From the beginning of the 20th century onward, Freud’s writings concentrated on elucidating the common processes—repression, the unconscious, childhood sexuality, and the libido—that gave rise to both normal and neurotic phenomena. World War I then turned his attention to external traumas and the role of the ego in mediating between the conflicting demands of the id on one side and the superego and civilization on the other. Freud’s lasting contribution to thinking about mental illness was to successfully expand the range of disorders well beyond conditions thought to have an organic basis or the psychoses. Neuroses resulted from interactions between individuals and their human environments: no physical defect needed to be present. Psychiatrists came to have legitimate claims to treat distressing states that had previously been viewed as purely psychogenic in nature and therefore outside of the medical or neurological realm. Moreover, his blurring of the boundaries between the neuroses and normality created a zone of ambiguity that mental health professionals came to exploit. They came to treat a vast expanse of common occurrences including interpersonal conflicts, the psychic results of traumas, and everyday problems of living.
The Role of the Psychiatrist in the Pain Clinic
