14 Psychoanalysis: A Global Perspective

Psychoanalysis: A Global Perspective

Learning Objectives
● Understand the limitations of focusing exclusively on Sigmund Freud, Alfred Adler, and
Carl Jung in psychoanalysis – realize the value of incorporating diverse and lesser-known perspectives.
● Explain the main psychoanalytic contributions of Josef Breuer, Melanie Klein, and Sudhir Kakar.
● Describe the evolution and influence of psychoanalysis across different cultures and countries.

Introduction

While Sigmund Freud, Carl Jung, and Alfred Adler are widely recognized as the founders of psychoanalytic theory, the contributions of lesser-known pioneers such as Josef Breuer, Melanie Klein, and Sudhir Kakar have played a crucial role in the global expansion and diversification of psychoanalytic thought, incorporating unique cultural, social, and feminist perspectives that challenge and enrich traditional psychoanalytic theory and practice. The evolution of psychoanalysis has been a dynamic journey, transcending its origins to encompass a rich tapestry of cultural narratives and theoretical advancements. Our goal is to shift the focus from the well-trodden paths laid by Freud, Jung, and Adler, to highlight the instrumental yet often overlooked work of psychoanalysts from diverse backgrounds. By examining the contributions of these figures, we uncover a more inclusive and comprehensive understanding of psychoanalysis, one that respects its foundational principles while also embracing the learnings from different cultural and social contexts. Our exploration delves into the historical development of psychoanalytic theory, spotlighting those who expanded its boundaries beyond the traditional Freudian circle, to offer a global perspective on the unconscious mind, therapeutic techniques, and the broader implications of psychoanalytic practice.

Background
The foundational trio of Sigmund Freud, Alfred Adler, and Carl Jung significantly shaped the early landscape of psychoanalysis; their names remain dominant in psychoanalytic discussions to this day. Freud’s groundbreaking introduction of the unconscious mind and human psyche (id, ego, superego), along with his theories of dream analysis, psychosexual stages of development, and the Oedipus complex, laid the intricate groundwork for what would become psychoanalytic theory (Breuer & Freud, 1893). Meanwhile, Adler’s emphasis on the inferiority complex and individual psychology provided new, social and goal-oriented dimensions to psychoanalysis (Watts, 2015). Jung further expanded the domain of psychoanalysis by proposing the ideas of the collective unconscious and archetypes, expanding its scope beyond individual experiences (Jung, 1936). Together, these pioneers established a robust foundation for the development of psychoanalytic theory. While Freud, Adler, and Jung were central to the development of psychoanalytic theory, pioneers such as Josef Breuer, Melanie Klein and Sudhir Kakar introduced critical concepts that diversified and deepened psychoanalytic ideas and practices. Josef Breuer’s early work, particularly his treatment of Anna O. with the “talking cure,” not only laid the groundwork for psychoanalytic therapy but also directly influenced Freud’s subsequent theories (Macmillan, 1977). Melanie Klein’s Object Relations Theory revolutionized our understanding of early childhood, asserting that our initial relationships and experiences with caregivers fundamentally shape our future relationships and mental health (Sayers, 1987). Breuer, Klein, and Kakar – collectively expanded the psychoanalytic dialogue, infusing it with diverse perspectives that enriched its depth and applicability. The evaluation of psychoanalysis as a predominantly W.E.I.R.D. (Western, Educated, Industrialized, Rich, Democratic) phenomenon raises important questions about its universality and applicability across diverse cultural contexts. Originally developed within the confines of Western society, psychoanalysis has rightfully faced scrutiny for its potential biases and limitations when applied outside its cultural bubble. Acknowledging this critique is essential for the ongoing evolution of psychoanalytic theory and practice. The contributions of non-Western psychoanalysts, such as Sudhir Kakar, show the necessity of expanding psychoanalytic perspectives to encompass a global view. These contributions not only challenge the field to reconsider its foundational assumptions but also enrich the discipline by incorporating a variety of cultural practices and understandings of the human psyche. Embracing a cross-cultural perspective in psychoanalysis opens the door to more inclusive and effective therapeutic practices, underscoring the importance of cultural sensitivity and adaptability in the global mental health landscape. Similarly, and of equal importance, it is also necessary to amplify female psychoanalytic voices to provide an alternative perspective to the traditional male bias in the field. A global perspective on psychoanalysis is crucial today as it can provide a much more comprehensive understanding of mental health, acknowledging diverse cultural narratives and practices in therapy. The reality is that not everyone fits into the W.E.I.R.D. (Western, Educated, Industrialized, Rich, Democratic) mold, which has historically informed much of psychoanalytic
theory and practice. By broadening our approach to include diverse cultural insights, we can pave the way for more effective and sensitive mental health treatment across various cultural settings. In modern psychoanalytic teachings, there remains an overemphasis on the work of Sigmund Freud (and his trio, including Alfred Adler and Carl Jung) – creating a gap in the literature on contributions from females and/or non-Western psychoanalysts. All contributors, regardless of gender or geographical origin, should get their rightful share of credit. We also believe that it is essential for psychoanalysis to adopt more empirical and experimental research in today’s era – especially in the form of studies that examine therapeutic applications and outcomes in diverse cultures. In order for this field to compete against other psychological disciplines, it should hold up to the scientific method. Such work is essential not only for validating the effectiveness of psychoanalytic practices across diverse populations but also for ensuring that the voices and perspectives of all contributors, regardless of their gender or geographical origin, are recognized and valued. This approach will not only fill the existing gaps in the literature but also enrich the psychoanalytic discourse, making it more relevant and inclusive in today’s globalized world.

