John Heaton is, amongst others, a practising psychiatrist and psychotherapist, a regular lecturer on the Advanced Diploma in Existential Psychotherapy programme at Regent’s College, London, and a long- and some-time editor of the Journal for Existential Analysis.

This is Heaton’s third book with Wittgenstein in its title. In it, he applies the great philosopher’s insights to the psychotherapeutic process in all its forms. Heaton’s principle thesis is that many of our deepest and most intractable problems find their roots in linguistic confusions and limitations, and are resolved not by the search for causes inherent in the various pseudo-scientific doctrines and theories of the mind (such as those of Freud and Klein), but by careful attention to the use of language. This is particularly true in neurosis and psychosis in which language is used not so much to clarify and to communicate as to deceive and to obfuscate.

Like all the best things, the talking cure has its roots in ancient Greece with such luminaries as Socrates and Diogenes the Cynic (see my post on Diogenes here). Upon being asked to name the most beautiful of all things, Diogenes replied ‘parrhesia’ (free speech, full expression), and his intransigently courageous and sometimes delightfully shocking behaviour consistently accorded with this, his, truth. The self-understanding that underlies parrhesia is revealed not in reductionist propositions based on questionable pictures of the mind, but in the singular use of language – both by the expression and by its truthfulness. In short, it is revealed not in causes, but in reasons, with all their multiplicities and particularities.

For Wittgenstein as for Heaton, the talking cure is, like philosophy itself, a battle against the bewitchment of intelligence by means of language, for it is not knowledge but understanding that is needed to live an integrated, productive, and, dare I say it, happy, life. To date, this important, indeed, devastating, critique has had little or no impact on psychotherapeutic practices, and Heaton’s revolutionary book requires and deserves to be read not only by psychotherapists and psychiatrists but by every mental health professional. Although the book is not difficult to leaf through, she with little more than a scientific background may find it difficult to understand, accept, or come to terms with certain concepts. As Lichtenberg tells us, ‘A book is like a mirror: if an ape looks into it an apostle is hardly likely to look out … he who understands the wise is wise already.’

Neel Burton

NB: This review has also been published in the September issue of the British Journal of Psychiatry.

People with a high level of anxiety have historically been referred to as ‘neurotic’. The term ‘neurosis’ derives from the Ancient Greek neuron (nerve) and loosely means ‘disease of the nerves’. The core feature of neurosis is anxiety, but neurosis can manifest as a range of other problems such as irritability, depression, perfectionism, obsessive-compulsive tendencies, and even personality disorders such as anankastic personality disorder. Although neurosis in some form or other is very common, it can prevent us from enjoying the moment, adapting usefully to our environment, and developing a richer, more complex, and more fulfilling outlook on life. The psychiatrist Carl Jung (1875-1961) believed that neurotic people fundamentally had issues with the meaning and purpose of their life. In his autobiography of 1961, Memories, Dreams, Reflections, he noted that ‘The majority of my patients consisted not of believers but of those who had lost their faith’. Interestingly, Jung also believed that neurosis could be beneficial to some people despite its debilitating effects.

The most original, influential, and contentious theory of neurosis is that of Sigmund Freud (1856-1939). Freud attended medical school at the University of Vienna from 1873 to 1881, carrying out research in physiology under the German scientist Ernst von Brűcke and later specialising in neurology. In 1885-86 he spent the best part of a year in Paris, and returned to Vienna inspired by the French neurologist Jean-Martin Charcot’s use of hypnosis in the treatment of ‘hysteria’, an old-fashioned term referring to the conversion of anxiety into physical and psychological symptoms. Freud opened a private practice for the treatment of neuropsychiatric disorders but eventually gave up the practice of hypnosis, instead preferring the method of ‘free association’ which involved asking patients to relax on a couch and say whatever came into their minds. In 1895, inspired by the case of a patient called Anna O, he published the seminal Studies on Hysteria with his friend and colleague Josef Breuer. After publishing The Interpretation of Dreams in 1899 and The Psychopathology of Everyday Life in 1901, both public successes, Freud obtained a professorship at the University of Vienna where he began to gather a devoted following. He remained a prolific writer throughout his life, publishing (amongst others) Three Essays on the Theory of Sexuality in 1905, Totem and Taboo in 1913, and Beyond the Pleasure Principle in 1920. After the Nazi annexation of Austria in 1938, he fled to London, where he died the following year of cancer of the jaw. His daughter, Anna Freud, became a distinguished psychoanalyst who developed the concept of ego defense mechanisms (see other posts on this blog).

