuroses: anxiety hysteria, conversion hysteria and obsessional neuroses (p. 341). These disorders are treatable by the patient undergoing psychoanalysis. These disorders have a common cause: the frustrations encountered by the person when unable to fulfill their sexual desires (p. 341). With transference neuroses, the patient must work his way through a variety of symptoms before understanding the underlying causes (p. 433). A more detailed discussion of ‘transference neuroses’ is found later in this paper.  

      Freud defines ‘sexual’ as “everything related to the distinction between the two sexes” (p. 344). The sexual act is the central point of psychoanalytic theory. ‘Sexual’ is everything that includes pleasure, the body, the sexual organs, someone of the opposite sex, and any action that aims to perform the sexual act (p. 344). Included in his definition are reproduction, kissing, and masturbation.

     Homosexuals (or inverts) are individuals who are aroused by members of their own sex and do not want to reproduce. Freud says they represent themselves as a “third sex” (p. 346).  Freud offers a list of abnormal sexual behavior: replacing the part of the body where two people normally have sex (the sex object has changed), making “an introductory or preparatory” act as the aim of their sexual desires, causing pain and humiliation during sex (sadists), enjoying pain and humiliation (masochists), and imagining the satisfaction of the sexual act through fantasies (p. 347).

     Freud says that unless we understand these abnormal types of sexual behavior, we cannot understand or establish normal sexual behavior (p. 348). According to Freud “neurotic symptoms are substitutes for sexual satisfaction” (p. 349). He justifies this theory by comparing neurotic symptoms to those he says are perverse individuals (p. 349). These individuals are motivated by sexual impulses in the unconscious. Freud believes that if a person does not have a normal sex life, the result is perverse sexual behavior. He argues there is something latent in these people, causing their perversions to surface. The differences between perverse and normal sexuality is their “dominating component instincts” and sexual aims (p. 364).  

     Neurotic symptoms are the manifestation of early childhood sexual experiences. From age three, the sexual life of the child shows similarities to that of an adult (p. 368). Freud argues that the development of the libido occurs even younger. This “pre-genital stage” is characterized by sadistic and anal instincts (p. 369). Masculine and feminine do not play any role at this stage.  Freud uses the terms, “active and passive” to describe the infant’s behavior, before associating himself with his sexual identity. With the sadistic-anal phase of libido development, there are genital organizations such as the sensual sucking of the mouth (p. 370). Even the ancient Egyptians represented children with a finger in their mouths. The functioning of the libido passes through several stages, “like that of a caterpillar into a butterfly” (p. 371). A long series of breaks can occur during the development phases of the libido, causing neurotic symptoms later in life.  

     Freud’s Oedipus complex explains why a little boy wants his mother all to himself. He resents his father, and does not like his father showing affection toward his mother. He is happy when his father is working, on a trip, or is absent (p. 375). His mother attends to his needs, and he expresses feelings that he wants to marry her (p. 375). However, he also shows affection toward his father as well. These conflicting feelings toward the mother and father find their way into the child’s unconscious. The same phenomenon occurs in little girls with the father as the object of affection, and the mother posing the threat. Sharing the parents with brothers and sisters is undesirable, and the child does not want them in the family. Freud says incest is a detestable idea, however, in ancient Greek mythology it was allowed and not frowned upon (p. 378).

     Freud says that psychoanalysis validates the Oedipus complex. A man’s hatred toward his father surfaces as does his sexual desire for his mother. During puberty, the child’s sexual instincts remind him of familiar incestuous objects, and the libido is ignited.  Freud argues that the neurotic is unable to transfer his libido to an outside sexual object, and the Oedipus complex is the “nucleus of the neuroses” (p. 380).     

     As discussed, Freud is claiming that the libido goes through a multi-staged development process. He elaborates on the significance of this developmental process, and explains how its disruption can cause neuroses later in life. He says there are two issues to be concerned about: regression and inhibition. With inhibition, there is variation in the biological stages of development (p. 383). Some of the necessary functions are held back in the early stages, and some of the stages may not be completed properly. Each organism and human being will experience varying amounts of inhibition throughout their development. This lagging behind in development is due to instinctual fixation (p. 385).    

