Infantile sexuality

Freud's stages of development were based upon which bodily organ he considered predominant. During the first year of life, the infant's capacity for physical gratification is centred upon the mouth, so this stage is labelled 'oral.' From the ages of 1 to 3, the anus gains pride of place. The anal stage is succeeded by the phallic stage, in which libidinal interest focuses upon the genitals and masturbation, although the child is still incapable of sexual fulfilment through intercourse with another person. After puberty, the 'normal' individual reaches the genital stage, in which satisfying sexual relations with a person of the opposite sex become possible; but traces from all the previous stages persist into adult life in even the most mature characters. If a patient could overcome the blocks imposed by repression and recall the earliest infantile sexual impulses, these could be brought into consciousness and abreacted, thus opening the previously impeded path towards sexual maturity.

Breuer and Freud published Studies on Hysteria as joint authors in 1895. This is generally reckoned to be the first psychoanalytic book. The second was The Interpretation of Dreams which appeared in November 1899. The term 'psychotherapy' was introduced by the followers of the leader of the so-called Nancy school of hypnosis, Hippolyte Bernheim (1840-1919), and became widely popular. Bernheim, for a time, rivalled the fame of Charcot. Freud visited him in the summer of 1889. One of the facts Freud learned from Bernheim was that hypnosis was much more successful with the lower classes, who tended to comply with the suggestions of their social superiors. The time was ripe for the introduction of a form of psychotherapy suitable for the 'carriage trade', who might respond better to a less authoritarian approach. Freud discovered that traumatic memories could be recovered without the dubious aid of hypnosis. If the patient lay supine on the couch and was honest enough to reveal everything which was passing through his mind, he would inevitably come upon disturbing material relevant to his neurotic problems. This technique was named free association. From 1892 onwards, Freud gradually abandoned the use of hypnosis in favour of this new procedure. This was an important innovation, because the employment of free association demanded that the patient took the lead, while the analyst remained a passive listener who issued interpretations rather than behaving like a conventional physician who gave orders or advice. Freud's clientèle, who were mostly upper class, may have welcomed an approach which allowed the patient to take the initiative rather than obey orders.

The ways in which the 'medical model' of the cause and treatment of neurosis was progressively modified is dealt with in greater detail in Chapter 3.2. Freud's discovery of transference eventually led to psychoanalysis and its derivatives becoming more concerned with the development and maldevelopment of the patient's relationships with significant others from infancy onward than with his or her infantile sexuality. Psychoanalysis became a technique of emotional re-education in which investigation, interpretation, and consequent modification of the patient's attitudes toward the analyst, rather than exploration of infantile sexuality, became the principal vehicle of change.

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