Psychoanalysis began with hypnosis. Before the couch, the dream interpretation and the free association, there was a young Viennese doctor trying, not very successfully, to put his patients into a trance. His decision to stop changed the course of both fields.
Learning from the masters
In 1885 Sigmund Freud, then a neurologist of 29, won a grant to study in Paris with Jean-Martin Charcot at the Salpêtrière hospital. He watched Charcot use hypnosis to produce and remove paralyses in patients with hysteria.
The lesson Freud took was profound: ideas can cause physical symptoms. If a suggestion could create a paralysis, perhaps an idea the patient was unaware of was causing the real one.
In 1889 he visited the rival school at Nancy to improve his technique, and watched Hippolyte Bernheim at work. He translated books by both Charcot and Bernheim into German.
The cathartic method
The other influence was closer to home. Josef Breuer, an older Viennese physician and friend, had treated a young woman known as “Anna O.” in 1881 and 1882. She had an array of symptoms: paralyses, disturbed speech and vision, an inability to drink.
Breuer found that when she talked, in a hypnotic state, about the occasion on which a symptom first appeared, and expressed the feelings that went with it, the symptom eased. She called it her “talking cure.”
Breuer and Freud called it the cathartic method: recovering a forgotten, emotionally charged memory under hypnosis and discharging the feeling attached to it. They published it together in 1895 in Studies on Hysteria.
Later historians have shown that Anna O.’s recovery was far less complete than the published account implied. She was real, however: Bertha Pappenheim, who went on to become a pioneering social worker.
Why Freud stopped
Through the early 1890s Freud used hypnosis less and less, and then not at all. He gave several reasons.
He was not very good at it. By his own account, he could not hypnotize many of his patients, or not deeply enough. Some disliked it.
The results did not last. Symptoms removed by suggestion tended to return, or were replaced by others.
It depended on the relationship. Improvement seemed to hold only while the patient remained attached to the doctor.
It hid what he wanted to see. Freud came to believe that the patient’s resistance to remembering was the important thing. Hypnosis went around resistance instead of examining it.
It was uncomfortable. He described a patient waking from hypnosis and throwing her arms round his neck. The incident convinced him of the force of what he would later call transference, and that hypnosis concealed it.
What replaced it
For a time Freud pressed his hand on the patient’s forehead and insisted that a memory would come. Then he dropped that too, and simply asked patients to say whatever came into their minds without censoring it.
This was free association. The patient lay on a couch with Freud out of sight, a physical arrangement left over from hypnosis.
What psychoanalysis kept
More than is often admitted.
- The couch and the quiet room
- A relaxed, inward-looking state
- The idea of mental processes outside awareness
- The idea that symptoms have meanings
- The intense relationship between patient and therapist
Freud himself remarked that psychoanalysis only began once hypnosis was set aside, but he also acknowledged how much it owed.
The cost to hypnosis
Freud’s prestige was immense. When he pronounced hypnosis superficial and unreliable, much of psychiatry agreed. For roughly the first half of the twentieth century, hypnosis was neglected in mainstream practice, kept alive by a handful of researchers and by its use in two world wars.
Was Freud right?
Partly.
He had a point. Simply commanding a symptom to disappear often does not last. Modern hypnotherapy rarely works like that. It teaches skills, builds expectation, and is combined with other therapy.
He was mistaken. His failures reflected the authoritarian style of the day and his own limited skill. Hypnotizability varies, and not everyone needs deep trance. Later research showed good, lasting results for pain, gut disorders and more.
He left a problem. The cathartic method assumed that hypnosis recovers accurate buried memories. We now know it can create false ones. Ironically, Freud himself came to doubt his patients’ recovered memories of childhood events, though for other reasons.
Freud returned briefly to the subject late in life, suggesting that the “pure gold” of analysis might one day have to be alloyed with the “copper” of direct suggestion in order to help large numbers of people.
Hypnoanalysis
Others tried to combine the two. During and after the world wars, psychiatrists used hypnosis within an analytic framework to treat traumatised soldiers quickly. The approach, called hypnoanalysis, still has practitioners, though it inherits the memory problem.
The bottom line
Freud gave up hypnosis because it did not suit him or his aims, and built psychoanalysis in the space it left. His dismissal held hypnosis back for decades. The irony is that so much of his method, starting with the couch, was hypnosis with the name removed.
Next in the series: Hypnosis in Wartime: Treating Shell Shock
This article is for general information and is not medical advice.