FROM CASES OF HYSTERIA TO THE THERAPEUTIC SOCIETY
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be the related treatment techniques and therapeutic action? Where were
we on these issues to start wi th and where are we now, what has been
changed and discarded, what has been retained as useful, what is still con–
troversial? Let me get back to these questions after a very brief historical
overvIew.
Freud started his studies in hysteria with the idea of a reality trauma–
parental seduction-where both unpleasant affect and memory of the
event had to be repressed. As Freud discovered and elaborated on infant
sexuality and the vicissitudes of the libido and the centrality of the
Oedipus complex in normal development and in pathology, this reality
explanation of pathology was dropped and replaced by internal fantasy. As
you probably know, there has been much controversy about the reason for
this shift, i.e. the genuine conviction or political pressure. However, be that
as it may, Freud spent the next twenty years elaborating his libido theory
to the relative neglect of the ego and reali ty object relations in order to
stress the importance of these unacceptable instincts. At this point the
agencies of the mind were the ystems: Unconscious, Preconscious and
Conscious; the conflict was between gratification of the sexual instinct and
conscious reali ty opposi tion; development addressed only the ontogeny of
the libido; the Oedipus complex was central. Not all of Freud's early fol–
lowers stayed with these conceptualizations. Rank shifted the key of
pathology in the "Birth Trauma" as both the prototype and central con–
figuration of the neuroses. Jung stressed a more mythical, inherited and
archaic concept of soul and ego ideal. Adler developed a theory of mastery
and "masculine protest" he called individual psychology. And Ferenczi and
his Hungarian followers, Imre Herman and the Balints in the twenties and
thirties, shifted the core conflict from the oedipal complex to earlier faulty
mother/child interactions, developing such concepts as the "Basic Fault"
and "Confusion of Tongues" between mother and child and related treat–
ment techniques such as "indulgences" and "corrective essential
experience," practiced by Alexander later in America, to compensate for
the early deprivation. Most of these "innovators" in Freud's time, except
for Ferenczi, as mentioned earlier, were considered dissidents by Freud and
extruded from the analytic movement, an attitude toward "deviation" and
innovative practices until fairly recently by analytic orthodoxy. More cur–
rently, however, this attitude has changed markedly and pluralism of
theory, as discussed above, is being widely accepted, used and taught.
Certainly all the work with children, child observation and child analysis,
the development lines of Anna Freud and Mahler's separation-individua–
tion theories, even Melanie Klein's paranoid and depressive position, have
been integrated in today's psychoanalytic thinking, and have shifted the
emphasis from the centrality of the Oedipus complex to include the
nuclear conflicts of earlier object relations, the rapprochement phase, the