      With regression, the person returns to a prior stage in the developmental process. Freud says “fixation and regression are not independent of each other” (p. 385). It is difficult for the person to avoid fixations, because they offer him satisfaction. Freud says to understand a patient’s neuroses the analyst must understand fixation and regression (p. 385). This understanding will lead to uncovering the causes of neuroses. Symptoms of neuroses are the effects of conflicts arising from new ways to satisfy the libido (p. 405).     

     Freud defines symptoms of psychical illness as “acts detrimental, or at least useless, to the subject’s life as a whole” (p. 404). He complains about these symptoms, and wants to stop the pain and suffering they are causing. The person is harmed by the amount of mental energy he needs to fight against these symptoms. Freud argues that this quantity of energy exhausts the person and stops him from living a normal life.

     For the neuroses of hysteria, the libido and the unconscious are on one side of the *ego, and consciousness and reality are on the other side (p. 406). The libido finds fixations to break through repressions “in the activities and experiences of infantile sexuality” (p. 406). Instinct plays an important role in the “innate disposition of the child”, which expresses itself in childhood, and additional instincts are awakened by interaction with the outside world through experience. Constitutional dispositions are inherited from family and are important considerations for understanding the symptoms of neuroses. Both the ‘inherited constitution’ and ‘acquired disposition’ from early childhood must be understood in conjunction with the disposition (from fixation of the libido), and the accidental adult experience (traumatic) (p. 408). 

     Freud argues that people hold a low valuation of reality and neglect the distinction between what is real and what is fantasy (p. 415). He says it takes a long time before the patient can equate reality and fantasy (p. 415). Patients create fantasies containing psychical realities that are as important as experiences in material reality. Both realities should be taken seriously by the analyst because “in the world of neuroses it is the psychical reality which is the decisive kind” (p. 415). The ‘source material’ for fantasies comes from instinct. The reason the same fantasies are created on the same occasions is due to primal fantasies. Freud argues that the psychology of neuroses “has stored in it more of the antiquities of human development than any other source” (p. 418). One the most popular forms of fantasy are day-dreams. This use of the imagination creates feelings of happiness and pleasure when there is none. Day-dreams can either be conscious or unconscious. These unconscious day-dreams are the source of night dreams and of neurotic symptoms.

     The libido moves into fantasy during the formation of neurotic symptoms. Carl Jung named this phenomenon “introversion” (p. 421). It is a process of the libido turning away from real satisfaction and energizing fantasies which are not helpful while treating neuroses. The introvert is not a neurotic, but he is on his way to becoming one unless he finds a way to release his frustrated sexual energy from the libido.  

     According to Freud, the ego cannot be trusted, nor is it impartial (p. 427). The power of the ego dismisses the unconscious and negates the importance of the libido. This type of thought- action causes repression. The importance of repressed “demands of sexuality” should never be underestimated, but from the ego’s point of view, sexual matters are not important. If the person believes the ego, it will act passively and disguise neurotic symptoms. However, in the case of obsessional neuroses, the ego admits something is wrong, but it still tries to defend itself (p. 429).  

     The ego plays a much greater part in “narcissistic neuroses” (more on this topic later in this paper) (p. 428). By investigating the various types of neuroses’, the analyst can determine how strongly the ego is influencing the thoughts and actions of the patient. The ego is never absent, and is always found playing a role in mental disorders. With traumatic neuroses, the ego is motivated by protection and advantage. This motivation protects the ego from danger and threats.

     Traumatic neuroses will not resolve itself until the danger or threat is no longer a possibility. While the threat is still there, the person will take “a flight into illness” as the ego represses inner conflicts and keeps the symptoms of neuroses intact. (p. 430). Freud attempts to simplify his theories on treating neuroses by explaining that if sexual issues are normal, the person does not suffer from ‘actual neuroses’ (p. 433). He acknowledges the problem of judgments when using the word ‘normal’, but says as a rough guide - his gauge of ‘normal’ versus ‘neurotic’ retains its value (p. 433). There are three forms of ‘actual neuroses: neurasthenia, anxiety neuroses, and hypochondria (p. 438). ‘Actual neuroses’ contributes to the formation of neurotic symptoms. Freud explores the relationships between neurasthenia and: 1) transference neuroses (conversion hysteria), 2) anxiety neuroses, and, 3) hypochondria.  