Joseph Breuer
Josef Breuer, often overshadowed by his more famous colleague, Sigmund Freud, played a crucial role in the early development of psychoanalytic theory with his innovative therapy techniques and insights into the unconscious mind. Breuer’s work with his patient, Anna O. (real name Bertha Pappenheim), led to the development of the talking cure, a foundational method in psychoanalytic therapy, where patients are encouraged to talk about their experiences and emotions (Macmillan, 1977). Specifically, Anna O. was suffering from a range of symptoms – including partial paralysis, disturbances of vision and speech, and hysteria (a broad term at the time, generally referring to general physical and mental health symptoms without a known cause, typically in females). Breuer’s approach was groundbreaking. He discovered that when Anna was encouraged to speak about her experiences and feelings, particularly those which were distressing or repressed, her symptoms began to alleviate. This was an important moment in the history of psychoanalysis, as it displayed the major impact that verbal expression, i.e. the talking cure, could have on alleviating mental distress. Anna herself thought the process to be releasing pent-up trauma, whereas Breuer believed that the act of verbalizing troubling memories and emotions helped Anna O. process them in a way that was better for her psyche (Macmillan,
1977). This concept of talking through issues relieving real mental health issues essentially laid the groundwork for psychoanalytic therapeutic practices. Josef Breuer was a mentor to Sigmund Freud, and they both collaborated on work that introduced the theory that unconscious memories of traumatic events could lead to physical symptoms – a foundational concept in psychoanalysis (Breuer & Freud, 1893). Specifically, they determined that hysterical symptoms were closely linked to traumas that the patient
“intentionally repressed from his conscious thought and inhibited and suppressed” (Breuer & Freud, 1893, p. 10). Interestingly, in their experience, patients could only properly process these traumas through the therapeutic practice of hypnosis – which would eliminate the distressing physical symptoms. Josef Breuer’s mentorship and collaboration with Sigmund Freud played a crucial role in the birth of psychoanalysis. While Breuer’s work, especially his treatment of Anna O. using the talking cure, laid much of the psychoanalytic foundation, Freud would later expand on these ideas and deviate significantly from Breuer’s beliefs and practices. For instance, Freud developed a comprehensive framework that placed much more emphasis on sexuality and the Oedipus complex. Breuer, though initially a collaborator, was more conservative in his views and hesitant to fully embrace Freud’s emphasis on sexuality as a pivotal element in the human psyche. Despite his eventual differences with Freud, the contributions of Josef Breuer to the early development of psychoanalysis should not be understated. To this day, when we think of therapy, many of us are essentially thinking of the talking cure. We use it often, whether in a
professional or personal setting. And much of that is thanks to the work of Josef Breuer with Anna O. His insight into the therapeutic potential of talking through traumatic experiences provided a critical foundation for the field. While Freud is often heralded as the father of psychoanalysis, it is evident that Breuer’s initial discoveries and his influence on Freud warrant him significant recognition and credit within the history of psychoanalytic theory.

