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The powerful impact of classical psychoanalytic theory on the practice of psychoanalysis in the United States rested initially upon its presentation as a scientific study of the mind, in health and disturbance, particularly with regard to manifestations of unconscious processes. The appeal of Freud's scientific certainty to psychiatrists in the United States related not only to their medical training but also to the sense that they were discovering a new approach to people suffering from emotional distress and illnesses. Psychoanalysis, while introduced into the United States in the 1920s, blossomed into the dominant therapeutic modality in the 1950s and 1960s; in those decades, which marked the height of “therapeutic optimism,” it was seen as having potential for treating a broad range of patients, ranging from functional “neurotics” suffering from “internal conflict” to psychotic patients diagnosed with major mental illnesses.
The essence of classical psychoanalysis, as promulgated by Freud and his followers in the United States, included the centrality of the drives, both sexual and aggressive, and their derivatives, seen as residing, from infancy