In Studies on Hysteria, Freud and Breuer formulated the psychoanalytic theory according to which neuroses have their origins in deeply traumatic and consequently repressed experiences. Treatment requires the patient to recall these repressed experiences into consciousness and to confront them once and for all, leading to a sudden and dramatic outpouring of emotion (catharsis) and the gaining of insight. This can be achieved through the methods of free association and dream interpretation, and a relative lack of direct involvement by the psychoanalyst so as to encourage the patient to project his thoughts and feelings onto him – a process called ‘transference’ (by contrast, in ‘countertransference’ it is the psychoanalyst who projects his thoughts and feelings onto the patient). In the course of analysis, the patient is likely to display ‘resistance’ in the form of changing the topic, blanking out, falling asleep, coming late, or missing an appointment; such behaviour merely suggests that he is close to recalling repressed material but afraid of doing so. Other than dream interpretation and free association, other recognized routes into the unconscious are parapraxes (slips of the tongue) and jokes. For this reason, Freud famously noted that ‘there is no such thing as a joke.’

In The Interpretation of Dreams (1899), Freud developed his ‘topographical model’ of the mind, describing the conscious, unconscious, and a layer between the two called the preconscious which, though not conscious, could be readily accessed. Freud later became dissatisfied with the topographical model and replaced it with a so-called ‘structural model’ according to which the mind is divided into the id, ego, and superego (see figure). The id is fully unconscious and contains our drives and repressed feelings and emotions. It is dominated by the ‘pleasure principle’, and so seeks out immediate gratification. The id is opposed by the partly conscious superego, a sort of moral judge arising from the internalisation of parental figures and, by extension, of society itself. In the middle sits the mostly conscious ego. Dominated by the ‘reality principle’, the function of the ego is to reconciliate the id and the superego and thereby enable us to engage with reality. Neurotic anxiety arises when the ego is overwhelmed by the demands made upon it by the id, the superego, and reality. To cope with these demands, the ego employs defense mechanisms to block or distort impulses from the id, thereby making them more acceptable and less threatening. A broad range of ego defence mechanisms have since been recognised.

Freud's structural and topographical models of the mind

For Freud, the drives or instincts that motivate human behaviour (‘life instinct’) are primarily driven by the sex drive or ‘libido’ (Latin, I desire). This life-instinct is counterbalanced by the ‘death instinct’, the unconscious desire to be dead and at peace (the ‘Nirvana principle’). Even in children the libido is the primary motivating force, and children must progress through various stages of psychosexual development before they can reach psychosexual maturity. Each one of these stages of psychosexual development (except the latent stage) is focussed on the erogenous zone – the mouth, the anus, the phallus, or the genitals – that provides the greatest pleasure at that stage. For Freud, neuroses ultimately arise from frustrations encountered during a stage of psychosexual development, and are therefore sexual in nature. Freud’s stages of psychosexual development are summarised in the table below.

The Oedipus/Electra complex is arguably the most controversial of Freud’s theories, and can be interpreted either literally (as Freud intended it to be) or metaphorically. According to Freud, the phallic stage gives rise to the Oedipus complex, Oedipus being a mythological King of Thebes who inadvertently killed his father and married his mother. In the Oedipus complex, a boy sees his mother as a love-object, and feels the need to compete with his father for her attention. His father becomes a threat to him and so he begins to fear for his penis (‘castration anxiety’). As his father is stronger than he is, he has no choice but to displace his feelings for his mother onto other girls and to begin identifying with his father/aggressor – thereby becoming a man like him. Girls do not go through the Oedipus complex but through the Electra complex, Electra being a mythological Princess of Mycenae who wanted her brother Orestes to avenge their father’s death by killing their mother. In the Electra complex, a girl this time sees her father as a love-object, because she feels the need to have a baby as a substitute for the penis that she is lacking. As she discovers that her father is not available to her as a love-object, she displaces her feelings for him onto other boys and begins to identify with her mother – thereby becoming a woman like her. In either case, the main task in the phallic stage is the establishment of sexual identity.

Although much derided in his time and still today, Freud is unquestionably one of the deepest and most original thinkers of the 20th century. He is credited with discovering the unconscious and inventing psychoanalysis, and had a colossal influence not only on his field of psychiatry but also on art, literature, and the humanities. He may have been thinking of himself when he noted that, ‘The voice of intelligence is soft, but does not die until it has made itself heard.’ (‘Die Stimme des Intellekts ist leise, aber sie ruht nicht, ehe sie sich Gehör verschafft hat.’)