Melanie Klein
Melanie Klein’s development of Object Relations Theory and her innovative work in child psychoanalysis marked a significant departure from traditional psychoanalysis – offering new insights into early childhood psychology. Klein used her personal experiences as a woman and a mother to inform her thought processes and theory development in the field of psychoanalysis (Sayers, 1987). One of her major theoretical contributions was Object Relations Theory – which focuses on how relating to others, especially our caregivers during infancy, fundamentally shapes our personality and emotional development (Sayers, 1987). For instance, Klein felt that depression would develop in an individual due to the fear that expressions of anger would cause loved ones to leave them which instead causes an inward self-hatred (Sayers, 1987). Thus, according to Object Relations Theory, the formation of these negative object relations, with the objects being our loved ones, are the cause of emotional disorders. Klein theorized that a way to treat emotional disorders, such as anxiety or depression, would be to use dream interpretation and association to allow the individual to work through their emotional issues and instead create good object relations which will change the course of their emotional development in a positive direction (Sayers, 1987). Klein also had major contributions to the field of psychoanalysis through her ideas around the paranoid-schizoid and depressive stages, which she suggested were critical phases in early childhood mental development (Roth, 2001). The paranoid-schizoid stage is the earliest stage and serves as the only means by which the infant can structure their experiences for the first three to four months of life (Roth, 2001). The paranoid-schizoid position is a complex psychological structure which allows an infant to divide their perceptions into either ‘good’ (things the infant wants) or ‘bad’ (things the infant wants to avoid) objects as a way to minimize anxiety. The two basic defence mechanisms within the paranoid-schizoid position that the infant uses to help form these ‘good’ and ‘bad’ categories, and protect against anxiety, are splitting and projection. Splitting refers to the unconscious process of dividing a single object into two or more objects. For instance, the mother may have two completely different objects, a ‘good’ one and a ‘bad’ one, which are entirely separate within the infant’s mind. Projection happens when an infant projects unwanted impulses onto objects outside of themself, attributing negative feelings as coming from the world. For example, projecting aggression onto someone they dislike. Both splitting and projection serve as ways to protect the sense of self in the infant and prevent anxiety and confusion. The depressive stage comes later, at around 6 months. However, the individual will go back and forth between the paranoid-schizoid and depressive stages through the rest of their life (Roth, 2001). The depressive position is when the infant fears the loss of a good object due to their own destructive impulses. They become concerned with preserving the good object, which is accompanied by feelings of guilt and remorse (Lesmeister, 1998). This danger of losing a good object can still be prevented by employing the defence mechanisms of the paranoid-schizoid stage, splitting and projection (Lesmeister, 1998). Overall, Klein was highly influential with her in-depth analysis of the infant psyche and the unconscious influences on emotional development. Her theories marked a new era of thought for psychoanalysis and her work still has influence in psychoanalytic thought today.

Sudhir Kakar
Psychoanalysis, like other schools of thought in psychology, is heavily dominated by Western perspective, culture, and social norms. Studies in psychoanalysis have yielded results that are biased in terms of representation. The bias towards Western beliefs is also present in the interpretation of data and behaviors. Expressions, body language, and societal dynamics vary across cultures and cannot be analyzed with the same set of criteria. When the Western lens is applied to populations from the “opposite civilization pole” (Kakar, 1982, p. 290), individuals often get misunderstood. Sudhir Kakar, an Indian psychoanalyst who began his practice in 1975, advocates for psychoanalysis while calling for a change in its approach. He recognizes that the field does not sufficiently emphasize the importance of social, cultural, and religious influences. Kakar also criticizes the tendency of the West to generalize their own data to other populations, pointing out that treatments based on these findings do not have the same benefits and impact on Indian people (Kakar, 1982). Kakar identifies factors that distinguish Indians from Westerners by studying Hindu males. One such factor is the caste system – traditional social hierarchy in India that divides people into rigid groups based on their birth and occupation. This influences all aspects of an Indian’s life, including experiences, opportunities, and privileges. The caste system illustrates why we cannot overgeneralize people globally, let alone within a single country (Kakar, 2000).

Indian society, like other Eastern societies, is a deeply collectivist culture, implying that treatment of these individuals also requires an understanding of their family and close-knit circle. This contrasts with the individualistic culture of the West, where goals, wishes, and aspirations center around the self. This difference underscores the need for a considerate and distinct lens when studying foreign populations. Kakar notes that researchers often misinterpret the behaviors of Hindu mothers, who express love and affection differently than Western mothers. This does not mean Indian mothers love less, but it seems to be a common misinterpretation (Kakar, 2000). Misunderstanding of Indian culture is exemplified once again in the way religion is understood. Buddhism, another dominant religion in India, is simplistically interpreted by some Western psychoanalysts. For example, Mason, a Western psychoanalyst mentioned by Kakar, described the Buddha as “a man struggling with clinical depression who warded off this depression by proclaiming it universal” (Kakar, 1982, p. 294). This statement exemplifies an extreme oversimplification of an entire religion and culture. Kakar criticizes Western psychoanalysts for their closed-mindedness and urges them to approach foreign populations with an open and fully informed approach (Kakar, 1982). Kakar argues that this failure to understand diverse perspectives is because the greater the cultural difference, the more likely people are to oppose it (Kakar, 1982).

