JMS Pearce
Hull, England

 

The understanding of mental illness was barren until Freud’s time, scarcely risen from medieval notions of madness, moral inferiority, and witchcraft.

Sigmund Freud (1856–1939) began his career in histology and experimental physiology during six years spent in Ernst Brucke’s laboratory. He published a book on aphasia and was director of neurology at the Vienna Institute for Children’s Diseases. At the Salpêtrière he studied with Charcot, who initiated his interest in hypnosis and hysterical illness, which he famously followed on return to Vienna. In November 1902, Freud invited the recently qualified Alfred Adler to join “a small circle of colleagues and supporters” at his house to discuss interesting subjects in psychology and neuropathology.

The group met regularly as the Mittwochsgesellschaft (Wednesday Society) in Freud’s home. Most of their patients suffered from a variety of neuroses. By 1906, there were seventeen members. The group then expanded, but after internal disagreements, in 1908 was reformed as the Vienna Psychoanalytic Society with Freud as president, a position he passed onto Alfred Adler in 1910. It continued until 1938, by which time it had registered a total of 150 members.

Freud, Adler, and Jung were pioneers of so-called depth psychology, which emphasizes the unconscious and psychodynamic theories. Many of their ideas have persisted, but they paid little attention to organic and affective psychoses. At the same time, psychotic illnesses were explored by Paul Eugen Bleuler (1857–1939), who established schizophrenia and introduced psychoanalytic ideas into his Burghölzli clinic. Emil Wilhelm Kraepelin (1856–1926), another distinguished contemporary, was also more focused on psychoses and the modern scientific classification in psychiatry.

 

Alfred Adler (1870–1937)

Alfred Adler. Via Hudson Kent. Fair use.

Adler was born on Mariahilfer Straße in Rudolfsheim, a Viennese municipality. His parents were Pauline, and Leopold Adler, a Hungarian-born grain merchant.

A frail child, he suffered from rickets and survived pneumonia. He studied medicine at the University of Vienna, graduating in 1895. In 1897 he married Raissa Timofeyewna Epstein, an intellectual socialist; they had four children. His daughter Alexandra became professor of psychiatry at the New York University College of Medicine.

After working in eye diseases and general practice, Adler turned to psychological studies in 1902 when he joined Freud’s psychoanalytical group. Dissent began when in 1908 Adler presented his paper “The aggressive instinct in life and in neurosis.” Freud criticized Adler for overemphasizing social and conscious processes; Adler in turn denounced Freud’s view that early sexual development determined later psychological problems. He later stated emphatically that he was not a disciple of Freud and left the group in 1911 to set up his own practice. Adler and Freud came to dislike each other. In 1912, Adler founded the Society of Individual Psychology for psychotherapy as an alternative to Freudian psychoanalysis. He was the first major figure to break away from the Freudian school. Three years later, Carl Jung left the group to propagate his notions of personality whereby individuals strive to achieve a “wholeness,” including all feelings and behavior, both conscious and unconscious.

Though rooted in Freudian psychoanalysis, Adler’s system of individual psychology introduced the term “inferiority feeling” or “inferiority complex.” He developed a supportive psychotherapy to correct by gentle discourse and persuasion the mistaken “unconscious” childhood emotions of inferiority leading to social integration and a sense of belonging. Adlerian theory was a holistic approach. It emphasized that every person has a sense of inferiority and from childhood works to overcome this inferiority by “striving for superiority” in order to achieve happiness.¹ When this failed neurosis was the result. This approach set him apart from Freud’s Vienna Circle. His awareness of social problems and the need for a sense of belonging was a principal tenet of his credo.

His clinical treatment attempted to uncover the subconscious reason for symptoms using the therapeutic functions of insight and “teleological,” that is purposeful meaning. They were predicated on six concepts in Adlerian theory: striving for success or superiority, subjective perception, unity and self-consistency, social interest, style of life, and creative power.²

Adler held equality, civil rights, mutual respect, and the advancement of democracy as his principal aims.² His “Individual Psychology” (Über den nervösen Charakter, 1912) was a holistic attempt to achieve success and happiness.² He became popular and widely influential because his attitude was gentle, optimistic, and plausible.

A socialist idealist, he believed that people are social, decision-making, indivisible beings whose actions and psychological movement have purpose. Each person is able to make personal choices. It has been suggested that cognitive behavioral therapy (pioneered in the 1950s and 1960s by the American psychiatrist Aaron Beck) is rooted in Adlerian psychotherapy.

The limitations to Adlerian therapy are that it cannot be used in people devoid of insight or incapable of introspection; it is time-consuming and arguably places undue emphasis on early childhood. It fails to formulate accepted clinical diagnoses. As with psychoanalytical theory, Adler’s ideas are subjective, and as such difficult to verify or refute scientifically. He paid scant attention to dementia, manic-depressive disorders, or to dementia praecox. Basic concepts of understanding mental illness gradually have changed to more biological and neurological frameworks.³

Adler served with the Austro-Hungarian Army in World War I. His reputation grew, and in 1930, before the advent of Hitler’s Nazism in 1933, he was made a freeman of the city of Vienna. He established many child guidance clinics and lectured in Europe and the United States, becoming visiting professor at Columbia University in 1927. He converted to Christianity despite his Jewish heritage, which led to the Nazis closing down his clinics during the 1930s. He therefore emigrated to the Long Island College of Medicine in New York.⁴

The Alfred Adler Institute of New York contains many published items of his works. A psychological appraisal is found in Gisela Elfe’s text.⁵ In his work he exerted a significant influence on later psychologists such as Abraham Maslow, Rollo May, Viktor Frankl, and Albert Ellis. His writings never wholly abandoned Freudian insights. A prolific author, he wrote more than 300 books and articles; amongst them are:

• The Neurotic Constitution (1917),
• The Practice and Theory of Individual Psychology (1924),
• Understanding Human Nature (1927),
• The Pattern of Life (1930),
• The Science of Living (1930),
• What Life Could Mean to You (1931),
• The Problems of Neurosis (1930).
  

In 1937, Adler whilst on a lecture tour in Aberdeen died after a suspected heart attack. His body was cremated in Edinburgh but the ashes were believed lost, and were not reclaimed until 2007 when they were discovered in a casket at Warriston crematorium in Edinburgh and finally returned to Vienna for burial in 2011.

 

References

1. Adler A. Uber Minderwertigkeit von Organen (Study of Organ Inferiority and Its Psychical Compensation). 1st ed. Kessinger Publishing, 2007.
2. Ansbacher HL and Ansbacher RR. The Individual Psychology of Alfred Adler: A Systematic Presentation in Selection from his Writings. New York: Harper & Row, 1956/1964.
3. Field TA, Beeson ET, and Jones LK. The new ABCs: A practitioner’s guide to neuroscience-informed cognitive-behavior therapy. Journal of Mental Health Counseling 2015; 37(3).
4. Rattner J. Alfred Adler. New York: F. Ungar, 1983.
5. Elfe G. Adlerian Year Book: A Collection of Topical Essays. London: Adlerian Society UK, 2018: 89-102.

 

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JMS PEARCE is a retired neurologist and author with a particular interest in the history of medicine and science.

 

Spring 2023  |  Sections  |  Psychiatry & Psychology