     Freud discusses why neurotics suffer from anxiety (p. 440). He refers to anxiety as nervousness and “angst” (translated as fear, being frightened, afraid, etc.) (p. 440 fn).  However, the nervous person may not have angst, and the person with angst may not be nervous. There is a difference between ‘real anxiety’ and ‘neurotic anxiety’. Freud revises his outlook on ‘real anxiety’ by saying that it is not necessarily a rational response to a dangerous situation. There is “preparedness” for danger which causes increased sensory responses or ‘real anxiety’ (p. 442). Preparedness is an automatic response for avoiding consequences in a given situation. Anxiety is a subjective state, and the individual experiences motor innervations, discharges and feelings of pleasure or displeasure which have important affects (p. 443). The prototype for these sensations is the act of birth. This traumatic event translates into similar sensations and feelings of anxiety that are caused by impending danger (p. 444). With neurotic anxiety, “there is a general apprehensiveness, a kind of freely floating anxiety which is ready to attach itself to any idea that is in any way suitable” (p. 446).  This state is called, expectant anxiety or anxious expectation (p. 446). These people suffer from constant anxiety and assume the worst will occur in every situation. Sometimes, these individuals are referred to as being over-anxious or pessimistic. Other forms of anxiety include a long list of phobias: “the anxiety of phobias is positively overwhelming” (p. 447). Solitude is also dangerous and people should try to avoid it. Extreme phobias such as: agoraphobia, fear of darkness, thunderstorms etc., are classified by Freud as “anxiety hysteria” (p. 448). Anxiety equivalents occur when there is no sign of danger or any recognizable cause. The resulting anxiety attack can be manifested by a “single, intensely developed symptom” (p. 449). Freud argues that expectant anxiety is closely related to the patient’s sex life or situation affecting the libido. (p. 450). For example, anxiety neuroses disappears when sexually abusive behavior is eliminated. At the time of the writing of this book, the connection between anxiety states and sexual restraint was an accepted theory throughout the medical community – even for those physicians who did not practice psychoanalysis (p. 450).      

     Freud says anxiety is linked to the libido. The highs and lows of the libido are subject to repression. With phobias, there is a changing of the libido into anxiety which is “bound to an external danger”, and the worry of taking various precautions to avoid danger (p. 458). A phobia can also be a defense mechanism against an external danger relating back to the “dreaded libido” (p. 458). Repression is similar to flight by the ego from the libido when danger is felt (p. 258). ‘Anticathexis’ is used by the ego (as a defense mechanism) as the process of repression occurs, and must be maintained for the repression to be stabilized (p. 459). Freud believes that anxiety is a central point in psychology and is linked to the libido and the unconscious. 

     There are differences between ego-instincts and sexual instincts. Sexual instincts are connected more strongly to anxiety than ego-instincts. Unsatisfied libido changes into anxiety whereas hunger and thirst do not. Freud treats the person’s sexual life as distinctly separate from self-preservation and other aspects of being. The libido can attach itself to objects and the person’s ego. When the ego is fixated onto the person’s body and personality (instead of an outside object), this universal phenomenon is known as narcissism (p. 465). Freud says narcissism could be the original psychological state of humanity, which develops into “object-love” (p. 465). However, narcissism may still continue to manifest itself along with object-love (p. 465). According to Freud, “auto-eroticism would thus be the sexual activity of the narcissistic stage of allocation of the libido” (p. 465).  Narcissistic disorders provide insights into the way the ego “observes, criticizes, and compares itself to other parts of the ego” (p. 479). The person measures himself according to an ‘ideal ego’ which he has created for himself. Freud believes that this ideal ego is created for the purpose of re-establishing a connection with the “self-satisfaction” of infantile narcissism. The self-observing aspect of the ego is: the ego center, conscience, dream-censor and repressor of wishful impulses (p. 479).

      The aim of psychoanalysis is to make conscious, what is unconscious, lift repression, and fill- in gaps of memory (p. 486). The patient will become what he might have become under optimal conditions. He can become a mentally healthy person. However, there are other forms of mental illnesses that fail to respond to psychoanalysis. However, Freud still maintains that with most mental illnesses, the original conflict between the ego and the libido is the cause of repression.