Conclusion and Next Steps
The exploration of psychoanalysis through the contributions of figures like Josef Breuer, Melanie Klein, and Sudhir Kakar reveals the critical role these lesser-known pioneers have played in enriching and diversifying psychoanalytic theory with their culturally nuanced, social, and feminist insights, thereby challenging and broadening the traditional Freudian paradigm to encompass a more global and inclusive perspective. As we look to the future of psychoanalysis and its role within the broader context of global mental health, it’s clear that several pivotal steps need to be taken to ensure the field’s growth and relevance. First and foremost, there is a pressing need for psychoanalytic research to extend beyond the confines of W.E.I.R.D. (Western, Educated, Industrialized, Rich, and Democratic) societies. Psychoanalytic concepts must be validated across broader cultures and societies. Second, the modern psychology community must acknowledge and prioritize the underrepresented voices in the field of psychoanalysis – working together to elevate the contributions of psychoanalysts from diverse backgrounds (outside of the dominant narrative provided by Freud, Adler, and Jung). Additionally, mental health practitioners that are actively practicing psychoanalysis in some form should be encouraged to be cautious of personalized differences that may exist. In other words, they should adapt their approaches to account for differences that may exist due to society, culture, religion, etc. Lastly, collaboration between psychoanalysts and other academic disciplines that specialize in cultural differences, such as anthropology and sociology, could significantly enhance psychoanalytic practices. Such interdisciplinary cooperation would facilitate a deeper understanding of how cultural contexts influence traditional psychoanalytic theory, ultimately leading to more nuanced and effective therapy for those that need it.

Definitions
● W.E.I.R.D. Culture: Describes societies that have disproportionately contributed to psychological research and theory – ones that are Western, Educated, Industrialized, Rich, and Democratic.
● Talking Cure: Established by Josef Breuer during his work with Anna O. It is a foundational method in psychoanalytic therapy where patients are encouraged to talk about their experiences and emotions, leading to the alleviation of mental distress.
● Hysteria: A generic medical term in the 1900s, typically referring to general physical and mental health symptoms without a known cause, usually in females.
● Object Relations Theory: A theory developed by Melanie Klein that focuses on how our relationships, especially with caregivers during infancy, fundamentally shape our
personality and emotional development.
● Splitting: One of two basic defence mechanisms within the paranoid-schizoid position proposed by Melanie Klein. Splitting refers to the unconscious process of dividing a single object into two or more objects. For instance, the mother may have two completely different objects, a ‘good’ one and a ‘bad’ one, which are entirely separate within the
infant’s mind.
● Projection: One of two basic defence mechanisms within the paranoid-schizoid position proposed by Melanie Klein. Projection happens when an infant projects unwanted impulses onto objects outside of themself, attributing negative feelings as coming from the world. For example, projecting aggression onto someone they dislike.
● Caste System: A traditional social hierarchy in India that divides people into rigid groups based on their birth and occupation, influencing all aspects of an individual’s life,
including experiences, opportunities, and privileges.
● Collectivist Culture: A societal structure where goals are centered around the community and family, emphasizing group cohesion and collective well-being over
individual achievement. Modern day collectivist cultures include, for example, much of China, Japan, and India.
● Individualist Culture: A societal structure characterized by a focus on personal goals, with an emphasis on individual achievement and autonomy. Modern day individualist
countries include, for example, much of the United States, United Kingdom, and Australia.

Discussion Questions
● How do the contributions of Josef Breuer, Melanie Klein, and Sudhir Kakar challenge the principles of psychoanalysis established by Freud, Adler, and Jung? Consider their unique theories and approaches and compare them to that of the “foundational trio”?
● Discuss the role of cultural, social, and feminist perspectives in shaping the evolution of psychoanalysis. How do these perspectives both enrich and complicate our understanding of psychoanalysis as a global discipline?
● Psychoanalysis has traditionally centered around a Western perspective. Given the critiques provided by figures like Sudhir Kakar, discuss the challenges and opportunities of applying psychoanalytic theory to non-Western cultures. How can psychoanalysts ensure their practices are effective across diverse populations?
● Is traditional psychoanalysis a true science? Does taking a more global perspective change that? Explain how the scientific method might be applied to this discipline in order to support its practical use in modern therapy.

References
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Jung, C. G. (1936). The concept of the collective unconscious. Collected works, 9(1), 42.
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Kakar, S. (2000). In defense of the inner world. International Journal of Group Tensions – New York, 29(3/4), 371-378.
Kakar, S. (2008). Culture and psyche: Selected essays. Oxford University Press. 18
Lesmeister, R. (1998). The super-ego, the voice of the self and the depressive position. The Journal of Analytical Psychology, 43(2), 287-303.
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Macmillan, M. B. (1977). The cathartic method and the expectancies of Breuer and Anna O.
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Roth, P. (2001). The paranoid-schizoid position. Kleinian theory: A contemporary perspective, 32-46.
Sayers, J. (1987). Melanie Klein, psychoanalysis, and feminism. Feminist Review, (25), 23. https://doi.org/10.2307/1395033
Watts, R. E. (2015). Adler’s individual psychology: The original positive psychology. Revista de psicoterapia, 26(102), 123-131