Jung in a Nutshell

The Oracle of Delphi

Whilst no one can escape using ego defence mechanisms altogether, some ego defence mechanisms are thought to be more helpful or ‘mature’ than others. For example, if a person feels angry with his boss, he may go home and kick the dog (‘displacement’), or he may go out and play a good game of tennis (‘sublimation’). Sublimation is the channeling of negative feelings into useful activities such as study, sport, or art, and is thought to be a far more mature defence mechanism than displacement, which is the redirection of negative feelings towards someone or something less important.

There are a number of other ‘mature’ ego defence mechanisms like sublimation. Altruism, for example, is (contentiously) thought of as a form of sublimation in which a person copes with his anxiety by stepping outside himself and helping others. By focusing on the needs of others, people in altruistic careers such as nursing or teaching may be able to push their needs into the background. Similarly, people who care for a disabled or elderly person may experience profound anxiety and distress once this role is removed from them.

Another mature ego defence mechanism is humour. By seeing the absurd or ridiculous aspect of an emotion, event, or situation, a person is able to put it into its proper context and thereby to diffuse the anxiety that it provokes in him. If human beings laugh so much, this is no doubt because they have the most developed unconscious in the animal kingdom, and Freud himself famously noted that ‘there is no such thing as a joke’. The things that people laugh about most are their errors and inadequacies, and the difficult challenges that they face such as personal identity, social and sexual relationships, and death.

Further up the scale of mature ego defence mechanisms is ascetism, which involves denying the importance of what people normally fear and strive for, and so denying the very grounds for anxiety. The Austrian psychoanalyst Wilhelm Stekel (1868–1940) felt that ‘anxiety is fear of one’s self’; if the importance of the self can be denied, so too can the grounds for anxiety. If people in modern societies are more anxious than people from another time or people from traditional societies, this is perhaps because of the undue emphasis that modern societies place on the self. In the Bhagavad Gita, the Hindu ‘Song of God’, the god Krishna appears to the archer Arjuna in the midst of the battlefield of Kurukshetra and tells him not to give up but to do his duty and fight on. In either case, all the men on the battlefield are one day condemned to die – as are all men. Their deaths are trivial, because the spirit in them, their human essence, does not depend on their particular forms or incarnations for its continued existence. Krishna says, ‘When one sees eternity in things that pass away and infinity in finite things, then one has pure knowledge.’

There has never been a time when you and I have not existed, nor will there be a time when we will cease to exist (…) the wise are not deluded by these changes.

– Bhagavad Gita

Arguably the most mature of all ego defence mechanisms is anticipation. Anticipation involves finding self-knowledge and, like the blind prophet Teiresias, using this self-knowledge to predict or ‘anticipate’ our feelings and reactions. In the Ancient World the greatest of all the oracles was the oracle at Delphi, and inscribed on the forecourt of the temple of Apollo at Delphi was a simple two-word command.

Γνῶθι σεαυτόν

‘Know thyself.’

Adapted from The Meaning of Madness.

Being entirely honest with oneself is a good exercise.
- Sigmund Freud

In Freudian psychoanalytic theory, ego defence mechanisms are unconscious processes that we use to diffuse the anxiety that arises when who we really are (our unconscious ‘id’) comes into conflict with who we think we are or who we think we should be (our conscious ‘superego’). For example, at an unconscious level a man may find himself attracted to another man, but at a conscious level he may find this attraction completely unacceptable. To diffuse the anxiety that arises from this conflict, he may use one or several of a number of defence mechanisms. For example, (1) he may refuse to admit to himself that he is attracted to this man. Or (2) he may superficially adopt ideas and behaviours that are diametrically opposed to the fact that he is attracted to this man, for example, go out for several pints with the lads, speak in a gruff voice, and bang his fists on the counter. Or (3) he may transfer or ‘project’ his attraction onto somebody else and then berate him for being ‘gay’ (young children can teach us much through utterances such as ‘mirror, mirror’ and ‘what you say is what you are’). In each case, he has used one of three common ego defence mechanisms which are, respectively, denial, reaction formation, and projection. A broad range of such ego defence mechanisms are recognised, and the combination in which we use them reflects our personality. Whilst we cannot escape using ego defence mechanisms, we can gain some insight into how they are used and of how we use them. This self-knowledge enables us to better understand what is happening to us and around us, and, quite simply, to make the best of it.

Related posts:
The manic defence
Cognitive dissonance