     Freud explains there comes a time in therapy when the patient takes a special interest in the doctor (p. 491). Everything connected to the doctor becomes important, and his own illness becomes less important. The patient shows his gratitude, and he and the doctor develop a good working relationship. The doctor is also pleased with the reactions of the patient and forms a favorable opinion of him (p. 491). Soon, the patient is talking about how fortunate he is to have found such a wonderful doctor, and he tells his family and friends all about him. Finally, others begin to notice that the patient is speaking of nothing else but the merits of the doctor. During this period, the treatment is going well and the patient is responding favorably to the doctor’s insights and interpretations. Eventually, problems develop when the patient says he has no additional information to provide to the doctor. The patient’s behavior changes and he becomes uncooperative and stubborn. The doctor is being confronted with “formidable resistance” (p. 492). Freud clarifies this situation by explaining that the patient is transferring “intense feelings of affection” toward the doctor, which are not justified by the doctor’s behavior. This leads to difficulties in treatment, because many patients feel they have fallen in love with the doctor. This idea reinforces the patients’ beliefs that all they needed was love to cure them. Ironically, Freud argues, the more experience the doctor has, the more he is prone to believing that the patient’s transferred feelings are real. Young and elderly women are both thinking they love the doctor (even if the doctor is unattractive), because the phenomenon of transference is intertwined with the nature of the mental illness (p. 494). Transference of feelings onto the doctor is caused by the relationship that has been formed during treatment. These feelings would not have occurred outside the treatment room. Transference can be a “passionate demand for love” or a moderate one (p. 494). With male patients the same type of attachment can occur. Freud says “sublimated” forms of transference take place, but sexual desire is rare (except in cases of homosexuality) (p. 494). There is always the potential for any normal person to transfer his feelings onto another (or object). However, with transference neuroses, the libido is the vivifying agent of suppressed impulses that are expressed as symptoms of the neuroses.   

Direct suggestion is a method of psychoanalysis that is used to treat the symptoms of neuroses (p. 501). Freud refers to a “struggle” between doctor and patient, as the doctor’s authority goes up against the motives of the illness. However, the doctor is warned not to treat these motives directly. Freud argues that suggestive therapy should be “rapid, reliable, and not disagreeable for the patient” (p. 502). However, due to mixed results working with patients for many years, Freud says that by renouncing direct suggestion, there is no great loss in the treatment process (p. 503).

     Hypnotic treatment covers up various psychological issues, while analytic treatment exposes these issues and eliminates them. Hypnotic treatment uses suggestive therapy which strengthens repressions, while analytic treatment uses suggestion to change the outcome of inner conflicts (p. 504). Analytic treatment seeks to overcome the patients’ resistances, so the patient can attain higher levels of mental development. This treatment also allows the patient to recover without fear of the return of his neuroses (p. 504).

     Freud’s research supports his claims about the benefits of psychotherapy. There were many objections to his theories, but he knew these objections were groundless and his treatments were reasonable. Psychoanalysis is not a disguised form of suggestive treatment, but a form of medical treatment that “tells us about what influences our lives, the dynamics of the mind, and the unconscious” (p. 505).

      The libido is attached to the symptoms of the neurotic. To resolve symptoms, the analyst must take the patient back to his earliest memories. The conflicts which arose in childhood must be guided to a different outcome (p. 507). The reversal of repressions must be connected with the memories that caused the repressions originally. This therapeutic work falls into two phases: “the libido is forced from the symptoms into the transference and concentrated there; in the second, the struggle is waged around this new object and liberated from it” (p. 508).

      Freud does not give step-by-step instructions to his audience about how to proceed with treatment. However, he claims that psychoanalysis has met with great success. He recognizes the criticisms that were leveled at him, and the failures that occurred in treating many patients. He also acknowledged mistakes of the past, and the revisions he made to correct those mistakes. However, Freud does say that most patient cases are suited for psychoanalytic treatment. 

Later in his life, Freud changed his ideas about the unconscious. He thought the term was ambiguous and had too many conflicting uses (P. 21) He provided a new structure for discussing the various aspects of the mind: the “id” became the “uncoordinated instinctual trends”, the “ego”  - the “organized realistic part”, and the “superego” - the “critical and moralizing” part (p. 21).


                                                            Works Cited

Freud. S. (1987). Introductory lectures on psychoanalysis. (10^th ed.). Middlesex UK: Pelican  

     Books Ltd..