World-Making Libido vs. Deterministic Ego: How the Therapeutic Process Has Retained Many of its First Foundations

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What do you think of when you hear the word therapy? Some people imagine divorced couples trying to hash out their problems. Others imagine hypnosis. However, most people I know imagine the Freudian stereotype of a person lying on a couch talking about their childhood.

This quarter was introduced as the “self” section of Self, Culture, and Society, so it makes sense that we start by reading Freud. Regarded as the founding father of psychoanalysis, Freud was one of the first people to try to deconstruct the self from a psychological standpoint. Though nowadays many consider him and his theories outdated, he still laid the foundation for practically all psychological work today.

In this blog post I’m going to be analysing an older case study using terminology Freud coined later in his career. When I read Anna O’s case study, I saw a lot of myself in it. Not that I had the same experience as her in any way, but I’ve also been through the therapeutic process and saw similarities between her journey and mine. For those of you who haven’t read this study, Anna O went through a two year psychiatric process with Josef Breuer, a colleague of Freud’s. Anna O was stuck between her unconscious created world, and what her conscious wanted her to present as. Her condition started as anxiety and depression; however, it developed into a full-on hysteria with hallucinations and partial body paralysis. However, through her work with Dr. Breuer she was able to fully recover. The key was to be able to bring the unconsciously created world into the conscious, so that it can be processed.

Here’s how I’ve broken down Anna O’s condition:

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  • Conscious daydreaming both influences and is influenced by the unconsciously created world. The unconscious shapes all consciousness via the economic process. The consciousness provides additional stimuli for the unconscious.
  • The ego censors the unconscious libido-created world so that the conscious ego only comprehends what is socially, morally, and aesthetically acceptable to it.
  • When an unconscious thought is censored it becomes repressed. Explained by the economic model, repression conserves the energy of the unconscious thought. However, this energy is not processed by the conscious, so it manifests in both the mind and the body via affect.
  • The results of the affect manifesting in the mind and body are physical and mental symptoms, best demonstrated by Anna O’s hallucinations.
  • These hallucinations are then themselves censored, and Anna O no longer remembers them. As a result, they are repressed, and their energy is converted again into affect.
  • However, if the hallucinations become noticed by conscious thought, the ideas behind them are able to be processed. This results in rejection of the thought. After the thought has been rejected, the energy has been expelled and mental and physical health returns to normal.

As the chart demonstrates, the world of the libido — uninhibited desire — is controlled and created by the unconscious. The conscious either chooses to accept or deny this created world. It determines whether the libido is repressed or rejected, and whether the patient is sick or healthy respectively.

The process of rejection — consciously processing ideas — eventually cured Anna O. Take this example:

The patient was suffering very badly from thirst; for, without being able to account for it any way, she suddenly found it impossible to drink… This had lasted for some six weeks, when one day during hypnosis she grumbled about her English lady-companion whom she did not care for, and went on to describe, with every sign of disgust, how she had once gone into that lady’s room and how her little dog — horrid creature! — had drunk out of a glass there… After giving further energetic expression to the anger she had held back, she asked for something to drink, drank a large quantity of water without any difficulty and woke from her hypnosis with the glass at her lips… When this had been described the symptom was permanently removed. (Studies on Hysteria, 34-35)

While in a hypnotic state, when the unconscious and the conscious are not as divided as they usually are, Anna O was able to describe why she didn’t want to drink. Immediately afterwards, her hydrophobia was cured.

So how does this work in someone who isn’t severely mentally ill? I’ve made my own diagram to try demonstrate how the interaction between libido and ego has affected me.

Anybody who knows me knows that I’m a compulsive planner. From my extensive four-year plans to my colour coded planner, I like to make sure each of my moves is meticulously calculated. At the end of the day though, I’m always wrong about the future. I’ve changed my four-year plan more than I’ve changed my major (which is a lot, by the way), and somehow — no matter how “realistically” I try to schedule my planner — I always do things late and out of order. So. Here is how I’ve broken down my chart:

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  • I plan out my future because I struggle with the thought that uncertainty is okay. On the flip side, this reinforces the fact that uncertainty is okay because, even though I always deviate from plan, everything turns out fine.
  • My ego doesn’t like the fact that the future is unknown, so it makes sure that that isn’t my first thought. This sends me the message: plan more stringently next time!
  • So, the acceptance of uncertainty is repressed. We know that the energy is converted into affect, which manifests physically and mentally in my body.
  • Thanks affect! Now I’m depressed because life is uncertain, which means I’ve failed at planning out every moment of my life. I also get really bad chronic back pain, which also gives me tension headaches and migraines. I know that I’m depressed because I can’t plan out the future, but my consciousness censors this yet again because it’s stubborn and prefers being right to being healthy.
  • I’m now depressed and in pain, so I go to therapy to explore my consciousness. While I’m there we return to the obvious source of the problem: that I can’t accept uncertainty. After five or so years, I have somewhat accepted the fact that planning isn’t always a fail-safe. I have rejected the idea, and have now returned to relative mental and physical stability.

While my issues are way less severe than Anna O’s, I still experienced the same process as she did. My unconscious created a world where I was happy and living in the now, but my conscious determined I couldn’t live that way. Then I went to therapy and began the rejection process. And, like Anna O, I can say that it really worked for me.

So, what can we take away from this? First, that psychology is awesome. But also that our minds are in constant flux. The unconscious creates its own world based on desire, and the conscious determines how that world should affect its mind and body based on how it wants to be viewed. For Anna O, that meant keeping her anger and frustration secret so she could be the perfect daughter to her dying father. For me, it’s avoiding uncertainty so I look like I always know what I’m doing. At the end of the day though, it’s important to remember that neither the ego nor the libido is 100% perfect. Like everything else in life, it’s all about finding balance.

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2 thoughts on “World-Making Libido vs. Deterministic Ego: How the Therapeutic Process Has Retained Many of its First Foundations

  1. I really liked your post, Emilia! Both of your flow charts helped me to visualize the process of conflict, repression, symptoms, and return to health that the case studies and lectures detail. Your analysis raised some questions for me regarding whether or not it could be possible to have a society that both did not cause its members to experience neurotic symptoms and was also able to advance its civilization project? It seems as though, with everyone having individual experiences (in addition to society’s “education”) that there are simply too many variables to account for. Therefore, this question seems to be one of wondering if our society will ever reach a place where we stop stigmatizing mental illness (because we realize that it is rooted in society), and instead work to universalize mental health care, so that everyone can relieve their symptoms through self-knowledge. Thanks again for a thought-provoking post!

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  2. This is extremely well done with the flow charts being especially helpful. (I also laughed at the comic you chose to open with. It was a humorous look at the experience of talking therapy, especially as the joke is the person can sense the event that it will be necessary to suppress and therefore bring about problems.) I was intrigued by your post to make the very personal connection, namely because my mental health history makes me severely question Freud’s belief that everything must come from something in the unconscious. I guess I just like my explanations easily testable and accessible to me without a watchman. I was curious if you believed the current stigma against mental illness is simply part of the education process of the ego or if it was a reaction to the symptoms brought on by the ego forcing the libido’s unsavory urges into the unconscious?

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