Psychoanalytic Method and the Mischief of Freud-Bashers
Psychoanalytic Method and the Mischief of Freud-Bashers
Psychotherapy is as old as civilization. Literally soul therapy, the term is a misnomer, since soul is a mystical notion and what is meant is the whole person. The misnomer also survives in the name psychiatry, literally soul medicine. Yet nobody is crusading against psychiatry and psychotherapy because soul is unscientific. What is important is that psychotherapy and psychiatry are job descriptions that refer to what we actually do when as providers or recipients of the service called psychotherapy, we use words to convey meaningful messages to each other, or to evoke desirable acts from each other.
Doings, i.e., operations, are in the realm of method. Operationally, we should properly call psychotherapy word therapy. But we think and speak with words: it is not only the proverbial pen but also the spoken word that is mightier than the sword. Words connect us as speakers and listeners, both in everyday dialogue and in that special conversation we call psychotherapy, words that speak of love or hatred, that hurt or heal.
Healing human suffering through the spoken word has its roots in such a common experience as the soothing words of the mother to a child that is hurting, whether physically or psychologically. Later in life such solicitude is sublimated as care and empathy, the sympathy for another person's suffering, an essential ingredient of every therapy. Anna O. made history when she called the conversations with her doctor, Josef Breuer (1895d), the future mentor of Freud, the "talking cure," at a time when cure still meant treatment. Here is another interesting connection between words and what they stand for. Today treatment means physical therapy of physical illness, but etymologically treatment is related to tractatus and treatise, i.e., discourse. Similarly, doctor, one who treats the body, derives from the Latin verb docere, to teach, as in doctrine, or teaching.
Today psychotherapy is practiced formally by professionals-psychiatrists, psychologists, social workers and psychoanalysts-and informally, by others, in ways folksy or fancy, in all walks of life. It is also practiced in dealings with doctors, dentists, lawyers, clergy and in the mass media. Prominent in the history of psychotherapy and its entry into medical science were pioneers Franz Anton Mesmer and his followers and Sigmund Freud, the founder of psychoanalysis.
Freud coined the term psychoanalysis as a synonym for psychotherapy and developed a method, or technique, for understanding and interpreting the verbal productions of persons in health and disease. He enriched the method of psychotherapy he learned from Breuer by adding the technique of free association and the concept of transference. This enabled Freud to discover depth psychology, an analytical method for understanding the meaningful connection between manifest content of symptoms, thoughts, dreams and acts and their latent content, and hence the motivational dynamics of consciously deliberate versus covertly-driven behavior.
The discovery that symptoms had this dual structure, conscious and unconscious, that they were not just brain events but mind events, enabled Freud to elucidate the role of fantasy, the emotions, psychological trauma and the role of sex and love in human relations. But experiences are told in words, meanings are shaped into memories, metaphors, and myths, i.e., stories. In time, the above-defined aspects of Freud's method became the generic foundation for all the other schools of dynamic verbal therapy, whatever their theories (Lothane 1981, 1983, 1984, 1994a).
Following early endorsement by psychiatry's Eugen Bleuler in Zurich, psychoanalysis went on to revolutionize the static-descriptive, organic psychiatry of the turn of the century , converting it into the dynamic psychiatry of today, especially in the United States. Freud influenced the ideas of Adolf Meyer, M.D., a Swiss immigrant who knew Bleuler, William Alanson White, M.D., and the interpersonal dynamic concepts of Harry Stack Sullivan, M.D.
The foregoing is relevant to meet the currently oft-heard criticism that psychotherapy or psychoanalysis is not scientific, as if scientific is one and the same defining criterion for all the known sciences. Are botany, mathematics, paleontology, physics and psychology sciences in the same way? Rather, since science means knowledge, to qualify as a scientific discipline, psychoanalysis should be defined by its own method.
When seen from the vantage of method, psychotherapy qualifies as scientific when it is empirical, i.e., based on experience, observation, rigorous thinking and critical judgment. To proceed empirically is not the same as being able to reproduce observed phenomena experimentally, in closed laboratory situations, nor does it mean that every phenomenon can be quantified: experimentation and quantification cannot be the sole scientific criteria for studying persons in life situations.
To make another comparison: medicine is not a quantitative science per se, it is an empirical art of healing the body utilizing a number of basic sciences: anatomy, physiology, bacteriology, pathology, pharmacology and others. Psychotherapy, psychoanalysis and dynamic psychiatry are empirical healing arts of persons suffering from problems in living and/or mental disorders.
What are their basic sciences? The social sciences of anthropology, history and philosophy, but also knowledge provided by the sciences of experimental psychology, biology, epidemiology, pharmacology. As healing arts and as discourse, both medicine and psychotherapy can be enriched by human wisdom from any source, most importantly by great literature, art and religion. Over and above, both medicine and psychotherapy are ruled by a special code of ethics that applies to the doctor/patient relationship. The Hippocratic oath in medicine and the requirement of impartiality in psychoanalysis are both based on the principle of serving, not using, the patient.
Whereas the therapeutic situation is not reproducible like a laboratory experiment, no more than a life situation is, it can be defined methodologically and tested operationally. While imperfect and liable to error, it remains a unique field of observation of human nature, and when properly controlled for error, it becomes a reliable setup for such observation. A well-managed psychotherapeutic situation, and a properly conducted case study, meet the requirements of science, e.g., as shown in studies by Luborsky. In summary, psychotherapy is an empirical method, or technique, based on procedures and processes employed in the therapeutic situation, and in keeping with ethical principles.