Psychoanalysis is converting neurotic misery to ordinary unhappiness. — S. Freud
When asked what the point or purpose psychoanalysis served, Freud answered with the quote at the beginning of this article. While Freud was something of a pessimist, there is something useful and meaningful about his quote. Neurotic misery is painful and all consuming, while ordinary unhappiness, while unpleasant, leaves room for other feelings. When my patients ask me what the point of psychoanalysis is, I often find myself thinking about this quote. They are often coming to me with intense, painful feelings, and the quote above is a kind of starting point for me in formulating a discussion about analysis. Most of us want all painful feelings to go away, but the truth of the matter is that we will carry some level of those feelings with us throughout life no matter what we do. Analysis can give people suffering from neurotic misery, as Freud put it, significant relief, even though they will still carry some of the painful feelings at the end of the analytic process. So what is it then that we are doing with analysis and what does it offer?
There are three fundamental principles that analysis holds as truths about the human experience. I will state them here because I think it gives us some idea of what analysis is trying to do. 1. Humans are not born as a blank slate. We are all born with basic inborn needs that must be satisfied for our survival. There is some debate about what this all entails, but suffice it to say here that we are born with innate needs that we need to have fulfilled. Initially we are dependent on others to fill them but has we grow we learn to do that for ourselves. That leads to the second fundamental principal. 2. The main task of mental development is to learn to meet these needs in the world. We learn as we grow to meet our innate needs by going out into the world and finding the things that satisfy our inborn needs we call “drives” in analysis. Finally, 3. Most of the ways we satisfy our needs are performed unconsciously. This is one of the most crucial things to get about psychoanalysis. We are not always aware of the ways we go about satisfying our needs. This becomes the foundation of the work of analysis. To uncover the ways we do what we do and to bring it to our conscious awareness is at the heart of the analytic work.
As a final word about analysis I would like to talk for a few minutes about the use of the couch. As you may have seen in movies, a person engaged in psychoanalysis lies on a couch with the analyst sitting behind them out of view. This traditional frame makes use of a few things that can be helpful in analysis. Lying on a couch frees the mind from having to pay attention to holding the body upright sitting in a chair and not having the analyst in view, removes the social need to focus on body language signals. The person on the couch has greater access to their own thoughts and the couch allows for the mind to regress a little and have greater access to deeper, more primitive parts of the mind.
The goal of the mind is to function unconsciously. The work of analysis is to bring that unconscious function into conscious awareness. Connected to that goal is the need to attach meaning to what we think and feel. By talking about that out loud and putting it into words, we are able to convert unconscious action into conscious thought that is named and whose meaning we understand which in turn allows us to change those automatic patterns and make real, lasting change.
–Stephen M. Taylor, MD
Knowing You 