324 Abnormal Psychology
Freud rejected the possibility that in his psychoanalysis
he might have led patients to report false memories of sexual
seductions. Instead he concluded that the memories he had
elicited were real—but not of real experiences. The memo-
ries were memories of infantile fantasies of sexual seduction
created because they had wished either to be seduced or to
seduce. Why, if the patients had fantasized sexual seduc-
tion in early childhood, had they repressed the memories
of these fantasies? Freud answered this question with the
further assumption that childhood sexual fantasies are always
incestuous—hidden behind the fantasies of seduction were
infantile wishes for erotic gratification with their parents that
led to fear of parental wrath and punishment, and so the
memories of the fantasies were repressed. Freud also had to
explain why neurotic patients had incestuous sexual fan-
tasies, and this he did with the generalization that all young
children create such fantasies. Mentally healthy individuals
would show the same resistances if presented with evidence
that they had once had such fantasies. To Freud, the only dif-
ference between patients and nonpatients was that the analyst
was in a position to bring pressure to bear on patients, so as
to induce them to realize and overcome their resistances. In
short, Freud claimed that criticism of his theory by others was
itself evidence for the validity of the theory.
The Psychoses
Psychoanalytic theory was least developed in the matter of
the major psychoses, especially schizophrenia and bipolar
affective disorder. However, the central theme of psychoana-
lytic thinking about the psychoses, and the schizophrenias in
particular, determined that they arise from a massive failure
of repression of unconscious material.
From this perspective, schizophrenia symptoms are like
dream-material intruding into and controlling consciousness
in the waking state. Freud referred to psychosis as a waking
dream. The central difference between the neuroses and the
psychoses, according to Freud, was that the neurotic did not
deny the existence of reality, whereas the psychotic did deny
reality and tried to substitute something else for it.
Freud’s extensive modifications were manufactured in
order to shore up the suppositions from which the theory had
originated. And for more than a hundred years, analysts in-
doctrinated with Freudian theory or its various modifications
directed the course of therapy to the elucidation of childhood
erotic fantasies and wishes. Freud elaborated his psychoana-
lytic theory, publishing extensively, until his death in 1939.
Freud died in London, where he had moved from Vienna
after the U.S. government intervened with the German Nazi
government to permit him to do so.
Empirical Studies of Psychoanalytic Theory and PracticeThe years following Freud’s death saw increasing pressure
for empirical evidence both for the hypotheses that underlay
the theory and for the claims that psychoanalytic therapy
provided an effective treatment for the neuroses. In a now
famous, albeit controversial study, Hans Eysenck (1952),
using data from the work of Denker (1946), compared out-
comes of intensive psychoanalytic treatment, brief treatment
by general practitioners, and no treatment at all for neuroses.
Denker’s study had reported that, although psychoanalysis
had produced a 44% rate of significant improvement, other
psychotherapies had produced 64%, and general practitioners
had produced the best results with 72%. Eysenck’s analysis
implied that the more intensive and prolonged the therapy
(psychoanalysis being the best example of this) the less likely
was the patient to make a significant recovery.
Eysenck’s study left reasonable grounds for criticism, in
that he failed to match the groups for severity (or anything
else), and he left the definitions of cure unreported. In spite
of these criticisms, two key conclusions could reasonably be
drawn: (a) up to that time, no systematic, methodologically
adequate attempt had been made to test the efficacy of psy-
chotherapy, and (b) the rate of improvement of the patients in
Denker’s study vastly exceeded anything reported by psycho-
analysis. References to the reports of Freud himself on the
success of his efforts provided to be seriously unreliable. The
application of Freudian ideas to the major mental illnesses
was to come later, and came fraught with problems.
One consequence of the rise of psychodynamic ideas and
practices was that, given the avoidance of biological methods
of either diagnosis or treatment, no a priorireason justified
why the practitioner should have medical training. Freud
himself was to remark that medical training was unnecessary
for the practice of psychoanalysis. In the United States, how-
ever, until the second half of the century, psychotherapy was
carefully regulated and defined as a medical technique, only
to be provided by a psychologist or social worker under the
supervision of a psychiatrist. Indeed in some jurisdictions the
supervisor needed only to be a physician without formal psy-
chiatric qualifications. (See chapters by Benjamin, DeLeon,
Freedheim, & VandenBos and Routh & Reisman in this
volume.)Morton Prince and Multiple PersonalityBoston neurologist Morton Prince (1854–1929) adapted
the theories and methods of Freud and Janet to his own inter-
ests in the study of neuroses, the unconscious, and hyp-
nosis. Prince was interested in both conversion hysteria and